Probenecid Cefoxitin

Spectinomycin 2 g IM once, or ceftizoxime 500 mg IM once, or cefotaxime 500 mg IM once, or cefoxitin 2 g IM once with probenecid I g po once, or gatifloxacin 400 mg po once, or lomefloxacin 400 mg po once, or norfloxacin 800 mg po once plus... 

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

Uncomplicated gonorrhea-2 g IM with 1 g oral probenecid given concurrently or up to 30 minutes before cefoxitin. 

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. 

Ko H, Cathcart KS, Griffith DL, et al. Pharmacokinetics of intravenously administered cefmetazole and cefoxitin and effects of probenecid on cefmetazole elimination. Antimicrob Agents Chemother 1989 33 356-361. 

Vlasses PH, Holbrook AM, Schrogie JJ, et al. Effect of orally administered probenecid on the pharmacokinetics of cefoxitin. Antimicrob Agents Chemother 1980 17 847-855. 

Reeves DS, Bullock DW, Bywater MJ, Holt HA, White LO, Thornhill DP. The effect of probenecid on the pharmacokinetics and distribution of cefoxitin in healthy volunteers. Br J Clin Pharmacol 1981 ll(4) 353-9. 

Other Beta-lactam Antibiotics - Several newer cephalosporins and cephamy-clns have been tested clinically in gonorrhea. Cefazolln, cefoxitin, cefu-roxime, cefamandole, and others are effective In vitro,10 21 but have given variable results in clinical trials.22-24 Cefuroxlme is the most effective, with cure rates in uncomplicated infection of 98-100% when 1.0-1.5 gm is given IM with probenecid 1.0 gm orally, and is effective against PPNG.25... 

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... 

Bint AJ, Reeves DS, Holt HA. Effect of probenecid on serum cefoxitin concentrations. J Antimicrob Chemother (1977) 3, 627-8. 

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