Cefoxitin
MEFOXIN
What it isPBP-inhibiting cephamycin with anaerobic activity; abdominal and pelvic infection, and colorectal prophylaxis.
Why this oneIt covers anaerobes, which the true second-generation cephalosporins do not.
What limits itIt induces AmpC beta-lactamases, so resistance emerges on therapy. Short half-life; frequent dosing.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| General treatment (usual range) | Adults | 1–2 g q6–8h IV | 1–2 g q6–8h | 12 g/day |
| Uncomplicated infections | Adults | 1 g q6–8h IV | 1 g q6–8h | 12 g/day |
| Moderately severe/severe infections | Adults | 1 g q4h or 2 g q6–8h IV | 1 g q4h or 2 g q6–8h | 12 g/day |
| Higher-dose infections (e.g. gas gangrene) | Adults | 2 g q4h or 3 g q6h IV | 2 g q4h or 3 g q6h | 12 g/day |
| Perioperative prophylaxis | Adults | 2 g IV pre-op, then 2 g q6h ×≤24 h | ||
| General treatment | Children ≥3 mo | 80–160 mg/kg/day divided into 4–6 doses | 80–160 mg/kg/day divided 4–6× | 12 g/day |
| Perioperative prophylaxis | Children ≥3 mo | 30–40 mg/kg/dose at designated times | 30–40 mg/kg/dose |
Renal After 1–2 g loading dose: 1–2 g q8–12h (CrCl 30–50), 1–2 g q12–24h (10–29), 0.5–1 g q12–24h (5–9), 0.5–1 g q24–48h (<5). Hemodialysis: loading dose after each session
Hepatic Undefined
Instructions
- IV administration after reconstitution
- Do not add to aminoglycoside solutions — administer separately
- GABHS infection: treat ≥10 days; max 12 g/day
Cautions
- Hypersensitivity/anaphylaxis; cross-reactivity in penicillin-allergic patients
- Pseudomembranous colitis
- Possible exacerbation of myasthenia gravis
- Seizures reported with cephalosporins in renal impairment
- Positive Coombs (especially with azotemia)
Adverse reactions
- Local: thrombophlebitis
- Allergic: rash, urticaria, pruritus, eosinophilia, fever, anaphylaxis
- Diarrhea/pseudomembranous colitis, nausea, vomiting
- Blood: eosinophilia, leukopenia/neutropenia, anemia, thrombocytopenia
- Transient AST/ALT/LDH/ALP elevations; increased creatinine/BUN
Pregnancy No teratogenic/fetal-toxic effects in rats/mice (slight fetal weight decrease); rabbit abortion/maternal death; use only if clearly needed
Lactation Undefined
NO BOXED WARNINGS
Principal riskIt induces AmpC beta-lactamases, so resistance emerges on therapy
Cost, est. cash$20–$1,500/dose or month
Generic entry1987
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityAllergy, gastrointestinal effects and agent-specific renal, hepatic, hematologic or interaction risks.
Mechanism of action: Cefoxitin ballicule
