Cefoxitin Indications and Dosage
- Bacteroides fragilis
- Bacteroides sp.
- bone and joint infections
- cervicitis
- Clostridium sp.
- Eikenella corrodens
- endometritis
- Escherichia coli
- Fusobacterium sp.
- gonorrhea
- gynecologic infections
- Haemophilus influenzae (beta-lactamase negative)
- Haemophilus influenzae (beta-lactamase positive)
- intraabdominal abscess
- intraabdominal infections
- Klebsiella pneumoniae
- Klebsiella sp.
- lower respiratory tract infections
- lung abscess
- Morganella morganii
- Neisseria gonorrhoeae
- pelvic cellulitis
- pelvic inflammatory disease (PID)
- Peptococcus sp.
- Peptostreptococcus sp.
- peritonitis
- pneumonia
- proctitis
- Proteus mirabilis
- Proteus vulgaris
- Providencia rettgeri
- Salmonella sp.
- septicemia
- Shigella sp.
- skin and skin structure infections
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Streptococcus pneumoniae
- Streptococcus pyogenes (group A beta-hemolytic streptococci)
- surgical infection prophylaxis
- urethritis
- urinary tract infection (UTI)
Cefoxitin Indications and Dosage
NOTE: To reduce the development of drug-resistant bacteria and maintain the effectiveness of antibacterial drugs, this drug should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
The following organisms are generally considered susceptible to cefoxitin in vitro: Bacteroides fragilis; Bacteroides sp.; Clostridium sp.; Eikenella corrodens; Escherichia coli; Fusobacterium sp.; Haemophilus influenzae (beta-lactamase negative); Haemophilus influenzae (beta-lactamase positive); Klebsiella pneumoniae; Klebsiella sp.; Morganella morganii; Neisseria gonorrhoeae; Peptococcus sp.; Peptostreptococcus sp.; Proteus mirabilis; Proteus vulgaris; Providencia rettgeri; Salmonella sp.; Shigella sp.; Staphylococcus aureus (MSSA); Staphylococcus epidermidis; Streptococcus pneumoniae; Streptococcus pyogenes (group A beta-hemolytic streptococci).
For the treatment of the following infections due to susceptible organisms: intraabdominal infections (e.g., peritonitis, intraabdominal abscess), gynecologic infections (e.g., pelvic cellulitis, endometritis), lower respiratory tract infections (e.g., lung abscess, pneumonia), skin and skin structure infections, bone and joint infections, septicemia, and urinary tract infection (UTI):
Parenteral dosage:
Adults and adolescents: 1 - 2 g IV or IM every 6 - 8 hrs, depending on the severity of the infection and the susceptibility of the organism(s). The manufacturer recommends 1 g IV or IM every 6 - 8 hours for uncomplicated infections, and 1 g IV every 4 hours or 2 g IV every 6 - 8 hours for moderately-severe or severe infections. For infections requiring higher dosages, 2 g IV every 4 hours or 3 g IV every 6 hours can be used. Maximum dose is 12 g/day.
Children and infants >= 3 months: For mild to moderate infections, 80 - 100 mg/kg/day IV or IM in divided doses every 6 - 8 hours. For severe infections, 100 - 160 mg/kg/day IV or IM in divided doses every 4 - 6 hours. Maximum dose is 12 g/day.[6661]
Infants < 3 months of age † and Neonates † : While the manufacturer makes no specific dosage recommendations, 90 - 100 mg/kg/day IV in divided doses every 8 hours has been suggested.[9526][9527]
For use in surgical infection prophylaxis:
Parenteral dosage:
Adults and adolescents: 1 - 2 g IV 30 - 60 minutes prior to surgery, followed by 1 - 2 g IV every 6 - 8 hours for no more than 24 hours after surgery, depending on the procedure. The 2 g dose is recommended by the manufacturer in uncontaminated GI surgery, or vaginal or abdominal hysterectomy. For patients undergoing cesarian section, the manufacturer recommends either a single 2 g IV dose given as soon as the umbilical cord is clamped or a 3-dose regimen that consists of 2 g IV as soon as the umbilical cord is clamped, followed by 2 g IV administered 4 hours and 8 hours after the first dose.
Children and infants >= 3 months: 30 - 40 mg/kg IV 30 - 60 minutes prior to surgery, followed by 30 - 40 mg/kg IV every 6 hours for no more than 24 hours after surgery, depending on the procedure.[6661]
For the treatment of pelvic inflammatory disease (PID):
Intravenous dosage:
Adults and adolescents: The CDC recommends cefoxitin 2 g IV every 6 hours continued for at least 24 hours after the patient demonstrates clinical improvement, in combination with doxycycline 100 mg PO (or IV, if necessary) every 12 hours for 14 days.[9442] [10058] When tubo-ovarian abscess is present, many health-care providers use clindamycin or metronidazole with doxycycline for continued therapy rather than doxycycline alone, because it provides more effective anaerobic coverage.[9442]
Intramuscular dosage (in combination with and followed by oral antibiotics):
Adults and adolescents: The CDC recommends cefoxitin 2 g IM as a single dose plus probenecid 1g PO given concurrently as a single dose plus oral doxycycline (100 mg PO twice daily) with or without oral metronidazole (500 mg PO twice daily) for 14 days.[9442] [10058]
For the treatment of uncomplicated gonorrhea (e.g., cervicitis, proctitis, urethritis):
Intramuscular dosage:
Adults, adolescents, and children >= 45 kg: As an alternative to first-line agents, the CDC recommends cefoxitin 2 g IM as a single dose in combination with probenecid 1 g PO plus a regimen effective against uncomplicated genital C. trachomatis infection (e.g., azithromycin as a single dose or doxycycline for 7 days), if chlamydial infection is not ruled out.[9442] [10058]
Maximum Dosage Limits:
- Adults: 12 g/day IV or IM.
- Elderly: 12 g/day IV or IM.
- Adolescents: 12 g/day IV or IM.
- Children: 160 mg/kg/day IV or IM., not to exceed 12 g/day.
- Infants >= 3 months: 160 mg/kg/day IV or IM.
- Infants < 3 months of age and neonates: 100 mg/kg/day IV has been suggested.
Patients with hepatic impairment:
Cefoxitin is primarily eliminated by the kidneys and is not metabolized by the liver. No dosage adjustments are required in patients with hepatic impairment.
Patients with renal impairment:
CrCl > 50 ml/min: No dosage adjustment needed.
CrCl 30 - 50 ml/min: Give an initial loading dose of 1 - 2 g IV or IM, then 1 - 2 g IV or IM every 8 - 12 hours.
CrCl 10 - 29 ml/min: Give an initial loading dose of 1 - 2 g IV or IM, then 1 - 2 g IV or IM every 12 - 24 hours.
CrCl 5 - 9 ml/min: Give an initial loading dose of 1 - 2 g IV or IM, then 0.5 - 1 g IV or IM every 12 - 24 hours.
CrCl < 5 ml/min: Give an initial loading dose of 1 - 2 g IV or IM, then 0.5 - 1 g IV or IM every 24 - 48 hours.
Intermittent hemodialysis:
A loading dose of 1 - 2 g IV should be given after each standard dialysis session, followed by maintenance doses based on the patient’s CrCl (see above).
[ Last revised: 4/18/2007 11:32:00 AM ]
References
. Mefoxin® (cefoxitin injection) package insert. Whitehouse Station, NJ: Merck & Co., Inc.; 2003 Aug.
. Centers for Disease Control and Prevention (CDC). Sexually Transmitted Diseases Treatment Guidelines 2006. MMWR 2006;55(no. RR-11):1 - 94.
. 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.
. Bennet R, Eriksson M, Nord CE, et al. Fecal bacterial microflora of newborn infants during intensive care management and treatment with five antibiotic regimens. Pediatr Infect Dis 1986;5:533 - 9.
. Centers for Disease Control and Prevention (CDC). Update to CDC’s Sexually Transmitted Diseases Treatment Guidelines, 2006. MMWR Weekly 2007;56(14):332 - 36.
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