View source for Cephamycin

==General==
*Type: [[Is Generation::2nd generation]] [[Is DrugClass::Cephalosporin]]
*Dosage Forms: powder for injection
*Dosage Strengths: 1g, 2g, 10g
*Routes of Administration: IV, IM
*Common Trade Names: Mefoxin (Cefoxitin), Cefotan (Cefotetan)

==Adult Dosing==
===General===
*Cefoxitin: 1-2g IM/IV q6-8h
*Cefotetan: 1-2g IM/IV q12h
*Max: 12g/day (Cefoxitin); 6g/day (Cefotetan)

===Pelvic Inflammatory Disease ([[PID]])===
*Cefoxitin: 2g IV q6h (plus [[Doxycycline]] 100mg PO/IV q12h)
*Cefotetan: 2g IV q12h (plus [[Doxycycline]] 100mg PO/IV q12h)

===Surgical Prophylaxis (Colorectal/Appendectomy)===
*Cefoxitin: 2g IV x1 (30-60 min before procedure)
*Cefotetan: 2g IV x1 (30-60 min before procedure)

===[[Gonorrhea]] Uncomplicated (Alternative)===
*Cefoxitin: 2g IM x 1 (plus [[Probenecid]] 1g PO x 1)

==Pediatric Dosing==
===General (>3 Months)===
*Cefoxitin:
**80-160 mg/kg/day IM/IV divided q4-6h
**Max 12g/day
*Cefotetan:
**40-60 mg/kg/day IM/IV divided q12h
**Max 6g/day

===Appendicitis (Complicated)===
*Cefoxitin: 160 mg/kg/day IV divided q6h
*Cefotetan: 40 mg/kg/day IV divided q12h

==Special Populations==
*Pregnancy: B
*Lactation: Safe
*Renal
**Adult (Cefoxitin)
***CrCl 30-50: 1-2g q8-12h
***CrCl 10-29: 1-2g q12-24h
***CrCl <10: 0.5-1g q24h
***Hemodialysis: Loading dose 1-2g x1, maintenance 1-2g post-dialysis
**Adult (Cefotetan)
***CrCl 10-30: Give usual dose q24h
***CrCl <10: Give usual dose q48h
***Hemodialysis: Give 500mg supplement (or 1/4 dose) post-dialysis
**Pediatric
***Adjust frequency based on GFR similar to adult adjustments
*Hepatic
**Not defined

==Contraindications==
*Allergy to class/drug
*History of serious hypersensitivity to penicillin

==Adverse Reactions==
===Serious===
*[[Anaphylaxis]]
*[[Stevens-Johnson Syndrome]]
*[[Clostridium difficile]]
*Hemolytic Anemia
*Hypoprothrombinemia (with bleeding) - ''Associated with N-MTT side chain (Cefotetan)''
*Disulfiram-like reaction (with alcohol) - ''Associated with N-MTT side chain (Cefotetan)''

===Common===
*[[Diarrhea]]
*[[Rash]]
*[[Nausea and Vomiting]]
*Injection site reaction (Thrombophlebitis)
*Eosinophilia
*Transaminitis

==Pharmacology==
*Half-life: 0.7-1h (Cefoxitin); 3-4.6h (Cefotetan)
*Metabolism: Not significantly metabolized (Cefoxitin); No metabolism (Cefotetan)
*Excretion: Urine
*Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
*Class Distinction: Possesses 7-alpha-methoxy group which confers high stability against beta-lactamases (especially those produced by Bacteroides fragilis).

==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''Sensitivity'''
|-
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S'''
|-
| ||[[Strep. Pneumoniae]]||'''S'''
|-
| ||[[Viridans strep]]||'''S'''
|-
| ||Strep. anginosus gp||'''S'''
|-
| ||[[Enterococcus faecalis]]||R
|-
| ||[[Enterococcus faecium]]||R
|-
| ||[[MSSA]]||'''S'''
|-
| ||[[MRSA]]||R
|-
| ||[[CA-MRSA]]||R
|-
| ||[[Staph. Epidermidis]]||I
|-
| ||[[C. jeikeium]]||R
|-
| ||[[L. monocytogenes]]||R
|-
| Gram Negatives||[[N. gonorrhoeae]]||'''S'''
|-
| ||[[N. meningitidis]]||'''S'''
|-
| ||[[Moraxella catarrhalis]]||'''S'''
|-
| ||[[H. influenzae]]||'''S'''
|-
| ||[[E. coli]]||'''S'''
|-
| ||[[Klebsiella]] sp||'''S'''
|-
| ||E. coli/Klebsiella ESBL+||R
|-
| ||E coli/Klebsiella KPC+||R
|-
| ||[[Enterobacter]] sp, AmpC neg||I
|-
| ||[[Enterobacter]] sp, AmpC pos||R
|-
| ||[[Serratia]] sp||R
|-
| ||Serratia marcescens||R
|-
| ||[[Salmonella]] sp||'''S'''
|-
| ||[[Shigella]] sp||'''S'''
|-
| ||[[Proteus mirabilis]]||'''S'''
|-
| ||[[Proteus vulgaris]]||'''S'''
|-
| ||[[Providencia sp.]]||'''S'''
|-
| ||[[Morganella sp.]]||I
|-
| ||[[Citrobacter freundii]]||R
|-
| ||[[Citrobacter diversus]]||'''S'''
|-
| ||[[Citrobacter sp.]]||I
|-
| ||[[Aeromonas sp]]||I
|-
| ||[[Acinetobacter sp.]]||R
|-
| ||[[Pseudomonas aeruginosa]]||R
|-
| ||[[Burkholderia cepacia]]||R
|-
| ||[[Stenotrophomonas maltophilia]]||R
|-
| ||[[Yersinia enterocolitica]]||'''S'''
|-
| ||[[Francisella tularensis]]||X1
|-
| ||[[Brucella sp.]]||X1
|-
| ||[[Legionella sp.]]||R
|-
| ||[[Pasteurella multocida]]||'''S'''
|-
| ||[[Haemophilus ducreyi]]||X1
|-
| ||[[Vibrio vulnificus]]||X1
|-
| Misc||[[Chlamydophila sp]]||X1
|-
| ||[[Mycoplasm pneumoniae]]||X1
|-
| ||[[Rickettsia sp]]||X1
|-
| ||[[Mycobacterium avium]]||R
|-
| Anaerobes||[[Actinomyces]]||'''S'''
|-
| ||[[Bacteroides fragilis]]||'''S'''
|-
| ||[[Prevotella melaninogenica]]||'''S'''
|-
| ||[[Clostridium difficile]]||X1
|-
| ||[[Clostridium (not difficile)]]||'''S'''
|-
| ||[[Fusobacterium necrophorum]]||'''S'''
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
|}

===Key===
{{Template:Antibacterial Spectra Key}}

==See Also==
*[[Antibiotics (Main)]]
*[[Cephalosporins]]

==References==
<references/>

[[Category:Pharmacology]] [[Category:ID]]