Cefoxitin

Indications

Cefoxitin is used for: Pneumonia, Intra-abdominal infections, UTI, Pelvic inflammatory disease, Lower Respiratory Tract Infections, Endometritis, Pelvic cellulitis, Gonorrhea, Lung abscess, Skin and skin structure infections, Bone and/or joint infections, Prophylaxis of surgical infections, Gynecological infections

Adult Dose

Adult: IV Prophylaxis of endometritis at caesarean section 2 g as a single dose as soon as the umblical cord is clamped. May be repeated 4 and 8 hr later if needed. IV/IM Susceptible infections 1-2 g 4-8 hrly. Up to 12 g/day for severe infections. Surgical prophylaxis 2 g 30-60 mins pre-op, then 6 hrly, usually for <24 hr. IM Uncomplicated UTI 1 g twice daily. Uncomplicated gonorrhoea W/ oral probenecid: 2 g as a single dose.

Child Dose

Child: IV, IM 80–160 mg/kg/day, max 12 g/day q6–8h

Renal Dose

Renal impairment: Loading dose: 1-2 g. Maintenance dose: According to CrCl. Haemodialysis patients: Repeat loading dose after each dialysis session. CrCl (ml/min) <5 0.5-1 g every 24-48 hr. 5-9 0.5-1 g every 12-24 hr. 10-29 1-2 g every 12-24 hr. 30-50 1-2 g every 8-12 hr.

Administration

IV Preparation Intermittent IV: reconstitute 1or 2 g w/ 10-20 mL SWI Continuous infusion: add reconstituted soln to D5W or NS IM Preparation Reconstitute by adding 2 mL SWI or 0.5-1% lidocaine HCl injection (without epinephrine) to each g of cefoxitin to obtain an approx 400 mg/mL solution IV Administration Injection: directly into a vein over 3-5-min or slowly into tubing of a compatible IV infusion solution IM Administration Deep into a large muscle (eg, upper outer quadrant of gluteus maximus)

Contra Indications

Hypersensitivity to cephalosporins.

Precautions

Hypersensitivity to penicillins; renal impairment; Porphyria. Monitor renal and haematologic status. Lactation: excreted in low concentrations in breast milk, use caution (AAP Committee states compatible w/ nursing)

Pregnancy-Lactation

Interactions

Reduces renal clearance w/ probenecid. Concurrent use of nephrotoxic agents (e.g. aminoglycosides, colistin, polymyxin B, vancomycin) may increase the risk of nephrotoxicity.

Adverse Effects

Side effects of Cefoxitin : 1-10% Diarrhea <1% Anemia,Eosinophilia,Transient leukopenia,Thrombocytopenia,SCr & BUN increased,Elevated LFT's Potentially Fatal: Pseudomembranous collitis.

Mechanism of Action

Cefoxitin inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis and arresting cell wall assembly resulting in bacterial cell death.