|
This information has been developed and provided by an independent third-party source. Merck & Co., Inc. does not endorse and is not responsible for the accuracy of the content, or for practices or
standards of non-Merck sources.
Pronunciation
(se FOKS i tin)
Generic Available (U.S.)
Yes: Excludes infusion
Index Terms
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Less active against staphylococci and streptococci than first generation cephalosporins, but active against anaerobes including Bacteroides fragilis; active against gram-negative enteric bacilli including E. coli, Klebsiella, and Proteus; used predominantly for respiratory tract, skin, bone and joint, urinary tract and gynecologic as well as septicemia; surgical prophylaxis; intra-abdominal infections and other mixed infections; indicated for bacterial Eikenella corrodens infections
Pregnancy Risk Factor
B
Pregnancy Considerations
Adverse events have not been observed in animal reproduction studies; therefore, cefoxitin is classified as pregnancy category B. Cefoxitin crosses the placenta and reaches the cord serum and amniotic fluid. Adequate well-controlled studies are not available in pregnant women.Peak serum concentrations of cefoxitin during pregnancy may be similar to or decreased compared to nonpregnant values. Maternal half-life may be shorter at term. Pregnancy-induced hypertension increases trough concentrations in the immediate postpartum period.
Lactation
Enters breast milk/use caution (AAP rates “compatible”; AAP 2001 update pending)
Breast-Feeding Considerations
Very small amounts of cefoxitin are excreted in breast milk. The manufacturer recommends that caution be exercised when administering cefoxitin to nursing women. Nondose-related effects could include modification of bowel flora. Cefoxitin pharmacokinetics may be altered immediately postpartum.
Contraindications
Hypersensitivity to cefoxitin, any component of the formulation, or other cephalosporins
Warnings/Precautions
Concerns related to adverse effects:
• 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.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment; modify dosage in severe impairment.
Adverse Reactions
1% to 10%: Gastrointestinal: Diarrhea
<1%: Anaphylaxis, angioedema, bone marrow suppression, BUN increased, creatinine increased, dyspnea, eosinophilia, exacerbation of myasthenia gravis, exfoliative dermatitis, fever, hemolytic anemia, hypotension, interstitial nephritis, jaundice, leukopenia, nausea, nephrotoxicity increased (with aminoglycosides), phlebitis, prolonged PT, pruritus, pseudomembranous colitis, rash, thrombocytopenia, thrombophlebitis, toxic epidermal necrolysis, transaminases increased, urticaria, vomiting
Reactions reported with other cephalosporins: Agranulocytosis, aplastic anemia, cholestasis, colitis, erythema multiforme, hemolytic anemia, hemorrhage, pancytopenia, renal dysfunction, serum-sickness reactions, seizure, Stevens-Johnson syndrome, superinfection, toxic nephropathy, vaginitis
Metabolism/Transport Effects
None known.
Drug Interactions
Aminoglycosides: Cephalosporins (2nd Generation) may enhance the nephrotoxic effect of Aminoglycosides. Risk C: Monitor therapy
BCG: Antibiotics may diminish the therapeutic effect of BCG. Risk X: Avoid combination
Probenecid: May increase the serum concentration of Cephalosporins. Risk C: Monitor therapy
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 24 hours after cessation of antibacterial agents. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Storage
Reconstituted solution is stable for 6 hours at room temperature or 7 days when refrigerated; I.V. infusion in NS or D5W solution is stable for 18 hours at room temperature or 48 hours when refrigerated. Premixed frozen solution, when thawed, is stable for 24 hours at room temperature or 21 days when refrigerated.
Reconstitution
Reconstitute vials with SWFI, bacteriostatic water for injection, NS, or D5W. For I.V. infusion, solutions may be further diluted in NS, D51/4NS, D51/2NS, D5NS, D5W, D10W, LR, D5LR, mannitol 10%, or sodium bicarbonate 5%.
Compatibility
Stable in D5LR, D51/4NS, D51/2NS, D5NS, D5W, D10W, LR, NS, mannitol 10%, sodium bicarbonate 5%; variable stability (consult detailed reference) in peritoneal dialysis solution.
Y-site administration: Compatible: Acyclovir, amifostine, amphotericin B cholesteryl sulfate complex, anidulafungin, aztreonam, bivalirudin, cyclosporine, cyclophosphamide, dexmedetomidine, diltiazem, docetaxel, doxorubicin liposome, etoposide phosphate, famotidine, fluconazole, foscarnet, gemcitabine, granisetron, hetastarch in lactate electrolyte injection (Hextend®), hydromorphone, linezolid, magnesium sulfate, meperidine, morphine, multivitamins, ondansetron, oxytocin, propofol, ranitidine, remifentanil, teniposide, thiotepa. Incompatible: Anakinra, fenoldopam, filgrastim, hetastarch in NS, pantoprazole, pemetrexed, pentamidine. Variable (consult detailed reference): Cisatracurium, vancomycin.
Compatibility in syringe: Compatible: Heparin. Incompatible: Pantoprazole.
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.
Pharmacodynamics/Kinetics
Distribution: Widely to body tissues and fluids including pleural, synovial, ascitic, bile; poorly penetrates into CSF even with inflammation of the meninges
Protein binding: 65% to 79%
Half-life elimination: 45-60 minutes; significantly prolonged with renal impairment
Time to peak, serum: I.M.: 20-30 minutes
Excretion: Urine (85% as unchanged drug)
Dosage
Usual dosage range:
Infants >3 months and Children: I.M., I.V.: 80-160 mg/kg/day in divided doses every 4-6 hours (maximum dose: 12 g/day)
Adults: I.M., I.V.: 1-2 g every 6-8 hours (maximum dose: 12 g/day)
Note: I.M. injection is painful
Indication-specific dosing:
Infants >3 months and Children:
Mild-to-moderate infection: I.M., I.V.: 80-100 mg/kg/day in divided doses every 4-6 hours
Perioperative prophylaxis: I.V.: 30-40 mg/kg 30-60 minutes prior to surgery followed by 30-40 mg/kg/dose every 6 hours for no more than 24 hours after surgery depending on the procedure
Severe infection: I.M., I.V.: 100-160 mg/kg/day in divided doses every 4-6 hours
Adolescents and Adults:
Perioperative prophylaxis: I.M., I.V.: 1-2 g 30-60 minutes prior to surgery (may repeat in 2-5 hours intraoperatively) followed by 1-2 g every 6-8 hours for no more than 24 hours after surgery depending on the procedure
Adults:
Amnionitis, endomyometritis: I.M., I.V.: 2 g every 6-8 hours
Aspiration pneumonia, empyema, orbital cellulitis, parapharyngeal space, human bites: I.M., I.V.: 2 g every 8 hours
Intra-abdominal infection, complicated, community acquired, mild-to-moderate: I.V.: 2 g every 6 hours for 4-7 days (provided source controlled)
Liver abscess: I.V.: 1 g every 4 hours
Mycobacterium species, not MTB or MAI: I.V.: 12 g/day with amikacin
Pelvic inflammatory disease:
Inpatients: I.V.: 2 g every 6 hours plus doxycycline 100 mg I.V. or 100 mg orally every 12 hours until improved, followed by doxycycline 100 mg orally twice daily to complete 14 days
Outpatients: I.M.: 2 g plus probenecid 1 g orally as a single dose, followed by doxycycline 100 mg orally twice daily for 14 days
Dosing interval in renal impairment:
Clcr 30-50 mL/minute: Administer 1-2 g every 8-12 hours
Clcr 10-29 mL/minute: Administer 1-2 g every 12-24 hours
Clcr 5-9 mL/minute: Administer 0.5-1 g every 12-24 hours
Clcr <5 mL/minute: Administer 0.5-1 g every 24-48 hours
Hemodialysis: Moderately dialyzable (20% to 50%); administer a loading dose of 1-2 g after each hemodialysis; maintenance dose as noted above based on Clcr
Continuous arteriovenous or venovenous hemodiafiltration effects: Dose as for Clcr 10-50 mL/minute
Administration: I.M.
Inject deep I.M. into large muscle mass.
Administration: I.V.
Can be administered IVP over 3-5 minutes at a maximum concentration of 100 mg/mL or I.V. intermittent infusion over 10-60 minutes at a final concentration for I.V. administration not to exceed 40 mg/mL
Administration: I.V. Detail
pH: 4.2-7.0 (reconstituted solution); 6.5 (frozen premixed solution)
Monitoring Parameters
Monitor renal function periodically when used in combination with other nephrotoxic drugs; observe for signs and symptoms of anaphylaxis during first dose
Test Interactions
Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction
Dietary Considerations
Some products may contain sodium.
Patient Education
This medication is administered by injection or infusion. Report immediately any redness, swelling, burning, or pain at injection/infusion site; chest pain, palpitations, respiratory difficulty or swallowing; or itching or hives. Maintain adequate hydration, unless instructed to restrict fluid intake. May cause false test results with Clinitest®; use of another type of glucose testing is preferable. May cause diarrhea, GI distress, or nausea. Report rash; breathing or swallowing difficulty; persistent diarrhea, nausea, vomiting, or abdominal pain; changes in urinary pattern or pain on urination; opportunistic infection (eg, vaginal itching or drainage, sores in mouth, blood in stool or urine, unusual fever or chills); or CNS changes (eg, irritability, agitation, nervousness, insomnia, hallucinations).
Geriatric Considerations
Adjust dose for renal function in the elderly.
Anesthesia and Critical Care Concerns/Other Considerations
Evidence-Based Information: Surgical Prophylaxis: Cefoxitin should be avoided in patients with a history of serious beta-lactam allergy (eg, respiratory difficulty, angioedema, hives, hypotension). Examples of beta-lactam antibiotics include penicillin, ampicillin, piperacillin, and cephalosporins (Bratzler, 2004).
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins
Mental Health: Effects on Psychiatric Treatment
May rarely cause neutropenia; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Assess results of culture/sensitivity tests and patient's allergy history prior to therapy. Monitor for nephrotoxicity. Evaluate prothrombin time and CBC with differential. Monitor for diarrhea, nausea, vomiting, and nephrotoxicity. Advise patients with diabetes about use of Clinitest®. Teach patient to report hypersensitivity and opportunistic infection.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Infusion, premixed iso-osmotic dextrose solution:
Mefoxin®: 1 g (50 mL); 2 g (50 mL) [contains sodium 53.8 mg (2.3 mEq)/g]
Injection, powder for reconstitution: 1 g, 2 g, 10 g
References
Abramowicz M, “Antimicrobial Prophylaxis in Surgery,” Medical Letter on Drugs and Therapeutics, Handbook of Antimicrobial Therapy, 16th ed, New York, NY: Medical Letter, 2002.
American Academy of Pediatrics Committee on Drugs, "Transfer of Drugs and Other Chemicals Into Human Milk," Pediatrics, 2001, 108(3):776-89.
“Antimicrobial Prophylaxis in Surgery,” Med Lett Drugs Ther, 1993, 35(906):91-4.
Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al, “Antimicrobial Prophylaxis for Surgery: An Advisory Statement From the National Surgical Infection Prevention Project,” Clin Infect Dis, 2004, 38(12):1706-15.
Centers for Disease Control and Prevention, “Sexually Transmitted Diseases Treatment Guidelines, 2006,” MMWR, 2006, 55(RR-11): 1-94.
Centers for Disease Control and Prevention (CDC), "Sexually Transmitted Diseases Treatment Guidelines, 2010," MMWR Recomm Rep, 2010, 59(RR-12):1-110.
Donowitz GR and Mandell GL, “Beta-Lactam Antibiotics,” N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.
Feldman WE, Moffitt S, and Sprow N, “Clinical and Pharmacokinetic Evaluation of Parenteral Cefoxitin in Infants and Children,” Antimicrob Agents Chemother, 1980, 17(4):669-74.
Garcia MJ, Garcia A, Nieto MJ, et al, “Disposition of Cefoxitin in the Elderly,” Int J Clin Pharmacol Ther Toxicol, 1980, 18(11):503-9.
Marshall WF and Blair JE, “The Cephalosporins,” Mayo Clin Proc, 1999, 74(2):187-95.
Regazzi MB, Chirico G, Cristiani D, et al, “Cefoxitin in Newborn Infants. A Clinical and Pharmacokinetic Study,” Eur J Clin Pharmacol, 1983, 25(4):507-9.
Solomkin JS, Mazuski JE, Bradley JS, et al, “Diagnosis and Management of Complicated Intra-Abdominal Infections in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America,” Clin Infect Dis, 2010, 50(2):133-64.
International Brand Names
Lexi-Comp.com
Last full review/revision January 2012
|
