Cefotetan

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General

  • Type: Second generation cephalosporin
  • Dosage Forms: injectable solution, powder for injection
  • Dosage Strengths: injectable solution: 20mg/mL, 40mg/mL; powder for injection: 1g, 2g, 10g
  • Routes of Administration: IV, IM
  • Common Trade Names: Cefotan

Adult Dosing

Infection

  • Mild to Moderate, Bacterial
    • 1-2 g IM/IV q12h
      • Max: 4 g/day
  • Severe to Life Threatening, Bacterial
    • 2-3 g IV q 12h
      • Max: 6 g/day

UTI, uncomplicated

  • 500 mg IM/IV q12h

PID, severe

Prophylaxis

  • Surgical:
    • 2 g IV x1
  • Postcesarean:
    • 2 g IV x1

Pediatric Dosing

Infection, bacterial

  • 40-80 mg/kg/day IM/IV divided q12h
    • Max: 4 g/day or 6 g/day in life-threatening infection

PID, severe

Prophylaxis

  • Surgical, >1yo
    • 40 mg/kg IV x1

Special Populations

  • Pregnancy: B
  • Lactation: May use while breastfeeding
  • Renal Dosing
    • Adult
      • CrCl 10-30: Give q 24h
      • CrCl <10: Give q 48h
      • HD: Decrease usual dose 50% on dialysis days and 75% non-dialysis days
      • PD: 1 g q24h
    • Pediatric
      • CrCl 10-30: Give q 24h
      • CrCl <10: Give q 48h
      • HD: Decrease usual dose 50% on dialysis days and 75% non-dialysis days
      • PD: No supplement
  • Hepatic Dosing
    • Adult
      • Not defined
    • Pediatric
      • Not defined

Contraindications

  • Allergy to class/drug
  • Hemolytic anemia, cephalosporin-associated
  • Caution:
    • Hypersensitivity to penicillin
    • Elderly
    • Concurrent nephrotoxic agent
    • Renal impairment
    • Hepatic impairment
    • Seizure disorder
    • Malignancy
    • Malnutrition
    • GI disorder hx
    • Recent abx-associated C. diff colitis


Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 3-4.6h (10h w/ moderate renal impairment)
  • Metabolism: Minimal
  • Excretion: Urine primarily (51-81% unchanged)
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium X1
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae I
N. meningitidis I
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 S
Serratia marcescens X1
Salmonella sp X1
Shigella sp X1
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. S
Morganella sp. S
Citrobacter freundii R
Citrobacter diversus I
Citrobacter sp. I
Aeromonas sp S
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica I
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 X1
Anaerobes Actinomyces X1
Bacteroides fragilis I
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum X1
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014