Cefotaxime

	Zambia HIV National Guidelines
	Introduction HIV Counseling and Testing Sexually Transmitted Infections (STIs) General Principles of Antiretroviral Therapy for Chronic HIV Infection in Adults and Adolescents When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents Initial Regimen for ARV Therapy Adherence Baseline evaluation and Monitoring Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance ARV Therapy for Individuals with Tuberculosis Co-Infection Adverse Effects and Toxicity Immune Reconstitution Inflammatory Syndrome (IRIS) Changing or Stopping ART Treatment Failure Stopping ARV Therapy Post Exposure Prophylaxis Cotrimoxazole Prophylaxis WHO Staging in Adults and Adolescents Nutrition Care and Support Palliative Care in HIV and AIDS
	Guide Editors
	Editor In Chief Joel E. Gallant, MD, MPH Pharmacology Editor Paul Pham, PharmD, BCPS Zambia Guideline Team Peter Mwaba MMed PhD FRCP Alywn Mwinga MMed Isaac Zulu MMed MPH Velepie Mtonga MMed Albert Mwango MBChB Jabbin Mulwanda MMed FCS

Drugs>Antimicrobial Agents>

Cefotaxime

Paul A. Pham Pharm.D. and John G. Bartlett M.D.
09-11-2009

Zambia Specific Information

Available formulation in Zambia: Powder for injection: 500 mg; 1 g (as sodium salt) vial.
Good activity against S. pneumoniae, E.coli, Klebsiella, Enterobacter, Serratia and indole-positive Proteus species.
Empiric treatment of community acquired meningitis: cefotaxime 2gm IV q6h x 10d (plus dexamethasone 10 mg IV 6h x 4 days.)
Brain abscess: cefotaxime 2gm IV q6h (plus metronidazole).

Zambia Information Author: Paul A. Pham, Pharm. D.

INDICATIONS

FDA

Lower respiratory tract infections including pneumonia
Genitourinary infections
Gynecologic infection (including pelvic inflammatory disease, endometritis, and pelvic cellulitis
Bacteremia and septicemia
Skin and skin-structure infections
Intra-abdominal infections including peritonitis
Bone and joint infections
Central nervous system infections including meningitis and ventriculitis

NON-FDA APPROVED USES

Brain abscess(in combination with metronidazole)
Empyema(in combination with metronidazole)
Lyme disease: late Lyme arthritis and neuroborreliosis
STD ()

FORMS

brand name	generic	Mfg	brand forms	cost*
Claforan	Cefotaxime	Sanofi aventis US	IV vial 500mg	$7
			IV vial 1000mg	$10
			IV vial 2000mg	$20
			IV vial 10g	$88
Cefotaxime	Cefotaxime	Generic manufacturer	IV bag 1g/50mL	$17.90
			IV bag 2g/50mL	$31.63
			IV vial 500mg	$4.38
			IV vial 1g	$4.89
			IV vial 2g	$6.99
			IV vial 10g	$41.54
			IV vial 20g	$170.00

*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP). AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's information, and the McKesson database.

^Dosage is indicated in mg unless otherwise noted.

USUAL ADULT DOSING

Moderate to severe infections: 1-2gm IV q8h.
Meningitis and septicemia: 2gm IV q4-6h.
GC (urethritis and cervicitis): 500mg IM x 1.
GC (rectal in males): 1gm IM x 1.
GC (rectal in females): 500 mg IM x1.
Obese patients: consider 2 gm IV q4h.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose

DOSING FOR GLOMERULAR FILTRATION OF 10-50

1 gm-2 gm q8-12h (moderate to severe infections) or 2gm q8h (CNS infections)

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

1 gm-2 gm q12-24h (moderate to severe infections) or 2gm q12h (CNS infections)

DOSING IN HEMODIALYSIS

1-2 gm once-daily (dose post-HD on days of HD or supplement with 1 gm post dialysis)

DOSING IN PERITONEAL DIALYSIS

0.5-2 gm once-daily

DOSING IN HEMOFILTRATION

CVVH: 1-2 gm q12h; CVVHD: 2 gm q12h.

ADVERSE DRUG REACTIONS

GENERAL

Generally well tolerated

OCCASIONAL

Minimal phlebitis at infusion sites
Allergic reactions (eosinophilia); cross-allergy to PCN lower than 1st generation cephalosporin
Diarrhea and C. difficilecolitis
Positive Coombs' test

RARE

CNS: convulsions (high dose with renal failure); confusion, disorientation, and hallucinations
Drug fever
Neutropenia and thrombocytopenia
Hepatitis
Anaphylaxis reaction
Hemolytic anemia
Interstitial nephritis

DRUG INTERACTIONS

Probenecid: increase in cephalosporin serum concentration due to inhibition of tubular secretion by probenecid (no dose adjustment needed).

SPECTRUM

Detailed Spectrum of Activity

RESISTANCE

MIC breakpoint for S. pneumoniaeis < 0.5 mcg/mL (meningitis) and < 1 mcg/mL (non-meningitis).
MIC breakpoint for S. aureus: < 8 mcg/mL (sensitive); 16-32 mcg/mL (intermediate); > 64 mcg/mL (resistant).
MIC breakpoint for beta-hemolytic Streptococcus spp.: < 0.5 mcg/mL.
MIC breakpoint for S. viridans: < 1 mcg/mL (sensitive); 2 mcg/mL (intermediate); > 4 mcg/mL (resistant).
MIC breakpoint for Enterobacteriaceae and other gram-negative non-Enterobacteriaceae : < 8 mcg/mL (sensitive); 16-32 mcg/mL (intermediate); > 64 mcg/mL (resistant).

PHARMACOLOGY

Pharmacology

COMMENTS

A parenteral 3rd generation cephalosporin with reliable CNS penetration when dosed at 2gm IV q4h. Cefotaxime and ceftriaxone are the preferred parenteral cephalosporins for serious pneumococcal infections, but 3-5% of strains are resistant. Although less convenient dosing schedule, cefotaxime is therapeutically equivalent to ceftriaxone.

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