Cefotetan

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

• 2 g IV q12h with doxycycline

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

• Adolescents
  • 2g IV q12h with doxycycline

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

• Hypersensitivity reaction
• Anaphylaxis
• Stevens-Johnson Syndrome, toxic epidermal necrolysis
• Erythema multiforme
• Hemolytic anemia, Aplastic anemia
• Agranulocytosis, Pancytopenia, Neutropenia, Thrombocytopenia
• Superinfection
• C. diff associated diarrhea
• Seizures
• Hepatic impairment, nephrotoxicity

Common

• Diarrhea, Nausea
• Pruritus, Rash, Phlebitis, Urticaria
• Increased LFTs

Pharmacology

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

Antibiotic Sensitivities

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

• Antibiotics (Main)