Cefoxitin Contraindications and Precautions
- cephalosporin hypersensitivity
- breast-feeding
- coagulopathy
- colitis
- GI disease
- intramuscular injections
- penicillin hypersensitivity
- pregnancy
- renal disease
- renal impairment
- viral infection
- vitamin K deficiency
Cefoxitin Contraindications and Precautions
This drug does not treat viral infection (e.g., common cold). Prescribing cefoxitin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Patients should be told to complete the full course of treatment, even if they feel better earlier.
Cefoxitin should be used cautiously in patients with hypersensitivity to penicillin. The structural similarity between cefoxitin and penicillin causes these patients to be more susceptible to hypersensitivity reactions. Penicillins can cause a variety of hypersensitivity reactions ranging from mild rash to fatal anaphylaxis. Patients who have experienced severe penicillin hypersensitivity should not receive cefitoxin. Cross-reactivity to cephalosporins is approximately 3 - 7% with a documented history to penicillin. Cefoxitin should be used with caution in patients with cephalosporin hypersensitivity or cephamycin hypersensitivity.
Cephalosporins should be used with caution in patients with a history of GI disease, especially colitis, because the adverse GI effects associated with cephalosporin therapy can exacerbate the condition. Also, patients who develop diarrhea while taking or soon after taking cephalosporins should be considered for differential diagnosis of antibiotic-associated pseudomembranous colitis.
Cefoxitin is classified as FDA pregnancy risk category B. Cefoxitin crosses the placenta. Animal data reveal no teratogenic effects; however, a slight decrease in fetal weight was observed. Studies of doses 1 to 7.5 times the maximum recommended human dose in rabbits revealed a high incidence of abortion and maternal death. There are no adequate and well-controlled studies in pregnant women. Because animal studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Cefoxitin has not been studied for use during labor and delivery. Treatment should be given only if clearly needed.
Cephalosporins should be used with caution during breast-feeding, considering the benefit to the mother. Most cephalosporins are excreted in the breast milk in small quantities. Rare potential complications in the nursing infant include alterations of gut flora that might result in diarrhea or other related complications (e.g., dehydration). Nevertheless, the use of most antibiotics is considered compatible with breast feeding. Cephalosporins are generally considered compatible for use for lactating women by the American Academy of Pediatrics [4201] and other expert opinions.[7346]
All cephalosporins may rarely cause hypothrombinemia and have the potential to cause bleeding. Cephalosporins which contain the NMTT side chain (e.g., cefoperazone, cefamandole, cefotetan) have been associated with an increased risk for bleeding. Cephalosporins should be used cautiously in elderly patients and patients with a preexisting coagulopathy (e.g., vitamin K deficiency) since these patients are at a higher risk for developing bleeding complications.
Intramuscular injections should be administered cautiously to patients receiving cefoxitin. IM injections may cause bleeding, bruising, or hematomas due to hypothrombonemia effect secondary to cephalosporin therapy.
Cefoxitin should be used with caution in patients with renal disease or renal impairment since the drug is eliminated via renal mechanisms. Dosages may need to be reduced in these patients.
[ Last revised: 3/8/2004 10:30:00 AM ]
References
. American Academy of Pediatrics (AAP) Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics 2001;108:776 - 89.
. Bar-Oz B, Bulkowstein M, Benyamini L, et al. Use of antibiotic and analgesic drugs during lactation. Drug Saf 2003;26:925 - 35. Review.
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