Intramuscular, Intravenous Bone and joint infections, Gynaecological infections, Intra-abdominal infections, Lower respiratory tract infections
Adult: Usual dose: 1-2 g 12 hourly for 5-10 days depending on the severity of the infection. Severe: 2 g 12 hourly. Life threatening infections: 3 g 12 hourly up to max 6 g daily. All doses to be given by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes.
Intramuscular, Intravenous Skin and skin structure infections
Adult: Mild to moderate: 1 g 12 hourly. Severe: 2 g 12 hourly. K. pneumoniae infections: 1-2 g 12 hourly. All doses to be given for 5-10 days by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes.
Adult: 1-4 g daily for 5-10 days depending on the severity of the infection by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes.
Intravenous Prophylaxis of surgical infections
Adult: 1-2 g 30-60 minutes before the procedure or when the umbilical cord is clamped in caesarean section.
Intravenous Pelvic inflammatory disease
Adult: In combination with doxycycline: 2 g 12 hourly for 5-10 days.
Renal Impairment
ESRD patient on haemodialysis: One quarter of the usual dose 24 hourly on days between dialysis and half of the usual dose on the day of dialysis.
CrCl (mL/min)
Dosage
<10
Usual dose 48 hourly or one quarter of the usual dose 12 hourly.
10-30
Usual dose 24 hourly or half of the usual dose 12 hourly.
Reconstitution
IV: Reconstitute vials labelled as containing 1 g and 2 g with 10 or 20 mL respectively, of sterile water for inj. Further dilute with 50-100 mL of dextrose 5% inj or NaCl 0.9% inj for IV infusion. IM: Add 2 or 3 mL of sterile or bacteriostatic water for inj, NaCl 0.9% inj or 0.5% or 1% lidocaine hydrochloride inj to vials labelled as containing 1 g and 2 g, to provide a solution containing 400 mg/mL and 500 mg/mL, respectively.
Contraindications
Hypersensitivity to cefotetan and other cephalosporins. History of cephalosporin associated haemolytic anaemia.
Special Precautions
Patient with history of penicillin allergy, gastrointestinal disease (e.g. colitis), risk factors for INR elevation (e.g. malnourished or cancer patient). Renal and hepatic impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Anaphylaxis, elevated INR and bleeding, bacterial or fungal superinfection. Blood and lymphatic system disorders: Agranulocytosis, eosinophilia, leucopenia, neutropaenia, thrombocytosis, thrombocytopaenia. Gastrointestinal disorders: Diarrhoea, nausea. Injury, poisoning and procedural complications: Injection site phlebitis. Investigations: Increased SGOT, SGPT prolonged prothrombin time, increased BUN, and serum creatinine. Potentially Fatal: Severe haemolytic anaemia, pseudomembranous colitis.
Monitor coagulation parameters (e.g. INR/prothrombin time, haematologic parameters (e.g. CBC with differential), LFT and renal function periodically. Monitor signs and symptoms of haemolytic anaemia.
Drug Interactions
Enhanced nephrotoxic effect with aminoglycosides. Increased serum concentration with probenecid. May enhance the anticoagulant effect of vitamin K antagonists (e.g. warfarin). May diminish the therapeutic effect of Na picosulfate, BCG, typhoid and cholera vaccines.
Food Interaction
Disulfiram-like reaction may occur when given with alcohol.
Lab Interference
Positive direct Coombs test results. False-positive reaction in urinary glucose test using Benedict’s solution, Clinitest, Fehling’s solution. False-positive serum or urine creatinine with Jaffe’ reaction.
Action
Description: Mechanism of Action: Cefotetan is a 2nd generation cephalosporin which inhibits bacterial cell wall biosynthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn prevents the final transpeptidation step of peptidoglycan synthesis, thus arresting cell wall assembly resulting in bacterial cell death. Pharmacokinetics: Absorption: Time to peak plasma concentration: 1-3 hours (IM). Distribution: Widely distributed into body tissues and fluids (including bile, gallbladder, kidney, skin, tonsils, uterus, sputum, prostatic and peritoneal fluids). Crosses the placenta and enters breast milk (small amounts). Plasma protein binding: Approx 88%. Excretion: Via urine (approx 51-81% as unchanged drug). Elimination half-life: Approx 3-4.6 hours.
Chemical Structure
Cefotetan Source: National Center for Biotechnology Information. PubChem Database. Cefotetan, CID=53025, https://pubchem.ncbi.nlm.nih.gov/compound/Cefotetan (accessed on Jan. 21, 2020)
J01DC05 - cefotetan ; Belongs to the class of second-generation cephalosporins. Used in the systemic treatment of infections.
References
Anon. Cefotetan Disodium. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 07/03/2018.Anon. Cefotetan. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 07/03/2018.Buckingham R (ed). Cefotetan. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 07/03/2018.Cefotan Injection (GlaxoSmithKline for AstraZeneca Pharmaceuticals, LP). U.S. FDA. https://www.fda.gov/. Accessed 07/03/2018.Cefotan Injection, Solution Injection, Powder for Solution (AstraZeneca Pharmaceuticals, LP). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 07/03/2018.
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