Dosing and uses of Claforan (cefotaxime)
Adult dosage forms and strengths
injectable solution
- 20mg/mL
- 40mg/mL
powder for injection
- 500mg
- 1g
- 2g
- 10g
Gonococcal Urethritis/Cervicitis
0.5 g IM once
Gonorrhea, Rectal
Men: 1 g IM once
Women: 0.5 g IM once
Infections Caused by Susceptible Organisms
Uncomplicated: 1 g IV or IM q12hr
Moderate to severe: 1-2 g IV or IM q8hr
More serious (bloodstream infection [septicemia]): 2 g IV q6-8hr
Life-threatening: 2 g IV q4hr; not to exceed 12 g/day
Preparation for Surgery
Prophylaxis of surgical infection
1 g IM/IV once 30-90 minutes before start of procedure
Dosing Considerations
Susceptible organisms
- Bacteroides spp, Citrobacter spp, Clostridium spp, Enterobacter spp, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Moraxella catarrhalis, Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Peptococcus spp, Peptostreptococcus spp, Proteus mirabilis, Providencia rettgeri, Pseudomonas spp, Serratia spp, Staphylococcus aureus, Streptococcus agalactiae, Streptococcus pneumoniae, Streptococcus pyogenes
Pediatric dosage forms and strengths
injectable solution
- 20mg/mL
- 40mg/mL
powder for injection
- 500mg
- 1g
- 2g
- 10g
Infections Caused by Susceptible Organisms
<12 years or <50 kg: 50-200 mg/kg/day IV/IM divided q6-8hr
>12 years or >50 kg: 1-2 g IV/IM q8hr
Epiglottitis
<12 years or <50 kg: 150-200 mg/kg/day IV/IM divided q6hr plus clindamycin for 7-10 days
>12 years or >50 kg: 1-2 g IV/IM q8hr
Meningitis
<12 years or <50 kg: 200 mg/kg/day IV/IM divided q6hr
>12 years or >50 kg: 2 g IV q4-6hr in combination with other antimicrobial therapy as necessary
Pneumonia
<12 years or <50 kg: 200 mg/kg/day IV divided q8hr
>12 years or >50 kg: 1-2 g IV/IM q8hr
Sepsis
<12 years or <50 kg: 150 mg/kg/day IV divided q8hr
>12 years or >50 kg: 2 g IV q6-8hr
Typhoid Fever
<12 years or <50 kg: 150-200 mg/kg/day IV/IM divided q6-8hr; not to exceed 12 g/day
Fluoroquinolone resistant: 80 mg/kg/day IV/IM divided q6-8hr; not to exceed 12 g/day
>12 years or >50 kg: 1-2 g IV/IM q4-8hr
Dosing Considerations
Usual dosage range in children
- 0-1 week: 50 mg/kg IV q12hr
- 1-4 weeks: 50 mg/kg IV q8hr
- 1 month-12 years: 50-180 mg/kg/day IV divided q4-6hr
- >12 years: 1-2 g IV/IM q4-8hr
Claforan (cefotaxime) adverse (side) effects
Frequency not defined
Colitis
Diarrhea
Elevated blood urea nitrogen (BUN) and creatinine
Elevated hepatic transaminases
Eosinophilia
Fever
Injection site pain
Nausea
Pruritus
Rash
Thrombocytopenia
Transient neutropenia
Vomiting
Warnings
Contraindications
Documented hypersensitivity to drug or components
Cautions
Potentially life-threatening arrhythmia reported in patients receiving rapid bolus injection through central venous catheter
Prolonged treatment has been associated with granulocytopenia (>10 days)
Change infusion sites to minimize inflammation
Use with caution in patients with history of penicillin allergy
Use with caution in patients with history of colitis
Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy
May need to adjust dose in renal impairment
Cefotaxime may potentiate the nephrotoxic effects of nephrotoxic drugs, including aminoglycosides, NSAIDs, and furosemide
Pregnancy and lactation
Pregnancy category: B
Lactation: Drug enters breast milk; use with 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 Claforan (cefotaxime)
Mechanism of action
Binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death; resists degradation by beta-lactamase; proper dosing and appropriate route of administration are determined by condition of patient, severity of infection, and susceptibility of microorganism
Absorption
Peak plasma time: IM, 30 min
Distribution
Distribution: widely distributed to body tissues and fluids, including aqueous humor, ascitic and prostatic fluids, bone, penetrates CSF when meninges inflamed
Widely distributed to body tissues and fluids, including aqueous humor, ascitic and prostatic fluids, and bone; penetrates CSF when meninges are inflamed
Metabolism
Partially metabolized in liver
Metabolite: Desacetylcefotaxime (active)
Elimination
Half-life: Parent drug, 1-1.5 hr; active metabolite, 1-1.9 hr
Excretion: Urine
Administration
IV Incompatibilities
Additive: Aminoglycosides, aminophylline, sodium bicarbonate
Syringe: Doxapram
Y-site: Allopurinol, filgrastim, fluconazole, gemcitabine, hetastarch, pentamidine
IV Preparation
Intermittent injection: Reconstitute 1 or 2 g with 10 mL SWI
Infusion: Reconstitute infusion bottles with 50 or 100 mL NS or D5W
May be diluted further
