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Cefotaxime (United States: Limited availability): Pediatric drug information

Cefotaxime (United States: Limited availability): Pediatric drug information
(For additional information see "Cefotaxime (United States: Limited availability): Drug information" and see "Cefotaxime (United States: Limited availability): Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Therapeutic Category
  • Antibiotic, Cephalosporin (Third Generation)
Dosing: Neonatal

General dosing, susceptible infection: IM, IV:

Gestational age-directed dosing (Red Book [AAP 2018]):

Gestational Age

Postnatal Age

Dose

<32 weeks

<14 days

50 mg/kg/dose every 12 hours

14 to 28 days

50 mg/kg/dose every 8 hours

≥32 weeks

≤7 days

50 mg/kg/dose every 12 hours

8 to 28 days

50 mg/kg/dose every 8 hours

Weight-directed dosing (Bradley 2018):

Body

Weight

Postnatal

Age

Dose

<1 kg

≤14 days

50 mg/kg/dose every 12 hours

15 to 28 days

50 mg/kg/dose every 8 hours

29 to 60 days

50 mg/kg/dose every 6 hours

1 to 2 kg

≤7 days

50 mg/kg/dose every 12 hours

8 to 28 days

50 mg/kg/dose every 8 hours

29 to 60 days

50 mg/kg/dose every 6 hours

>2 kg

≤7 days

50 mg/kg/dose every 12 hours

8 to 28 days

50 mg/kg/dose every 8 hours

29 to 60 days

50 mg/kg/dose every 6 hours

Gonococcal infections, disseminated (including sepsis, arthritis, and meningitis)/scalp abscess: IM, IV: 25 mg/kg/dose every 12 hours for 7 days; therapy should be extended to 10 to 14 days if meningitis is documented (CDC [Workowski 2015])

Meningitis (IDSA [Tunkel 2004]): IV: Note: Treat for a minimum of 21 days; use smaller doses and longer intervals for neonates <2 kg.

PNA ≤7 days and ≥2 kg: 100 to 150 mg/kg/day divided every 8 to 12 hours

PNA >7 days and ≥2 kg: 150 to 200 mg/kg/day divided every 6 to 8 hours

Dosing: Pediatric

General dosing, susceptible infection: Infants, Children, and Adolescents: IM, IV: 150 to 180 mg/kg/day in divided doses every 8 hours; maximum daily dose: 8 g/day; higher doses necessary for treatment of meningitis (Bradley 2018; Red Book [AAP 2018]).

Acute bacterial rhinosinusitis, severe infection requiring hospitalization: Children and Adolescents: IV: 100 to 200 mg/kg/day divided every 6 hours for 10 to 14 days; maximum dose: 2,000 mg (IDSA [Chow 2012]).

Endocarditis, treatment: Children and Adolescents: IV: 200 mg/kg/day in divided doses every 6 hours; maximum daily dose: 12 g/day; treat for at least 4 to 6 weeks; longer durations may be necessary; may use in combination with gentamicin for some organisms (AHA [Baltimore 2015]).

Enteric bacterial infections, empiric treatment, HIV-exposed/-infected: Adolescents: IV: 1,000 mg every 8 hours (HHS [OI adult 2018]).

Gonorrhea, disseminated infections (including arthritis and arthritis-dermatitis syndrome) (as an alternative to ceftriaxone) (CDC [Workowski 2015]): Adolescents: IV: 1,000 mg every 8 hours in combination with azithromycin for a total duration of at least 7 days.

Intra-abdominal infection, complicated: Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day divided every 6 to 8 hours; maximum dose: 2,000 mg; use in combination with metronidazole (IDSA [Solomkin 2010]).

Lyme disease (Borrelia spp. infection) (alternative agent): Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day in divided doses every 6 to 8 hours; maximum daily dose: 6,000 mg/day. Duration of therapy depends on clinical syndrome; treat meningitis or radiculopathy for 14 to 21 days (IDSA/AAN/ACR [Lantos 2021]).

Meningitis: Infants, Children, and Adolescents: IV: 225 to 300 mg/kg/day divided every 6 to 8 hours; maximum dose: 2,000 mg/dose; use in combination with vancomycin for empiric coverage (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]); some experts recommend 300 mg/kg/day divided every 4 to 6 hours with a maximum daily dose of 12 g/day (Red Book [AAP 2018]).

Peritonitis (peritoneal dialysis) (ISPD [Warady 2012]): Infants, Children, and Adolescents: Intraperitoneal:

Intermittent: 30 mg/kg/dose every 24 hours in the long dwell.

Continuous: Loading dose: 500 mg per liter of dialysate; maintenance dose: 250 mg per liter; Note: 125 mg/liter has also been recommended as a maintenance dose (Aronoff 2007).

Pneumonia:

Bacterial pneumonia, HIV-exposed/-infected: Infants, Children, and Adolescents: IV: 150 to 200 mg/kg/day divided every 6 to 8 hours; maximum dose: 2,000 mg/dose (HHS [OI adult 2018]; HHS [OI pediatric 2016]).

Community-acquired pneumonia (CAP): Infants >3 months, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours; maximum dose: 2,000 mg; Note: May consider addition of vancomycin or clindamycin to empiric therapy if community-acquired MRSA suspected. In children ≥5 years, a macrolide antibiotic should be added if atypical pneumonia cannot be ruled out (IDSA/PIDS [Bradley 2011]).

Salmonellosis, HIV-exposed/-infected: Adolescents: IV: 1,000 mg every 8 hours (HHS [OI adult 2018]).

Skin and soft tissue infections, necrotizing: Infants, Children, and Adolescents: IV: 50 mg/kg/dose every 6 hours in combination with metronidazole or clindamycin; maximum dose: 2,000 mg/dose. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens 2014]).

Surgical prophylaxis: Children and Adolescents: IV: 50 mg/kg within 60 minutes prior to the procedure; may repeat in 3 hours if procedure is lengthy or if there is excessive blood loss; maximum dose: 1,000 mg; a larger maximum dose (2,000 mg) is recommended for obese patients (ASHP/IDSA [Bratzler 2013]).

Urinary tract infection: Infants and Children 2 to 24 months: IM, IV: 150 mg/kg/day divided every 6 to 8 hours (AAP 2011).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Infants, Children, and Adolescents: The following adjustments have been recommended (Aronoff 2007). Note: Renally adjusted dose recommendations are based on doses of 100 to 200 mg/kg/day divided every 8 hours.

GFR 30 to 50 mL/minute/1.73 m2: 35 to 70 mg/kg/dose every 8 to 12 hours

GFR 10 to 29 mL/minute/1.73 m2: 35 to 70 mg/kg/dose every 12 hours

GFR <10 mL/minute/1.73 m2: 35 to 70 mg/kg/dose every 24 hours

Intermittent hemodialysis: 35 to 70 mg/kg/dose every 24 hours

Peritoneal dialysis (PD): 35 to 70 mg/kg/dose every 24 hours

Continuous renal replacement therapy (CRRT): 35 to 70 mg/kg/dose every 12 hours

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Cefotaxime (United States: Limited availability): Drug information")

Acute bacterial rhinosinusitis, severe infection requiring hospitalization

Acute bacterial rhinosinusitis, severe infection requiring hospitalization (off-label use): IV: 2 g every 4 to 6 hours for 5 to 7 days (IDSA [Chow 2012]).

Bite wound

Bite wound (animal) (off-label use): IV: 1 to 2 g every 6 to 8 hours in combination with clindamycin or metronidazole for anaerobic coverage (IDSA [Stevens 2014]).

Brain abscess

Brain abscess (empiric treatment): IV: 2 g every 4 to 6 hours in combination with other antimicrobial therapy as warranted (eg, metronidazole) (Arlotti 2010; Brouwer 2014; Kowlessar 2006).

Cesarean delivery

Cesarean delivery: IM, IV: 1 g IV as soon as the umbilical cord is clamped, then 1 g IV or IM at 6 and 12 hours after the first dose.

Chronic obstructive pulmonary disease, acute exacerbation

Chronic obstructive pulmonary disease, acute exacerbation (hospitalized patients without risk factors for P. aeruginosa) (off-label use): IV: 1 g every 8 hours for 5 to 7 days; may switch to oral therapy following clinical improvement (GOLD 2021; Sethi 2022; van Zanten 2007).

Gonococcal infection, disseminated

Gonococcal infection, disseminated (arthritis and arthritis-dermatitis syndrome) (alternative agent) (off-label use): IV: 1 g every 8 hours. Total duration of therapy is at least 7 days (including oral step-down therapy); can usually switch to susceptibility-guided oral therapy after 24 to 48 hours. Give in combination with treatment for chlamydia if it has not been excluded (CDC [Workowski 2021]).

Gonococcal infection, uncomplicated

Gonococcal infection, uncomplicated (infection of the cervix, rectum, or urethra) (alternative agent):

Note: Use cefotaxime only if ceftriaxone is unavailable given a lack of contemporary efficacy data (CDC [Workowski 2021]).

IM: 500 mg as a single dose (CDC [Workowski 2021]; McCormack 1993); give in combination with treatment for chlamydia if it has not been excluded. Note: When treatment failure is suspected (eg, detection of N. gonorrhoeae after treatment without additional sexual exposure), consult an infectious diseases specialist. Report failures to the CDC through state and local health departments (CDC [Workowski 2021]).

Intra-abdominal infection, mild to moderate

Intra-abdominal infection, mild to moderate (community-acquired infection in patients without risk factors for resistance or treatment failure):

Cholecystitis, acute: IV: 2 g every 8 hours; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (SIS [Mazuski 2017]; SIS/IDSA [Solomkin 2010]; Vollmer 2021). Note: The addition of anaerobic therapy (eg, metronidazole) is recommended if biliary-enteric anastomosis is present (SIS/IDSA [Solomkin 2010]).

Other intra-abdominal infections (eg, perforated appendix, diverticulitis, intra-abdominal abscess): IV: 2 g every 8 hours in combination with metronidazole (Barshak 2021). Total duration of therapy (which may include transition to oral antibiotics) is 4 to 5 days following adequate source control (Sawyer 2015; SIS [Mazuski 2017]); for diverticulitis or uncomplicated appendicitis managed without intervention, duration is 7 to 10 days (Barshak 2021; Pemberton 2021).

Lyme disease

Lyme disease (Borrelia spp. infection) (alternative agent) (off-label use):

Carditis, patients requiring hospitalization: IV: 2 g every 8 hours for 14 to 21 days (including oral step-down therapy) (IDSA/AAN/ACR [Lantos 2021]).

Acute neurologic disease (eg, meningitis, radiculopathy), patients requiring hospitalization: IV: 2 g every 8 hours for 14 to 21 days (IDSA/AAN/ACR [Lantos 2021]).

Late neurologic disease: IV: 2 g every 8 hours for 14 to 28 days (IDSA/AAN/ACR [Lantos 2021]).

Recurrent arthritis after adequate oral treatment: IV: 2 g every 8 hours for 14 days; may extend to 28 days if inflammation is not resolving (IDSA/AAN/ACR [Lantos 2021].

Meningitis, bacterial

Meningitis, bacterial: As a component of empiric therapy (community-acquired infections) or pathogen-specific therapy (eg, Cutibacterium acnes, H. influenzae, N. meningitidis, S. agalactiae, S. pneumoniae, and susceptible gram-negative bacilli; alternative agent for certain pathogens):

IV: 2 g every 4 to 6 hours; for empiric therapy, use in combination with other appropriate agents (IDSA [Tunkel 2004]; IDSA [Tunkel 2017]).

Pneumonia, community-acquired

Pneumonia, community-acquired: Inpatients without risk factors for Pseudomonas aeruginosa:

IV: 1 to 2 g every 8 hours as part of an appropriate combination regimen. Total duration (which may include oral step-down therapy) is a minimum of 5 days; patients should be clinically stable with normal vital signs before therapy is discontinued (ATS/IDSA [Metlay 2019]).

Salmonella species infection

Salmonella species infection (alternative agent) (off-label use):

Enteric fever (Salmonella typhi and paratyphi): Empiric therapy for severe disease or an alternative directed therapy for quinolone-nonsusceptible infection: IV: 1 to 2 g every 6 to 8 hours for 10 to 14 days. Note: May be switched to an oral regimen based on susceptibility testing, if available. Geographic location at time of acquisition impacts risk of resistance; cefotaxime is not recommended if there is concern for extensively drug-resistant Salmonella spp. (Andrews 2021; WHO 2003).

Nontyphoidal Salmonella GI infection: IV: 1 to 2 g every 8 hours for 3 to 14 days (7 to 14 days in HIV-infected patients with a CD4 count ≥200 cells/mm3). Immunosuppressed patients (eg, HIV infected with CD4 count <200 cells/mm3) warrant a longer duration of treatment (eg, weeks to months). Note: Reserve antibiotic treatment for patients with severe illness or at high risk of invasive disease (eg, extremes of age, immunosuppression); reserve parenteral therapy for those who cannot tolerate oral agents (HHS [OI adult] 2020); Hohmann 2020a).

Nontyphoidal Salmonella bloodstream infection: IV: 1 to 2 g every 8 hours for 14 days. Note: Immunosuppressed patients (eg, HIV infected with CD4 count <200 cells/mm3) and those with an extraintestinal focus of infection warrant a longer duration of treatment (eg, weeks to months) (HHS [OI adult] 2020; Hohmann 2020b).

Sepsis

Sepsis: IV: 2 g every 6 to 8 hours.

Septic arthritis

Septic arthritis (as a component of empiric therapy for traumatic bacterial arthritis without risk factors for P. aeruginosa; pathogen-directed therapy for gram-negative bacilli): IV: 2 g every 8 hours. Total treatment duration is 3 to 4 weeks (in the absence of osteomyelitis), including oral step-down therapy. For empiric therapy, give as part of an appropriate combination regimen (Goldenberg 2022).

Skin and soft tissue necrotizing infections

Skin and soft tissue necrotizing infections (off-label use):

Polymicrobial infection: IV: 2 g every 6 hours, in combination with metronidazole or clindamycin for empiric therapy of polymicrobial infections. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens 2014]).

Necrotizing infection due to Vibrio vulnificus: IV: 2 g every 8 hours, in combination with doxycycline. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens 2014]).

Spontaneous bacterial peritonitis, treatment

Spontaneous bacterial peritonitis, treatment:

Note: For patients without sepsis or risk for multidrug resistance (AASLD [Biggins 2021]).

IV: 2 g every 8 hours; duration is for 5 to 7 days, as long as fever and pain have resolved (AASLD [Biggins 2021]; AASLD [Runyon 2013]; Runyon 2022).

Surgical prophylaxis

Surgical prophylaxis (off-label use): IV: 1 g within 60 minutes prior to surgical incision. Doses may be repeated in 3 hours if procedure is lengthy or if there is excessive blood loss (Bratzler 2013).

Obesity: The ASHP/IDSA/SIS/SHEA guidelines recommend that for patients weighing ≥120 kg (or alternatively defined as BMI >30 kg/m2), a dose of 2 g within 60 minutes prior to surgical incision should be administered (Bratzler 2013).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: IV:

Cefotaxime Dose Adjustments for Altered Kidney Function a

CrCl

If the usual indication-specific dose is 1 to 2 g every 8 hoursa

If the usual indication-specific dose is 1 to 2 g every 6 hoursa

If the usual indication-specific dose is 2 g every 4 hoursb

a Expert opinion derived from Bouchet 1991; Matzke 1985; Seguin 2009.

b Expert opinion only.

c Dialyzable (~40%) (Ings 1982): When scheduled dose falls on a dialysis day, administer after hemodialysis.

>50 mL/minute

No dosage adjustment necessary

No dosage adjustment necessary

No dosage adjustment necessary

>10 to 50 mL/minute

1 to 2 g every 12 hours

1 to 2 g every 8 hours

2 g every 6 to 8 hours

≤10 mL/minute

1 to 2 g every 24 hours

1 to 2 g every 12 hours

2 g every 12 hours

Hemodialysis, intermittent (thrice weekly)c

1 to 2 g every 24 hours

1 to 2 g every 12 hours

2 g every 12 hours

Peritoneal dialysisa

1 to 2 g every 24 hours

1 to 2 g every 12 hours

2 g every 12 hours

CRRT:

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions due to drug accumulation is important.

IV: Dose as for CrCl >10 to 50 mL/minute (expert opinion).

PIRRT (eg, sustained, low-efficiency diafiltration):

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection). Close monitoring of response and adverse reactions due to drug accumulation is important.

IV:

PIRRT days: Dose as for CrCl >10 to 50 mL/minute (on PIRRT days, when feasible administer one of the scheduled doses after the PIRRT session) (expert opinion).

Non-PIRRT days: Dose as for CrCl ≤10 mL/minute (expert opinion).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution Reconstituted, Injection:

Generic: 1 g (1 ea); 2 g (1 ea)

Solution Reconstituted, Injection [preservative free]:

Generic: 500 mg (1 ea [DSC]); 1 g (1 ea [DSC]); 2 g (1 ea [DSC]); 10 g (1 ea [DSC])

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Injection:

Generic: 1 g (1 ea); 2 g (1 ea)

Administration: Pediatric

Parenteral:

IM: Administer by deep IM injection into a large muscle mass such as the upper outer quadrant of the gluteus maximus. Doses of 2,000 mg should be divided and administered at two different sites.

IV:

IV Push: May be administered over 3 to 5 minutes; avoid rapid injection (<1 minute) due to association with arrhythmias

Intermittent infusion: Infuse over 15 to 30 minutes.

Administration: Adult

IM: Inject deep IM into large muscle mass. Individual doses of 2 g may be given if the dose is divided and administered in different IM sites.

IV: Can be administered IV bolus over at least 3 to 5 minutes or as an IV intermittent infusion over 15 to 30 minutes.

Storage/Stability

Store intact vials below 30°C (86°F). Protect from light. Reconstituted solution is stable for 12 to 24 hours at room temperature, 7 to 10 days when refrigerated, for 13 weeks when frozen. For IV infusion in NS or D5W, solution is stable for 24 hours at room temperature, 5 days when refrigerated, or 13 weeks when frozen in Viaflex plastic containers. Thawed solutions of frozen premixed bags are stable for 24 hours at room temperature or 10 days when refrigerated.

Use

Treatment of susceptible lower respiratory tract, skin and skin structure, bone and joint, intra-abdominal, genitourinary tract, and gynecologic infections, bacteremia/septicemia and documented or suspected central nervous system infections (eg, meningitis, ventriculitis) (FDA approved in all ages); prevention of postoperative surgical site infection in contaminated or potentially contaminated surgical procedures [eg, gastrointestinal and genitourinary tract surgeries and hysterectomy (abdominal or vaginal)] and caesarian section (FDA approved in all ages); has also been used for the treatment of peritonitis in patients with peritoneal catheters

Medication Safety Issues
Sound-alike/look-alike issues:

Cefotaxime may be confused with cefOXitin, cefuroxime

International issues:

Spectrocef [Italy] may be confused with Spectracef brand name for cefditoren [US, Great Britain, Mexico, Portugal, Spain]

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Dermatologic: Pruritus (≤2%), skin rash (≤2%)

Gastrointestinal: Colitis (≤1%), diarrhea (≤1%), nausea (≤1%), vomiting (≤1%)

Hematologic & oncologic: Eosinophilia (≤2%)

Local: Induration at injection site (IM ≤4%), inflammation at injection site (IV ≤4%), pain at injection site (IM ≤4%), tenderness at injection site (IM ≤4%)

Miscellaneous: Fever (≤2%)

<1%, postmarketing and/or case reports: Acute generalized exanthematous pustulosis, acute renal failure, agranulocytosis, anaphylaxis, bone marrow failure, brain disease, candidiasis, cardiac arrhythmia (after rapid IV injection via central catheter), cholestasis, Clostridioides difficile-associated diarrhea, dizziness, erythema multiforme, granulocytopenia, headache, hemolytic anemia, hepatitis, increased blood urea nitrogen, increased gamma-glutamyl transferase, increased lactate dehydrogenase, increased serum alkaline phosphatase, increased serum ALT, increased serum AST, increased serum bilirubin, increased serum creatinine, injection site phlebitis, interstitial nephritis, jaundice, leukopenia, local irritation, neutropenia, pancytopenia, positive direct Coombs test, pseudomembranous colitis, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis, urticaria, vaginitis

Contraindications

Hypersensitivity to cefotaxime, any component of the formulation, or other cephalosporins

Warnings/Precautions

Concerns related to adverse effects:

• Arrhythmia: A potentially life-threatening arrhythmia has been reported in patients who received a rapid (<1 minute) bolus injection via central venous catheter.

• Granulocytopenia: Granulocytopenia and more rarely agranulocytosis may develop during prolonged treatment (>10 days).

• Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).

• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.

• Tissue inflammation: Minimize tissue inflammation by changing infusion sites when needed.

Disease-related concerns:

• Colitis: Use with caution in patients with a history of colitis.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment may be required.

Metabolism/Transport Effects

None known.

Drug Interactions

Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Immune Checkpoint Inhibitors: Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Cefotaxime. Management: Avoid cefotaxime doses greater than 6 g/day with concurrent probenecid. Any patients receiving this combination should be monitored closely for evidence of cefotaxime toxicity. Risk D: Consider therapy modification

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Dietary Considerations

Some products may contain sodium.

Pregnancy Considerations

Cefotaxime crosses the human placenta.

Cefotaxime is approved for use in women undergoing cesarean section (consult current guidelines for appropriate use).

Monitoring Parameters

Observe for signs and symptoms of anaphylaxis during first dose; monitor infusion site for extravasation; with prolonged therapy, monitor renal, hepatic, and hematologic function periodically; number and type of stools/day for diarrhea

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested. Cefotaxime has activity in the presence of some beta-lactamases, both penicillinases and cephalosporinases, of gram-negative and gram-positive bacteria. Enterococcus species may be intrinsically resistant to cefotaxime. Most extended-spectrum beta-lactamase (ESBL)-producing and carbapenemase-producing isolates are resistant to cefotaxime.

Pharmacokinetics (Adult data unless noted)

Distribution: Widely to body tissues and fluids including aqueous humor, ascitic and prostatic fluids, bone; penetrates CSF best when meninges are inflamed

Protein binding: 31% to 50%

Metabolism: Partially hepatic to active metabolite, desacetylcefotaxime

Half-life elimination:

Cefotaxime: Infants ≤1500 g: 4.6 hours; Infants >1500 g: 3.4 hours; Children: 1.5 hours; Adults: 1 to 1.5 hours; prolonged with renal and/or hepatic impairment

Desacetylcefotaxime: 1.3 to 1.9 hours; prolonged with renal impairment (Ings 1982)

Time to peak, serum: IM: Within 30 minutes

Excretion: Urine (~60% as unchanged drug and metabolites)

Pricing: US

Solution (reconstituted) (Cefotaxime Sodium Injection)

1 g (per each): $11.76

2 g (per each): $23.56

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Antador (PT);
  • Benaxima (MX);
  • Biosint (MX);
  • Biotaksym (PL);
  • Biotax (IN);
  • Cefacolin (AR);
  • Cefalekol (HU);
  • Cefirad (KR);
  • Cefocam (PY);
  • Ceforan (EG);
  • Cefot (BD);
  • Cefotaksim (HR);
  • Cefotax (AE, BH, CY, IQ, IR, JO, JP, KW, LY, OM, RO, SA, SY, YE);
  • Cefotaxim (DE, NO);
  • Cefotrial (PE);
  • Cefox (PH);
  • Cefoxim (KR);
  • Cefpiran (KR);
  • Ceftax (AE, JO, QA, SA);
  • Cetax (TW);
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  • Clafotax (BH, JO, KW, SA);
  • Claraxim (TH);
  • Clatacef-3 (TH);
  • Clatax (ID);
  • Clavox (TW);
  • Diabec (BD);
  • Efotax (ID);
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  • Fot-Amsa (MX);
  • Fotax (BD);
  • Fotexina (CO, CR, DO, EC, GT, HN, MX, NI, PA, SV);
  • Foxime (EG);
  • Glocef (ID);
  • Gloryfen (MT);
  • Grifotaxima (CL);
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  • Kalfoxim (ID);
  • Lapixime (ID);
  • Letynol (MT);
  • Loraxime (UA);
  • Lyforan (IN);
  • Makrocef (HR);
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  • Newtaxime (KR);
  • Novatax (LK);
  • Omnatax (IN);
  • Oritaxim (BF, BJ, CI, ET, GH, GM, GN, KE, LR, MA, ML, MR, MU, MW, NE, NG, SC, SD, SL, SN, TN, TZ, UG, ZM, ZW);
  • Oritaxim-1000 (LK);
  • Pantaxin (PH);
  • Pentatrox (EG);
  • Primocef (AE);
  • Prinocef (BH);
  • Procefa (ID);
  • Racotax (LK);
  • Reftax (ZA);
  • Rekaxime (MY);
  • Saifulong (CN);
  • Sefotak (AE, BH, CY, CZ, IQ, IR, JO, KW, LY, OM, SA, SY, YE);
  • Sefox (PH);
  • Soclaf (ID);
  • Spirosine (GR);
  • Stoparen (GR, LB);
  • Talcef (PE);
  • Taporin (MX);
  • Tax-O-Bid (UA);
  • Taxibiotic (VN);
  • Taxim (BD);
  • Taximax (ID);
  • Taxime (AE, BH, CY, IQ, IR, JO, KW, LY, OM, SA, SY, YE);
  • Taximed (CZ);
  • Taximmed (VN);
  • Tebruxim (MX);
  • Tirdicef (ID);
  • Tirotax (BH, MX, QA);
  • Ultracef (UY);
  • Valoran (EE, MT);
  • Viken (MX);
  • Xedin (MX);
  • Xendin (CR, DO, GT, HN, NI, PA, SV);
  • Ximvex (PH);
  • Xorin (EG);
  • Zariviz (IT);
  • Zefocent (PH);
  • Zefotax (PH);
  • Zentro (PH);
  • Zetax (ET)


For country abbreviations used in Lexicomp (show table)
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Topic 13129 Version 257.0