Cefotaxime
CLAFORAN
What it isThird-generation PBP-inhibiting cephalosporin; meningitis, pneumonia, and sepsis.
Why this oneUnlike ceftriaxone it does not chelate calcium, so it is the third-generation agent for neonates.
What limits itFrequent dosing and renal adjustment. No pseudomonal cover; supply has been intermittent.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Gonococcal urethritis/cervicitis; rectal gonorrhea (female) | Adults | 0.5 g IM single dose | 0.5 g IM single dose | |
| Rectal gonorrhea (male) | Adults | 1 g IM single dose | 1 g IM single dose | |
| Uncomplicated infections | Adults | 1 g q12h IM or IV | 1 g q12h | 12 g/day |
| Moderate–severe infections | Adults | 1–2 g q8h IM or IV | 1–2 g q8h | 12 g/day |
| Higher-dose infections (e.g. septicemia) | Adults | 2 g q6–8h IV | 2 g q6–8h | 12 g/day |
| Life-threatening infections | Adults | 2 g q4h IV | 2 g q4h | 12 g/day |
| Perioperative prophylaxis | Adults | 1 g IM/IV 30–90 min pre-op | 1 g single dose | |
| General infections | Neonates 0–1 wk | 50 mg/kg/dose q12h IV | 50 mg/kg/dose q12h | |
| General infections | Neonates 1–4 wk | 50 mg/kg/dose q8h IV | 50 mg/kg/dose q8h | |
| General infections (<50 kg) | Infants/children 1 mo–12 y | 50–180 mg/kg/day IM/IV divided into 4–6 doses | 50–180 mg/kg/day divided 4–6× | 12 g/day |
Renal Dose reduction required in renal impairment (per full prescribing PRECAUTIONS; specifics not detailed in this label section)
Hepatic Undefined
Instructions
- IM or IV after reconstitution; IM doses of 2 g divided across different sites
- Do not admix with aminoglycoside solutions — administer separately
- GABHS infection: treat ≥10 days; max 12 g/day
Cautions
- Hypersensitivity/anaphylaxis; cross-reactivity in penicillin-allergic patients
- Pseudomembranous colitis
- Life-threatening arrhythmias with rapid (<60 sec) bolus via central catheter
- Encephalopathy with high doses in renal insufficiency; seizures reported
- Positive Coombs; granulocytopenia/neutropenia
Adverse reactions
- Local injection-site reactions (pain, induration, phlebitis)
- Rash, pruritus, fever, eosinophilia
- Colitis, diarrhea, nausea, vomiting
- Transient AST/ALT/LDH/ALP and BUN elevations; neutropenia/leukopenia
Pregnancy No animal embryotoxicity/teratogenicity; crosses placenta; use only if clearly needed
Lactation Undefined
NO BOXED WARNINGS
Principal riskFrequent dosing and renal adjustment
Classes and tags
Clinical profile
Mechanism of action: Cefotaxime ballicule
