Cefoxitin dosing

Jagelman DG, Fabian TC, Nichols RL, Stone HH, Wilson SE, Zellner SR Single-dose cefote-tan versus multiple dose cefoxitin as prophylaxis in colorectal surgery. Am J Surg 1988 155(suppl 5A) 71-76. 

Appendectomy Enteric gram-negative bacilli, anaerobes Cefoxitin or cefotetan 1 g x 1 Second intraoperative dose of cefoxitin may be required if procedure lasts longer than 3 hours IA... 

Single-dose therapy with cefotetan is adequate. Intraoperative dosing of cefoxitin may be required if the procedure extends beyond 3 hours. 

A single preoperative dose of cefazolin or cefoxitin is recommended for vaginal hysterectomy. For patients with /3-lactam hypersensitivity, a single preoperative dose of metronidazole or doxycycline is effective. 

Both cefazolin and antianaerobic cephalosporins (e.g., cefoxitin, cefote-tan) have been studied extensively for abdominal hysterectomy. Singledose cefotetan is superior to single-dose cefazolin. The antibiotic course should not exceed 24 hours in duration. 

Pelvic inflammatory disease (PID) - Cefoxitin 2 g IM plus probenecid, 1 g orally in a single dose concurrently. 

Action Monobactam, -1- cell wall S5mth Dose Adul. 1—2 g IV/EM q6-12h Peds. Premature 30 mg/kg/dose IV ql2h Term children 30 mg/kg/dose q6-8h X in renal impair Caution [B, +] Disp Inj SE NA /D, rash, pain at inj site Interac tions T Effects W/probenecid, aminoglycosides, i-lactam antibiotics X effects W7 cefoxitin, chloramphenicol, imipenem EMS Monitor for S/Sxs of super Infxn may cause aUCTgic Rxns rare cross-sensitivity Rxns to penicillins and cephalosporins have been rqwrted OD May cause Szs symptomatic and supportive... 

Urinary excretion is the major elimination path for most cephalosporins. When prescribing cephalosporins to patients with renal failure, practitioners must consider dose reduction or dose interval extension (Table 45.2). Renal tubular secretion contributes to the elimination of some cephalosporins, and an increase in cephalosporin plasma concentrations may occur when probenecid blocks renal tubular secretion of cephalosporins. Biliary elimination is important for some cephalosporins. Cefmetazole, cefoperazone (Cefobid), cefoxitin, and ceftriaxone achieve biliary concentrations greater than those in plasma. After parenteral administration of cefoperazone, 70% of the dose appears in the bile within 24 hours. Practitioners should decrease the dose of cefoperazone when prescribing for patients with hepatic failure or biliary obstruction. Metabolism is not a major elimination path for most cephalosporins. Cefotaxime is one of the few cephalosporins having an active metabolite, desacetyl cefotaxime. 

Cefoxitin 1-2g iVq.ehr S0% q.6hr q.S-12hr q.l2hr May produce faise increase in serum creatinine ieyel by interference with assay 1 g after dialysis 1 g/day Dose for GFR 10-50 ml/min... 

Cephalosporins distribute into most body fluids and tissues, including pleural fluid, synovial fluid, pericardial fluid and urine. Cephalosporins distribute into milk, but therapeutic concentrations are not reached following systemic administration at accepted dose rates. Cephalosporins cross the placenta but do not appear to cause adverse effects in the fetus. Their penetration into cortical and cancellous bone is usually adequate. Most cephalosporins penetrate poorly into the aqueous humor, accessory sex glands and CSF. Cephalosporins have typically low values in horses 0.191/kg for cefazolin, 0.151/kg for cefa-lotin, 0.171/kg for cefapirin, 0.41/kg for cefradine and 0.121/kg for cefoxitin. 

Liberman MA, Greason KL, Frame S, Ragland JJ. Single-dose cefotetan or cefoxitin versus multiple-dose cefoxitin as prophylaxis in patients undergoing appendectomy for acute nonperforated appendicitis. J Am Coll Surg 1995 180 77-80. 

A clinical study found that furosemide 80 mg increased the serum half-life of cefaloridine by 25%, and in another study cefaloridine clearance was reduced by fiirosemideA fiirther study found that brain concentrations of cefradine are markedly reduced by furosemide. In a study in 6 healthy subjects, furosemide 40 mg, given 1 hour before a 1-g intramuscular dose of ceftazidime, raised the serum ceftazidime levels by about 20 to 40% over 8 hours and increased the AUC by 28%. Furosemide given 3 hours before ceftazidime had much smaller effects." The serum half-lives of intravenous cefoxitin and cefiiroxime were not affected by oral furosemide. Ceftriaxone does not appear to interfere with the diuretic effects of furosemide. ... 

Cefoxitin Intramuscular/lntravenous Serum half-life increased from 39 to 129 minutes and clearance halved (intravenous) greater increase in AUC when probenecid given 1 hour before rather than with cefoxitin (intravenous) increasing dose of probenecid from 1 to 2 g increased AUC of cefoxitin (intramuscular) 21-23... 

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