Claforan

3rd Generation Cephalosporin Antibiotics

Cefotaxime is administered intravenously or intramuscularly.
One gram of cefotaxime in 14 mL of sterile water for injection is isotonic.
Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.

Infusion bottles, bulk packages, and frozen bags are for IV use only.
 
IV Push
Vials: reconstitute 500 mg, 1 g, or 2 g with 10 mL of sterile water for injection to give concentrations of 50, 95, or 180 mg/mL, respectively.
Inject directly into a vein over 3—5 minutes or slowly into the tubing of a freely-flowing compatible IV solution.
 
Intermittent or continuous IV infusion
Vials: the reconstituted powder (see above) may be further diluted with 50—1000 mL of a compatible IV solution.
Infusion bottles: reconstitute bottles containing 1 or 2 g with 50—100 mL of 0.9% Sodium Chloride injection or 5% Dextrose injection.
Frozen bags: thaw at room temperature. Do not force thaw. No reconstitution necessary.
Pharmacy bulk packages: reconstitute 10 grams with 47 or 97 mL of a compatible solution to give concentrations of 200 mg/mL or 100 mg/mL, respectively. Withdraw appropriate dose and dilute in a compatible IV solution.
ADD-Vantage vials: for IV infusion only. Reconstitute only with 0.9% Sodium Chloride injection or 5% Dextrose injection in the appropriate 50 or 100 mL flexible diluent container.
Infuse appropriate dose over 20—60 minutes.

Vials: reconstitute 500 mg, 1 g, or 2 g with 2, 3, 5 mL of sterile or bacteriostatic water for injection, respectively.
Inject deeply into a large muscle (i.e., upper outer quadrant of the gluteus maximus or lateral part of the thigh).

hemolytic anemia / Delayed / 0-1.0
seizures / Delayed / 0-1.0
agranulocytosis / Delayed / Incidence not known
pancytopenia / Delayed / Incidence not known
aplastic anemia / Delayed / Incidence not known
anaphylactoid reactions / Rapid / Incidence not known
renal failure (unspecified) / Delayed / Incidence not known
toxic epidermal necrolysis / Delayed / Incidence not known
azotemia / Delayed / Incidence not known
interstitial nephritis / Delayed / Incidence not known
erythema multiforme / Delayed / Incidence not known
angioedema / Rapid / Incidence not known
Stevens-Johnson syndrome / Delayed / Incidence not known
cholecystitis / Delayed / Incidence not known
acute generalized exanthematous pustulosis (AGEP) / Delayed / Incidence not known
C. difficile-associated diarrhea / Delayed / Incidence not known

eosinophilia / Delayed / 2.4-2.4
leukopenia / Delayed / 0-1.0
neutropenia / Delayed / 0-1.0
vaginitis / Delayed / 0-1.0
candidiasis / Delayed / 0-1.0
thrombocytopenia / Delayed / Incidence not known
bleeding / Early / Incidence not known
cholestasis / Delayed / Incidence not known
cholelithiasis / Delayed / Incidence not known
elevated hepatic enzymes / Delayed / Incidence not known
colitis / Delayed / Incidence not known
pseudomembranous colitis / Delayed / Incidence not known
superinfection / Delayed / Incidence not known

injection site reaction / Rapid / 4.3-4.3
fever / Early / 2.4-2.4
pruritus / Rapid / 2.4-2.4
maculopapular rash / Early / 2.4-2.4
headache / Early / 0-1.0
urticaria / Rapid / Incidence not known
dizziness / Early / Incidence not known
diarrhea / Early / Incidence not known
malaise / Early / Incidence not known
nausea / Early / Incidence not known
abdominal pain / Early / Incidence not known
vomiting / Early / Incidence not known
Jarisch-Herxheimer reaction / Early / Incidence not known

Claforan

Rx

Parenteral third-generation cephalosporin
Not effective for Pseudomonas aeruginosa infections
Used commonly for enteric gram-negative meningitis and sepsis, serious bacteremias, pneumonia, intra-abdominal infections, bone and joint infections, urinary tract infections, and skin and skin structure infections

2 g IV every 6 to 8 hours for severe infections and 2 g IV every 4 hours for life-threatening infections.

2 g IV every 6 to 8 hours for severe infections and 2 g IV every 4 hours for life-threatening infections.

150 to 180 mg/kg/day (Max: 8 g/day) IV or IM divided every 6 to 8 hours.[29912]

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.[29912]

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.[29912]

2 g IV every 4 hours. Start within 1 hour for septic shock or within 3 hours for possible sepsis without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response.

2 g IV every 4 hours. Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response.

150 to 180 mg/kg/day (Max: 8 g/day) IV divided every 6 to 8 hours.[29912] Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response.

50 mg/kg/dose IV every 8 hours.[29912] Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response. Neonates younger than 37 weeks gestational age were excluded from guideline scope.

50 mg/kg/dose IV every 12 hours.[29912] Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response. Neonates younger than 37 weeks gestational age were excluded from guideline scope.

50 mg/kg/dose IV every 8 hours.[29912]

50 mg/kg/dose IV every 12 hours.[29912]

2 g IV every 4 to 6 hours for 10 to 14 days; consider the addition of rifampin if dexamethasone is also given or ceftriaxone MIC is more than 2 mcg/mL.

2 g IV every 4 to 6 hours for 10 to 14 days; consider the addition of rifampin if dexamethasone is also given or ceftriaxone MIC is more than 2 mcg/mL.

200 to 300 mg/kg/day (Max: 12 g/day) IV divided every 4 to 6 hours for 10 to 14 days; consider the addition of rifampin if dexamethasone is also given or ceftriaxone MIC is more than 2 mcg/mL.

50 mg/kg/dose IV every 6 to 8 hours for 10 to 14 days; consider the addition of rifampin if dexamethasone is also given or ceftriaxone MIC is more than 2 mcg/mL.

50 mg/kg/dose IV every 8 to 12 hours for 10 to 14 days; consider the addition of rifampin if dexamethasone is also given or ceftriaxone MIC is more than 2 mcg/mL.

2 g IV every 4 to 6 hours for 14 to 21 days.

200 to 300 mg/kg/day (Max: 12 g/day) IV divided every 4 to 6 hours for 14 to 21 days.

50 mg/kg/dose IV every 6 to 8 hours for 14 to 21 days.

50 mg/kg/dose IV every 8 to 12 hours for 14 to 21 days.

2 g IV every 4 to 6 hours for 7 days.

2 g IV every 4 to 6 hours for 7 days.

200 to 300 mg/kg/day (Max: 12 g/day) IV divided every 4 to 6 hours for 7 days.

50 mg/kg/dose IV every 6 to 8 hours for 7 days.

50 mg/kg/dose IV every 8 to 12 hours for 7 days.

2 g IV every 4 to 6 hours for 10 to 21 days.

2 g IV every 4 to 6 hours for 10 to 21 days.

200 to 300 mg/kg/day (Max: 12 g/day) IV divided every 4 to 6 hours for 10 to 21 days.

50 mg/kg/dose IV every 6 to 8 hours for 2 weeks beyond the first sterile CSF culture or at least 21 days, whichever is longer.

50 mg/kg/dose IV every 8 to 12 hours for 2 weeks beyond the first sterile CSF culture or at least 21 days, whichever is longer.

2 g IV every 4 to 6 hours for 10 to 14 days.

200 to 300 mg/kg/day (Max: 12 g/day) IV divided every 4 to 6 hours for 10 to 14 days.

1 g IV or IM as a single dose within 30 to 90 minutes prior to the surgical incision. For cesarean section, 1 g IV or IM as soon as the umbilical cord is clamped, then 1 g IV or IM every 6 hours for 2 more doses. Clinical practice guidelines suggest 1 g IV, or for obese patients, 2 g IV within 60 minutes prior to the surgical incision. Intraoperative redosing 3 hours from the first preoperative dose and duration of prophylaxis less than 24 hours are suggested by clinical practice guidelines. Cefotaxime is FDA-approved for surgical procedures that may be classified as contaminated or potentially contaminated (i.e., abdominal or vaginal hysterectomy, gastrointestinal and genitourinary tract surgery). However, clinical practice guidelines recommend cefotaxime only in combination with ampicillin for liver transplantation.

50 mg/kg IV or IM as a single dose (Max: 1 g/dose; 2 g/dose in obese patients) within 60 minutes prior to the surgical incision, in combination with ampicillin. Repeat dose intraoperatively 3 hours after preoperative dose if surgery still in progress. The duration should not exceed 24 hours.

1 g IV or IM every 12 hours for uncomplicated infections; 1 to 2 g IV or IM every 8 hours for moderate to severe infections, and 2 g IV every 6 to 8 hours for severe infections. The maximum dosage is 12 g/day.

1 g IV or IM every 12 hours for uncomplicated infections; 1 to 2 g IV or IM every 8 hours for moderate to severe infections, and 2 g IV every 6 to 8 hours for severe infections. The maximum dosage is 12 g/day.

150 to 180 mg/kg/day IV or IM divided every 8 hours (Max: 8 g/day) is recommended by the American Academy of Pediatrics (AAP). 50 to 180 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 2 g/dose) is the FDA-approved dosage; use higher doses for more severe infections. For initial dosing for UTI in febrile patients 2 months to 2 years, 150 mg/kg/day IV divided every 6 to 8 hours for 7 to 14 days is recommended by AAP.

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours is recommended by the American Academy of Pediatrics (AAP). The FDA-approved dosage is 50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

2 g IV every 6 to 8 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Cefotaxime is recommended for mixed infections plus metronidazole or clindamycin and for Vibrio vulnificus infections plus doxycycline.

50 mg/kg/dose (Max: 2 g/dose) IV divided every 6 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Cefotaxime is recommended for mixed infections plus metronidazole or clindamycin.

50 mg/kg/dose IV every 8 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Cefotaxime is recommended as for mixed infections plus metronidazole or clindamycin.

50 mg/kg/dose IV every 12 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Cefotaxime is recommended for mixed infections plus metronidazole or clindamycin.

50 mg/kg/dose IV every 8 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Cefotaxime is recommended as for mixed infections plus metronidazole or clindamycin.

50 mg/kg/dose IV every 12 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Cefotaxime is recommended for mixed infections plus metronidazole or clindamycin.

1 to 2 g IV every 6 to 8 hours plus an anaerobic agent. In setting of a cat or dog bite, preemptive early antimicrobial therapy for 3 to 5 days is recommended for patients who are immunocompromised, asplenic, have advanced liver disease, have edema of the bite area, have moderate to severe injuries, particularly of the hand or face, or have penetrating injuries to the periosteum or joint capsule.

1 g IV or IM every 8 to 12 hours.

1 g IV or IM every 8 to 12 hours.

150 to 180 mg/kg/day IV or IM divided every 8 hours (Max: 1 g/dose). The FDA-approved dose is 50 to 180 mg/kg/day IV or IM divided every 4 to 6 hours (Max: 2 g/dose).

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

1 to 2 g IV or IM every 8 hours.

1 to 2 g IV or IM every 8 hours.

150 to 180 mg/kg/day IV or IM divided every 8 hours (Max: 2 g/dose). The FDA-approved dose is 50 to 180 mg/kg/day IV or IM divided every 4 to 6 hours (Max: 2 g/dose); use the higher doses for more severe infections.

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

2 g IV every 4 hours.

2 g IV every 4 hours.

150 to 180 mg/kg/day IV divided every 8 hours (Max: 12 g/day). The FDA-approved dose is 50 to 180 mg/kg/day IV divided every 4 to 6 hours (Max: 2 g/dose); use the higher doses for more severe infections.

50 mg/kg/dose IV every 8 hours.

50 mg/kg/dose IV every 12 hours.

50 mg/kg/dose IV every 8 hours.

50 mg/kg/dose IV every 12 hours.

1 to 2 g IV every 8 hours for 7 to 14 days for moderate or severe infections in patients with recent antibiotic exposure or infections with no complicating features or with ischemic limb/necrosis/gas forming plus clindamycin or metronidazole. Continue treatment for up to 28 days if infection is improving but is extensive and resolving slower than expected or if patient has severe peripheral artery disease.

2 g IV every 6 to 8 hours for 4 to 6 weeks.

2 g IV every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 3 to 4 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for severe or complicated infections.

150 to 200 mg/kg/day (Max: 8 g/day) IV divided every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 3 to 4 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for severe or complicated infections.

150 to 200 mg/kg/day IV divided every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 3 to 4 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for severe or complicated infections.

150 to 200 mg/kg/day IV divided every 6 to 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

2 g IV every 6 to 8 hours.  Treat for 1 to 2 weeks or until clinically improved, followed by oral step-down therapy for 2 to 4 weeks.

2 g IV every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 2 to 3 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for septic hip arthritis or severe or complicated infections.

150 to 200 mg/kg/day (Max: 8 g/day) IV divided every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 2 to 3 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for septic hip arthritis or severe or complicated infections.

150 to 200 mg/kg/day IV divided every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 2 to 3 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for septic hip arthritis or severe or complicated infections.

150 to 200 mg/kg/day IV divided every 6 to 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.

2 g IV every 8 hours until clinical improvement, then switch to oral stepdown therapy for a total of 14 to 21 days as an alternative. For acutely ill patients or prior to confirmation of Lyme neuroborreliosis, IV therapy is preferred with appropriate stepdown to oral treatment.

150 to 200 mg/kg/day (Max: 6 g/day) IV divided every 6 to 8 hours until clinical improvement, then switch to oral stepdown therapy for a total of 14 to 21 days as an alternative. For acutely ill patients or prior to confirmation of Lyme neuroborreliosis, IV therapy is preferred with appropriate stepdown to oral treatment.

2 g IV every 8 hours for 14 to 28 days. IV therapy is preferred.

150 to 200 mg/kg/day (Max: 6 g/day) IV divided every 6 to 8 hours for 14 to 28 days. IV therapy is preferred.

Not recommended by guidelines. The FDA-approved dosage is 500 mg IM as a single dose.

Not recommended by guidelines. The FDA-approved dosage is 500 mg IM as a single dose.

1 g IV every 8 hours for 7 days as an alternative. If treating for arthritis-dermatitis syndrome, may switch to an oral agent 24 to 48 hours after clinical improvement for a total of at least 7 days.

1 g IV every 8 hours for 7 days as an alternative. If treating for arthritis-dermatitis syndrome, may switch to an oral agent 24 to 48 hours after clinical improvement for a total of at least 7 days.

25 mg/kg/dose IV or IM every 12 hours for 7 days as an alternative.

Not recommended by guidelines. The FDA-approved dosage is 1 g IM as a single dose.

Not recommended by guidelines. The FDA-approved dosage is 1 g IM as a single dose.

25 mg/kg/dose IV every 12 hours for 10 to 14 days as an alternative.

100 mg/kg/dose IV or IM as a single dose for neonates unable to receive ceftriaxone.

1 g IV every 8 hours for 5 days. Routine use is not recommended.

1 g IV every 8 hours for 5 days. Routine use is not recommended.

1 g IV every 8 hours for 7 to 14 days as an alternative; treat for at least 14 days if concurrent bacteremia in persons with a CD4 count more than 200 cells/mm3. Treat for 2 to 6 weeks in persons with a CD4 count less than 200 cells/mm3. Follow with long-term suppressive therapy if recurrent bacteremia or gastroenteritis with a CD4 count less than 200 cells/mm3 and severe diarrhea.

1 g IV every 8 hours for 7 to 14 days as an alternative; treat for at least 14 days if concurrent bacteremia in persons with a CD4 count more than 200 cells/mm3. Treat for 2 to 6 weeks in persons with a CD4 count less than 200 cells/mm3. Follow with long-term suppressive therapy if recurrent bacteremia or gastroenteritis with a CD4 count less than 200 cells/mm3 and severe diarrhea.

1 g IV every 8 hours for 7 to 14 days; treat for 14 days if concurrent bacteremia.

1 g IV every 6 hours for 7 days as alternative therapy for severe disease.

150 to 180 mg/kg/day (Max: 4 g/day) IV divided every 8 hours for 7 days as alternative therapy for severe disease.

2 g IV every 4 to 6 hours for 5 to 10 days.

100 to 200 mg/kg/day IV divided every 6 hours (Max: 8 g/day) for 10 to 14 days.

1 g IV or IM every 12 hours for uncomplicated infections, 1 to 2 g IV or IM every 8 hours for moderate to severe infections, 2 g IV every 6 to 8 hours for severe infections, and 2 g IV every 4 hours for life-threatening infections. Max: 12 g/day.[29912] For community-acquired empyema, guidelines recommend cefotaxime in combination with metronidazole for at least 2 weeks after drainage and defervescence.[61949]

1 g IV or IM every 12 hours for uncomplicated infections, 1 to 2 g IV or IM every 8 hours for moderate to severe infections, 2 g IV every 6 to 8 hours for severe infections, and 2 g IV every 4 hours for life-threatening infections. Max: 12 g/day.

150 to 180 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 2 g/dose).[29912]

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

1 to 2 g IV every 8 hours for at least 5 days as part of combination therapy for hospitalized patients.

150 to 200 mg/kg/day (Max: 6 g/day) IV divided every 8 hours for 5 to 7 days.      Guidelines recommend empiric therapy with cefotaxime for hospitalized patients who are not fully immunized, in regions where local epidemiology of invasive pneumococcal strains documents high-level penicillin resistance, and for life-threatening infection. Consider combination therapy with a macrolide for suspected atypical pneumonia or with clindamycin or vancomycin for suspected infection due to S. aureus.[46963]

40 to 80 mg/kg/day IV divided every 8 to 12 hours for 10 to 14 days. Usual dose: 2 to 4 g/day.

40 to 80 mg/kg/day (Max: 4 g/day) IV divided every 8 to 12 hours for 10 to 14 days.

0.5 to 1 g intraperitoneally every 24 hours for 21 days.

30 mg/kg/dose (Max: 1 g/dose) intraperitoneally every 24 hours for 14 to 21 days.[53190]

500 mg/L intraperitoneal loading dose, followed by 250 mg/L in each dialysate exchange. Treat for 14 to 21 days.

1 to 2 g IV or IM every 8 hours for moderate to severe infections; 2 g IV every 6 to 8 hours for severe infections, and 2 g IV every 4 hours for life-threatening infections. The maximum dosage is 12 g/day.

1 to 2 g IV or IM every 8 hours for moderate to severe infections; 2 g IV every 6 to 8 hours for severe infections, and 2 g IV every 4 hours for life-threatening infections. The maximum dosage is 12 g/day.

50 to 180 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 2 g/dose).

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

50 mg/kg/dose IV or IM every 8 hours.

50 mg/kg/dose IV or IM every 12 hours.

1 to 2 g IV every 6 to 8 hours as part of combination therapy for 3 to 7 days. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess.

1 to 2 g IV every 6 to 8 hours as part of combination therapy for 3 to 7 days. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess.

150 to 200 mg/kg/day IV divided every 6 to 8 hours (Max: 2 g/dose) as part of combination therapy for 3 to 7 days. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess.

50 mg/kg/dose IV every 8 hours as part of combination therapy for 7 to 10 days. Cefotaxime is an option for necrotizing enterocolitis.

50 mg/kg/dose IV every 12 hours as part of combination therapy for 7 to 10 days. Cefotaxime is an option for necrotizing enterocolitis.

50 mg/kg/dose IV every 8 hours as part of combination therapy for 7 to 10 days. Cefotaxime is an option for necrotizing enterocolitis.

50 mg/kg/dose IV every 12 hours as part of combination therapy for 7 to 10 days. Cefotaxime is an option for necrotizing enterocolitis.

1 to 2 g IV every 6 to 8 hours as part of combination therapy. Antibiotics should be discontinued within 24 hours. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.

1 to 2 g IV every 6 to 8 hours as part of combination therapy. Antibiotics should be discontinued within 24 hours. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.

150 to 200 mg/kg/day IV divided every 6 to 8 hours (Max: 2 g/dose) as part of combination therapy. Antibiotics should be discontinued within 24 hours. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.

2 g IV every 8 hours for at least 5 to 7 days.

1 to 2 g IV or IM every 8 hours for moderate to severe infections and 2 g IV every 6 to 8 hours for severe infections. Cefotaxime in combination with doxycycline may be effective for inpatient, intravenous treatment of PID; however, there is decreased anaerobic activity and the addition of metronidazole should be considered. Cefotaxime should be continued for at least 24 to 48 hours after clinical improvement, and then stepdown to oral doxycycline and metronidazole for a total of 14 days of therapy. Additionally, for outpatient PID therapy, cefotaxime may be administered IM with oral doxycycline and metronidazole for 14 days.

1 to 2 g IV or IM every 8 hours for moderate to severe infections and 2 g IV every 6 to 8 hours for severe infections. Cefotaxime in combination with doxycycline may be effective for inpatient, intravenous treatment of PID; however, there is decreased anaerobic activity and the addition of metronidazole should be considered. Cefotaxime should be continued for at least 24 to 48 hours after clinical improvement, and then stepdown to oral doxycycline and metronidazole for a total of 14 days of therapy. Additionally, for outpatient PID therapy, cefotaxime may be administered IM with oral doxycycline and metronidazole for 14 days.

2 g IV every 6 to 8 hours for septicemia and 2 g IV every 4 hours for life-threatening infections are recommended in the FDA-approved labeling. Guidelines recommend cefotaxime as an alternate therapy for 4 weeks for native valve endocarditis (NVE) and for 6 weeks for prosthetic valve endocarditis (PVE) caused by HACEK microorganisms. In patients with penicillin-resistant streptococcal endocarditis with or without meningitis, high-dose cefotaxime is a reasonable option; if the isolate is cefotaxime-resistant, consider adding vancomycin and rifampin. Treat for 6 weeks for streptococcal PVE.

200 mg/kg/day IV divided every 6 hours (Max: 12 g/day). Guidelines recommend cefotaxime as a preferred therapy for 4 weeks for endocarditis caused by HACEK group organisms or for at least 6 weeks in combination with an aminoglycoside for other gram-negative microorganisms.

150 to 180 mg/kg/day IV divided every 8 hours is the general dosage recommended by the American Academy of Pediatrics (AAP).

50 mg/kg/dose IV every 8 hours is the general dosage recommended by the American Academy of Pediatrics (AAP).

50 mg/kg/dose IV every 12 hours is the general dosage recommended by the American Academy of Pediatrics (AAP).

50 mg/kg/dose IV every 8 hours is the general dosage recommended by the American Academy of Pediatrics (AAP).

50 mg/kg/dose IV every 12 hours is the general dosage recommended by the American Academy of Pediatrics (AAP).

100 mg/kg/dose IV or IM as a single dose for neonates unable to receive ceftriaxone and are at high risk for exposure (i.e., infants born to mothers at risk for gonococcal infection or with no prenatal care).

2 g IV every 8 hours in combination with doxycycline for 7 to 14 days.

50 to 60 mg/kg/dose (Max: 2 g/dose) IV every 8 hours in combination with doxycycline for 7 to 14 days.

†Indicates off-label use

Cefotaxime is metabolized by the liver to an active metabolite, desacetylcefotaxime. Dosage adjustments in patients with hepatic impairment without concomitant renal insufficiency are usually not necessary since cefotaxime has a high therapeutic index. However, specific guidelines for dosage adjustment in patients with hepatic impairment are not available.

Adults
CrCl more than 20 mL/min: no dosage adjustment needed.
CrCl 20 mL/min or less: reduce recommended dose by 50%.
 
Pediatric patients
The following dose adjustments are based on a usual recommended dose in children of 100 to 200 mg/kg/day IV/IM divided every 8 hours.
CrCl more than 50 mL/min/1.73 m2: no dosage adjustment needed.
CrCl 30 to 50 mL/min/1.73 m2: 35 to 70 mg/kg/dose IV/IM every 8 to 12 hours.
CrCl 10 to 29 mL/min/1.73 m2: 35 to 70 mg/kg/dose IV/IM every 12 hours.
CrCl less than 10 mL/min/1.73 m2: 35 to 70 mg/kg/dose IV/IM every 24 hours.
 
Intermittent hemodialysis
Approximately 50% of the serum concentration of cefotaxime is removed during a standard hemodialysis session. Some clinicians recommend that 0.5 to 2 g be given as single daily doses and that a supplemental dose of cefotaxime be given after each hemodialysis session. For pediatric patients, the recommended dose is 35 to 70 mg/kg/dose IV/IM every 24 hours, given after hemodialysis on dialysis days.
 
Peritoneal dialysis
For adult patients, give 1 g IV/IM every 24 hours. For pediatric patients, the recommended dose is 35 to 70 mg/kg/dose IV/IM every 24 hours.
 
Continuous renal replacement therapy (CRRT)
For adult patients, give 1 g IV/IM every 12 hours. For pediatric patients, the recommended dose is 35 to 70 mg/kg/dose IV/IM every 12 hours.

Acetaminophen; Ibuprofen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Amikacin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Aminoglycosides: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Amlodipine; Celecoxib: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Bupivacaine; Meloxicam: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Celecoxib: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Celecoxib; Tramadol: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Chlorpheniramine; Ibuprofen; Pseudoephedrine: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Diclofenac: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Diclofenac; Misoprostol: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Diflunisal: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Diphenhydramine; Ibuprofen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Diphenhydramine; Naproxen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Etodolac: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Fenoprofen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Flurbiprofen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Gentamicin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Hydrocodone; Ibuprofen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Ibuprofen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Ibuprofen; Famotidine: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Ibuprofen; Oxycodone: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Ibuprofen; Pseudoephedrine: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Indomethacin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Ketoprofen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Ketorolac: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Loop diuretics: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Clinicians should be aware that this may occur even in patients with minor or transient renal impairment.
Meclofenamate Sodium: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Mefenamic Acid: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Meloxicam: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Nabumetone: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Naproxen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Naproxen; Esomeprazole: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Naproxen; Pseudoephedrine: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Nonsteroidal antiinflammatory drugs: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Oral Contraceptives: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Oxaprozin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Paromomycin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Piroxicam: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Plazomicin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Probenecid: (Minor) Probenecid competitively inhibits renal tubular secretion of cefotaxime, thereby causing higher, prolonged serum levels of the drug.
Probenecid; Colchicine: (Minor) Probenecid competitively inhibits renal tubular secretion of cefotaxime, thereby causing higher, prolonged serum levels of the drug.
Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Major) Prior or concomitant use of antibiotics with sodium picosulfate; magnesium oxide; anhydrous citric acid may reduce efficacy of the bowel preparation as conversion of sodium picosulfate to its active metabolite bis-(p-hydroxy-phenyl)-pyridyl-2-methane (BHPM) is mediated by colonic bacteria. If possible, avoid coadministration. Certain antibiotics (i.e., tetracyclines and quinolones) may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Therefore, these antibiotics should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution.
Streptomycin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Sulindac: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Sumatriptan; Naproxen: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Tobramycin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Tolmetin: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Valdecoxib: (Minor) Cefotaxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides, nonsteroidal antiinflammatory drugs (NSAIDs), and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Warfarin: (Moderate) The concomitant use of warfarin with many classes of antibiotics, including cephalosporins, may increase the INR thereby potentiating the risk for bleeding. Inhibition of vitamin K synthesis due to alterations in the intestinal flora may be a mechanism; however, concurrent infection is also a potential risk factor for elevated INR. Additionally, certain cephalosporins (cefotetan, cefoperazone, cefamandole) are associated with prolongation of the prothrombin time due to the methylthiotetrazole (MTT) side chain at the R2 position, which disturbs the synthesis of vitamin K-dependent clotting factors in the liver. Monitor patients for signs and symptoms of bleeding. Additionally, increased monitoring of the INR, especially during initiation and upon discontinuation of the antibiotic, may be necessary.

Cefotaxime/Cefotaxime Sodium/Claforan Intramuscular Inj Pwd F/Sol: 1g, 2g, 10g, 500mg
Cefotaxime/Cefotaxime Sodium/Claforan Intravenous Inj Pwd F/Sol: 1g, 2g, 10g, 500mg

12 g/day IV/IM.

12 g/day IV/IM.

12 g/day IV/IM.

Weighing 50 kg or more: 12 g/day IV/IM.
Weighing less than 50 kg: 180 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 300 mg/kg/day (Max: 12 g/day) have been used off-label for meningitis.

180 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 300 mg/kg/day have been used off-label for meningitis.

8 days and older: 150 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 200 mg/kg/day have been used off-label for meningitis.
0 to 7 days: 100 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 150 mg/kg/day have been used off-label for meningitis.

Cefotaxime, like other beta-lactam antibiotics, is mainly bactericidal. It inhibits the third and final stage of bacterial cell wall synthesis by preferentially binding to specific penicillin-binding proteins (PBPs) that are located inside the bacterial cell wall. PBPs are responsible for several steps in the synthesis of the cell wall and are found in quantities of several hundred to several thousand molecules per bacterial cell. PBPs vary among different bacterial species. Thus, the intrinsic activity of cefotaxime as well as other cephalosporins and penicillins against a particular organism depends on its ability to gain access to and bind with the necessary PBP. Like all beta-lactam antibiotics, cefotaxime's ability to interfere with PBP-mediated cell wall synthesis ultimately leads to cell lysis. Lysis is mediated by bacterial cell wall autolytic enzymes (i.e., autolysins). The relationship between PBPs and autolysins is unclear, but it is possible that the beta-lactam antibiotic interferes with an autolysin inhibitor. Resistance to beta-lactam antibiotics can develop if there are changes in the PBPs, if cell wall permeability decreases, or if certain beta-lactamases are present. Cefotaxime retains activity against some beta-lactamase-producing isolates, including penicillinase and cephalosporinase; however, most extended spectrum beta-lactamase (ESBL)-producing and carbapenemase-producing isolates are resistant to the drug.

Cefotaxime is administered intravenously and intramuscularly. It is not absorbed from the GI tract. Approximately 13 to 38% of the circulating drug is protein-bound. It is distributed into most body tissues and fluids including gallbladder; liver; kidney; bone; uterus; ovary; sputum; bile; and peritoneal, pleural, and synovial fluids. It penetrates inflamed meninges and reaches therapeutic levels within the CSF. It crosses the placenta. Cefotaxime is metabolized primarily by the liver to desacetylcefotaxime, an active metabolite that displays 10% of the parent drug's antibacterial activity. Cefotaxime and its metabolites are excreted into the urine primarily via tubular secretion. A small percentage is excreted in breast milk. In patients with normal renal function, the elimination half-lives of cefotaxime and desacetylcefotaxime are 1 to 1.5 hours and 1.5 to 2 hours, respectively.

Peak serum levels of cefotaxime occur within 30 minutes following an IM dose.

Cefotaxime is classified as FDA pregnancy risk category B. Cefotaxime crosses the placenta. Animal data reveal no teratogenic or fetotoxic effects; however, a slight decrease in fetal and neonatal weight was observed. 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. Cefotaxime has not been studied for use during labor and delivery. Treatment should be given only if clearly needed.

Cefotaxime is excreted in breast milk in small quantities. The manufacturer recommends that it should be used with caution during breast-feeding, considering the benefit to the mother. Rare potential complications in the nursing infant include alterations of gut flora that might result in diarrhea or other related complications (e.g., dehydration). Cefotaxime is generally considered compatible for use for breast-feeding women by the American Academy of Pediatrics. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.