cefotaxime
Brand: Claforan
Prototype: ceftriaxone
Drug Class: third-generation cephalosporin
Drug Family: antibiotic
Subclass: parenteral third-generation cephalosporin
Organ Systems: infectious-disease
Mechanism of Action
Inhibits bacterial cell wall synthesis; broad gram-negative coverage including Enterobacteriaceae; good CNS penetration makes it suitable for bacterial meningitis treatment.
penicillin-binding proteins (PBPs)
Indications
- bacterial meningitis
- community-acquired pneumonia
- intra-abdominal infections
- septicemia
- gonorrhea
- neonatal infections
Contraindications
- cephalosporin hypersensitivity
Adverse Effects
Common
- injection site reactions
- diarrhea
- elevated LFTs
Serious
- anaphylaxis
- C. difficile colitis
- superinfection with resistant organisms
Pharmacokinetics (ADME)
| Absorption | IV/IM only |
| Distribution | widely distributed; good CSF penetration when meninges are inflamed |
| Metabolism | hepatic; active metabolite desacetylcefotaxime |
| Excretion | renal (60% unchanged, 25% as active metabolite) |
| Half-life | 1–1.5 hours (parent); 1.5–2 hours (metabolite) |
| Onset | immediate (IV) |
| Peak | 30 min (IM) |
| Duration | 6–8 hours |
| Protein Binding | 35–45% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| probenecid | reduces renal elimination of cefotaxime | minor |
| aminoglycosides | synergistic bactericidal activity against gram-negatives; additive nephrotoxicity risk | moderate |
Nursing Considerations
- Administer IV over 15–30 minutes or IM into large muscle mass; rotate injection sites.
- For bacterial meningitis, ensure doses are not missed and use maximum approved doses.
- Monitor renal function and LFTs during prolonged therapy.
- Reconstitute and store per manufacturer guidelines; solutions may be refrigerated for up to 5 days.
Clinical Pearls
- Cefotaxime is an acceptable alternative to ceftriaxone for bacterial meningitis, particularly in neonates where biliary sludging from ceftriaxone is a concern.
- Its active metabolite desacetylcefotaxime provides synergistic bactericidal activity, contributing to its broad-spectrum efficacy.
Safety Profile
Pregnancy generally-safe
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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