Dosing and uses of Cefotetan
Adult dosage forms and strengths
injectable solution
- 20mg/mL
- 40mg/mL
powder for injection
- 1g
- 2g
- 10g
Skin & Skin Structure (Mild to Moderate)
2 g IV q24hr
Skin & Skin Structure (Severe)
2 g IV q12hr
Urinary Tract
500 mg IV/IM q12hr; 1-2 g IV/IM q24hr; 1-2 g IV/IM q12hr
Other Infection Sites
1-2 g IV/IM q12hr
Severe Infection
2 g IV q12hr
Life-Threatening Infection
3 g IV q12hr
Surgery Infection Prophylaxis
Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV
Ruptured viscus: 1-2 g IV q12hr
Renal Impairment
CrCl 10-30 mL/min: Give qDay
CrCl <10 mL/min: Give q48hr
Other Indications & Uses
Dosage and route of administration depends on condition of patient, severity of infection, and susceptibility of causative organism
Bacteroides spp., C. perfringens, E. coli, H. influenzae, Klebsiella spp., M. morganii, N. gonorrhoeae, P. mirabilis, Peptococcus spp., Peptostreptococcus spp., Serratia spp., Staphylococci, group A beta-hemolytic Streptococcus, S. agalactiae, S. epidermidis, S. pyogenes
Pediatric dosage forms and strengths
injectable solution
- 20mg/mL
- 40mg/mL
powder for injection
- 1g
- 2g
- 10g
Severe Infection (Off-label)
40-80 mg/kg/day IV/IM divided q12hr
Geriatric dosage forms and strengths
Skin & skin structure (mild to moderate)
2 g IV q24hr
Skin & skin structure (severe)
2 g IV q12hr
Urinary tract
500 mg IV/IM q12hr; 1-2 g IV/IM q24hr; 1-2 g IV/IM q12hr
Other infection sites
1-2 g IV/IM q12hr
Severe infection
2 g IV q12hr
Life-threatening infection
3 g IV q12hr
Surgery infection prophylaxis
Colorectal, non-perforated appendectomy, hysterectomy: 1-2 g IV
Ruptured viscus: 1-2 g IV q12hr
Cefotetan adverse (side) effects
1-10%
Diarrhea (1%)
Hepatic enzyme elevation (1%)
Hypersensitivity reaction (1%)
<1%
Prolongation of bleeding time
Neutropenia
Thrombocytopenia
Immune-mediated hemolytic anemia
Warnings
Contraindications (additional)
Documented hypersensitivity
Coagulation disorders
Cautions (additional)
Reduce dosage by 1/2 if <10-30 mL/min creatinine clearance and by 1/4 if <10 mL/min; (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
Associated with rare but potentially fatal hemolytic anemia - monitor as needed
Current US formulation does not allow direct IV or IM administration
Inappropriate for pediatric mild-moderate infections (AAP)
Pregnancy and lactation
Pregnancy category: B
Lactation: excreted in breast milk, use caution
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Cefotetan
Mechanism of action
Second-generation cephalosporin used as single-drug therapy to provide broad gram-negative coverage and anaerobic coverage. Also provides some coverage of gram-positive bacteria. Half-life is 3.5 h. Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins; inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell wall death
Pharmacokinetics
Half-Life: 2.8-4.6 hr
Peak Plasma Time: 1.5-3 hr (IM)
Protein Bound: 76-90%
Distribution: Body fluids & tissue, including bile, sputum, prostatic & peritoneal fluids, low in CSF
Metabolism: Liver
Excretion: urine primarily unchanged; feces (20%)
Administration
IV Incompatibilities
Additive: aminoglycosides, heparin, tetracyclines
Syringe: doxapram, promethazine
Y-site: cisatracurium(?), promethazine, vancomycin, vinorelbine
IV Compatibilities
Solution: D5W, Ns
Y-site: allopurinol, amifostine, aztreonam, bivalirudin, dexmedetomidine, diltiazem, docetaxel, etoposide PO4, famotidine, fenoldopam, filgrastim, fluconazole, fludarabine, gatifloxacin, gemcitabine, granisetron, heparin, Hextend, reg insulin, linezolid, melphalan, meperidine, morphine SO4, paclitaxel, propofol, remifentanil, sargramostim, tacrolimus, teniposide, theophylline, thiotepa
IV Preparation (for powder)
Solution: add 10 mL diluent to 1 g vial; withdraw 10.5 mL (95 mg/mL)
IV Administration
Intermittent infusion over 20-60 min
Do not administer with other drugs
Canadian (but not US) formulations allow for IV inj or deep Im
