Name /bks_53161_deglins_md_disk/cefotaxime 02/11/2014 09:33AM Plate # 0-Composite pg 1 # 1

1 TIME/ACTION PROFILE (blood levels)

ROUTE ONSET PEAK DURATION PDF Page #1
cefotaxime (sef-oh-taks-eem) IM rapid 0.5 hr 4–12 hr
Claforan IV rapid end of infusion 4–12 hr
Classification
Therapeutic: anti-infectives Contraindications/Precautions
Pharmacologic: third-generation cephalosporins Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity
Pregnancy Category B to penicillins.
Use Cautiously in: Renal impairment (pdose recommended if CCr ⬍20 mL/
min); History of GI disease, especially colitis; Geri: Dosage adjustment may be nec-
Indications
Treatment of the following infections caused by susceptible organisms: Skin and skin essary due to age-relatedpin renal function.
structure infections, Bone and joint infections, Urinary tract infections, Gynecological Adverse Reactions/Side Effects
infections including gonorrhea, Lower respiratory tract infections, Intra-abdominal CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,
infections, Septicemia, Meningitis, Lyme disease. Perioperative prophylaxis. vomiting. Derm: rashes, pruritis, urticaria. Hemat: agranulocytosis, bleeding, eo-
Action sinophilia, hemolytic anemia, neutropenia, thrombocytopenia. Local: pain at IM
Binds to the bacterial cell wall membrane, causing cell death. Therapeutic Ef- site, phlebitis at IV site. Misc: allergic reactions including ANAPHYLAXIS, superinfec-
fects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of tion.
second-generation cephalosporins, but activity against staphylococci is less, whereas Interactions
activity against gram-negative pathogens is greater, even for organisms resistant to Drug-Drug: Probenecidpexcretion and increases serum levels. Concurrent use
first- and second-generation agents. Notable is increased action against: Acinetobac- of aminoglycosides mayqrisk of nephrotoxicity.
ter, Citrobacter, Enterobacter, Haemophilus influenzae(including ␤-lactamase-
producing strains), Haemophilus parainfluenzae, Escherichia coli, Klebsiella Route/Dosage
pneumoniae, Morganella morganii, Neisseria gonorrhoeae and meningitidis, IM, IV (Adults and Children ⬎12 yr): Most uncomplicated infections— 1 g q
Proteus, Providencia, Serratia, Moraxella catarrhalis, Borrelia burgdorferi. Has 12 hr. Moderate or severe infections— 1– 2 g q 6– 8 hr. Life-threatening infec-
some activity against anaerobes, includingBacteroides fragilis. Not active against tions— 2 g q 4 hr (maximum dose: 12 g/day). Gonococcal urethritis/cervicitis or
methicillin-resistant staphylococci. rectal gonorrhea in females— 500 mg IM (single dose). Rectal gonorrhea in
Pharmacokinetics males— 1 g IM (single dose). Perioperative prophylaxis— 1 g 30– 90 min before
Absorption: Well absorbed following IM administration; IV administration results initial incision (one-time dose).
in complete bioavailability. IM, IV (Children 1 mo-12 yr): ⬍ 50 kg — 100– 200 mg/kg/day divided q 6– 8 hr.
Distribution: Widely distributed. Crosses the placenta; enters breast milk in low Meningitis— 200 mg/kg/day divided q 6 hr. Invasive pneumococcal meningitis–
concentrations. CSF penetration better than with first- and second-generation agents. 225– 300 mg/kg/day divided q 6– 8 hr. ⱖ 50 kg— see adult dosing.
Metabolism and Excretion: Partly metabolized to active metabolite; 20– 36% IV (Neonates 1– 4 wk): 50 mg/kg q 6– 8 hr.
excreted unchanged in the urine. IV (Neonates ⱕ1 wk): 50 mg/kg q 8– 12 hr.
Half-life: Premature neonates: 5– 6 hr; Full– term neonates: 2– 3.4 hr; Children: Renal Impairment
1.5 hr; Adults: 1– 1.5 hr (qin renal impairment). IM, IV (Adults): CCr ⬍20 mL/min—pdose by 50%.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
Name /bks_53161_deglins_md_disk/cefotaxime 02/11/2014 09:33AM
2 IV Administration
NURSING IMPLICATIONS
Assessment
● Assess patient for infection (vital signs; appearance of wound, sputum, urine, and
stool; WBC) at beginning of and throughout therapy.
● Before initiating therapy, obtain a history to determine previous use of and reac-
tions to penicillins or cephalosporins. Persons with a negative history of penicillin
sensitivity may still have an allergic response.
● Obtain specimens for culture and sensitivity before initiating therapy. First dose
may be given before receiving results.
● Observe patient for signs and symptoms of anaphylaxis (rash, pruritus,
laryngeal edema, wheezing). Discontinue the drug and notify health
care professional immediately if these symptoms occur. Keep epineph-
rine, an antihistamine, and resuscitation equipment close by in the event
of an anaphylactic reaction.
● Monitor bowel function. Diarrhea, abdominal cramping, fever, and
bloody stools should be reported to health care professional promptly
as a sign of pseudomembranous colitis. May begin up to several weeks
following cessation of therapy.
● Lab Test Considerations: May cause positive results for Coombs’ test.
● May causeqserum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and cre-
atinine.
● May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia,
and eosinophilia.
Potential Nursing Diagnoses
Risk for infection (Indications) (Side Effects)
Diarrhea (Adverse Reactions)
Implementation
● IM: Reconstitute IM doses with sterile or bacteriostatic water for injection.
● Inject deep into a well-developed muscle mass; massage well.
● IV: Monitor injection site frequently for phlebitis (pain, redness, swelling).
Change sites every 48– 72 hr to prevent phlebitis.
● If aminoglycosides are administered concurrently, administer in separate sites, if
possible, at least 1 hr apart. If second site is unavailable, flush lines between medi-
cations.
Plate # 0-Composite pg 2 # 2
● pH: 4.7– 7.5.
● Direct IV: Reconstitute with at least 10 mL of sterile water for injection. Do not PDF Page #2
use preparations containing benzyl alcohol for neonates. Rate: Administer slowly
over 3– 5 min at a concentration of 100 mg/mL (maximum 150 mg/mL in fluid-
restricted patients).
● Intermittent Infusion: Diluent: Reconstituted solution may be further diluted
in D5W, D10W, lactated Ringer’s solution, D5/0.25% NaCl, D5/0.45% NaCl, D5/
0.9% NaCl, or 0.9% NaCl. Concentration: 20– 60 mg/mL. Solution may appear
light yellow to amber. Solution is stable for 24 hr at room temperature and 5 days
if refrigerated. Rate: Administer over 20– 30 min.
● Syringe Compatibility: heparin.
● Y-Site Compatibility: acyclovir, alfentanil, alprostadin, amifostine, aminophyl-
line, aminocaproic acid, amphotericin B lipid complex, anidulafungin, argatro-
ban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin,
bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium
gluconate, carboplatin, carmustine, cefoperazone, cefotetan, cefoxitin, ceftriax-
one, cefuroxime, cisplain, clindamycin, cyanocobalamin, cyclophosphamide, cy-
closporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmede-
tomidine, digoxin, diltiazem, docetaxel, dopamine, doxacurium, doxycyline,
enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, eryth-
romycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fen-
tanyl, fludarabine, fluorouracil, folic acid, furosemide, glycopyrrolate, granise-
tron, heparin, hetastarch, hydrocortisone, hydromorphone, ifosfamide,
imipenem/cilastatin, insulin, isoproterenol, ketamine, ketorolac, lidocaine, line-
zolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan,
meperidine, metaraminol, methotrexate, methoxamine, methyldopate, metoclo-
pramide, metoprolol, metronidazole, midazolam, milrinone, morphine, multivi-
tamins, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside,
norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, pacli-
taxel, palonosetron, pamidronate, pancuronium, penicillin G, perphenazine,
phenylephrine, phytonadione, potassium acetate, potassium chloride, procain-
amide, propofol, propranolol, pyridoxime, ranitidine, remifentanil, rituximab,
rocuronium, sargramostim, sodium acetate, streptokinase, succinylcholine, su-
fentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/cla-
vulanate, tigecycline, tirofiban, tolazoline, trimetaphan, vasopressin, verapamil,
vinorelbine, voriconazole, zoledronic acid.
䉷 2015 F.A. Davis Company CONTINUED
Name /bks_53161_deglins_md_disk/cefotaxime 02/11/2014 09:33AM Plate # 0-Composite pg 3 # 3

3
PDF Page #3
CONTINUED
cefotaxime
● Y-Site Incompatibility: alemtuzumab, allopurinol, amphotericin B liposome,
ampicillin/sulbactam, azathioprine, azithromycin, caspofungin, cefazolin, cefta-
zidime, chloramphenicol, chlorpromazine, dantrolene, diazepam, diazoxide, di-
phenhydramine, doxorubicin hydrochloride, filgrastim, ganciclovir, gemcitabine,
haloperidol, hydralazine, hydroxyzine, idarubicin, irinotecan, labetalol, methyl-
prednisolone, mitoxantrone, mycophenolate, pantoprazole, papaverine, peme-
trexed, pentamidine, pentazocine, pentobarbital, phenobarbital, phenytoin, pro-
chlorperazine, promethazine, protamine, quinupristin/dalfopristin, sodium
bicarbonate, trastuzumab, trimethoprim/sulfamethoxazole, vecuronium.
Patient/Family Teaching
● Advise patient to report signs of superinfection (furry overgrowth on the tongue,
vaginal itching or discharge, loose or foul-smelling stools) and allergy.
● Instruct patient to notify health care professional if fever and diarrhea
develop, especially if stool contains blood, pus, or mucus. Advise patient
not to treat diarrhea without consulting health care professional.
Evaluation/Desired Outcomes
● Resolution of the signs and symptoms of infection. Length of time for complete res-
olution depends on the organism and site of infection.
● Decreased incidence of infection when used for prophylaxis.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.