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HIV Guide
 Zambia HIV National Guidelines
 


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When to Start ARV Therapy for Chronic HIV Infection in Adults and Adolescents  

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Calculations: Ideal Body Weight, Body Mass Index and Creatinine Clearance  

ARV Therapy for Individuals with Tuberculosis Co-Infection  

Adverse Effects and Toxicity  

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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>
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Cefotaxime

Pham P and Bartlett JG
09-26-2008

  • 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).

REFERENCES

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* 
ClaforanCefotaxime Sanofi aventis US IV
vial
500mg
$7
      IV
vial
1000mg
$10
      IV
vial
2000mg
$20
      IV
vial
10g
$88
Cefotaxime CefotaximeGeneric 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.

RENAL DOSING

DOSING FOR GLOMERULAR FILTRATION OF 50-80

Usual dose

DOSING FOR GLOMERULAR FILTRATION OF 10-50

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

DOSING FOR GLOMERULAR FILTRATION OF <10 ML/MIN

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

DOSING IN HEMODIALYSIS

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

DOSING IN PERITONEAL DIALYSIS

0.5-2Gm 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. difficile colitis
  • 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

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.

REFERENCES

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