Intramuscular, Intravenous Bone and joint infections, Gynaecological infections, Intra-abdominal infections, Lower respiratory tract infections, Pyelonephritis, Septicaemia, Skin and skin structure infections, Urinary tract infections
Adult: Usual dose: 1-2 g 6-8 hourly via slow IV inj over 3-5 minutes, intermittent or continuous IV infusion, or deep IM inj. For severe cases, doses of up to Max of 12 g daily in 4-6 divided doses may be required. Dosage and route of administration are determined according to the susceptible causative organism, severity of the infection, and patient condition. Refer to specific product guidelines. Child: ≥3 months Usual dose: 80-160 mg/kg daily in 4-6 equally divided doses. Higher doses may be used for more severe infections. Max: 12 g daily. Dosage recommendations may vary among individual products and between countries (refer to specific product guidelines).
Intramuscular, Intravenous Prophylaxis of surgical infections
Adult: In patients undergoing uncontaminated gastrointestinal surgery, and vaginal or abdominal hysterectomy: Usual dose: 2 g given via IM or IV approx 30-60 minutes before the procedure, then 2 g 6 hourly after the 1st dose for not more than 24 hours. Dosage recommendation may vary among individual products or between countries (refer to specific product guidelines). Child: ≥3 months Usual dose: 30-40 mg/kg given via IV approx 30-60 minutes prior to surgery, followed by 30-40 mg/kg 6 hourly for not more than 24 hours. Dosage recommendations may vary among individual products and between countries (refer to specific product guidelines).
Intravenous Prophylaxis of surgical infections
Adult: In pregnant women undergoing caesarean section: 2 g as a single dose as soon as the umbilical cord is clamped; or a 3-dose regimen consisting of 2 g as soon as umbilical cord is clamped, followed by 2 g dose 4 hours and 8 hours after the initial dose. All doses are to be given via IV.
Renal Impairment
Initial loading dose: 1-2 g. Maintenance dose: Reduced according to the renal impairment (CrCl) of the patient. Doses may be given via IV or IM. Patient on haemodialysis: Administer 1-2 g loading dose after each haemodialysis session and give maintenance treatment depending on the renal impairment (CrCl) of the patient. Dosage recommendations may vary among individual products or between countries (refer to specific product guidelines).
CrCl (mL/min)
Dosage
<5
0.5-1 g 24-48 hourly.
5-9
0.5-1 g 12-24 hourly.
10-29
1-2 g 12-24 hourly.
30-50
1-2 g 8-12 hourly.
Reconstitution
IV: Inj: Reconstitute vials labelled as 1 g and 2 g with 10 mL and 10-20 mL of sterile water for inj, respectively. Shake to dissolve then withdraw the entire contents of the vial into a syringe. Intermittent/continuous infusion: Further dilute reconstituted solutions in 50-1,000 mL of appropriate IV solution (e.g. 0.9% NaCl solution, 5% or 10% dextrose in water, mixed solution of 5% dextrose in water and 0.9% NaCl solution, 5% dextrose in water buffered with 0.02% Na bicarbonate, 5% dextrose in water supplemented with 0.2% or 0.45% NaCl solution, Lactated Ringer’s solution, mixed solution of 5% dextrose in water and Lactated Ringer’s solution, 5% or 10% mannitol). IM: Reconstitute vials labelled as 1 g and 2 g with 2 mL and 4 mL of 0.5% or 1% lidocaine solution or sterile water for inj, respectively. Instructions for reconstitution or further dilution may vary among individual products or between countries. Refer to specific product guidelines.
Contraindications
Hypersensitivity to cefoxitin or other cephalosporins; history of severe hypersensitivity (e.g. anaphylactic reaction) to any other type of β-lactam antibacterial (e.g. penicillin, monobactams, carbapenems).
Special Precautions
Patient with a history of non-severe hypersensitivity to other β-lactam agents; history of gastrointestinal disease (e.g. colitis) or seizure disorders. Not recommended for the treatment of bacterial meningitis. No activity against Chlamydia trachomatis. Renal impairment. Children and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Fungal or bacterial superinfection (prolonged use); increased risk of encephalopathy or seizures (high doses or in reduced renal function). Eosinophilia and elevated AST (higher doses in children ≥3 months). Blood and lymphatic system disorders: Leucopenia, agranulocytosis, anaemia, haemolytic anaemia, thrombocytopenia, bone marrow failure. Gastrointestinal disorders: Diarrhoea, nausea, vomiting. General disorders and administration site conditions: Pyrexia; local thrombophlebitis (after IV administration); pain, induration and tenderness (following IM inj). Immune system disorders: Angioedema. Investigations: Increased ALT, serum lactate dehydrogenase, serum alkaline phosphatase, BUN and serum creatinine levels. Musculoskeletal and connective tissue disorders: Myasthenia gravis exacerbation. Renal and urinary disorders: Interstitial nephritis. Skin and subcutaneous tissue disorders: Rash, pruritus, urticaria, toxic epidermal necrolysis. Potentially Fatal: Hypersensitivity reactions; Clostridium difficile-associated diarrhoea and pseudomembranous colitis.
Perform culture and susceptibility tests; consult local institutional recommendation before treatment initiation due to antibiotic resistance risks. Screen patient allergy history before treatment initiation; assess for signs and symptoms of anaphylaxis during the 1st dose. Monitor renal function tests periodically especially when used concurrently with other nephrotoxic agents; prothrombin time/INR; CBC (with prolonged use).
Drug Interactions
May enhance the effects of oral anticoagulants. Probenecid reduces the renal excretion of cefoxitin. Increased risk of nephrotoxicity when given in combination with other nephrotoxic agents (e.g. aminoglycosides, diuretics).
Lab Interference
May cause positive direct Coombs' test, falsely high serum or urine creatinine values with Jaffe reaction, false-positive urinary glucose testing using cupric sulfate (e.g. Benedict's or Fehling's solution, Clinitest®), and moderate falsely increased results when measuring urinary 17-hydroxy-corticosteroid with Porter Silber reaction.
Action
Description: Mechanism of Action: Cefoxitin, a β-lactam antibiotic of the 2nd generation cephalosporins, exhibits its bactericidal effect by binding to one or more of the penicillin-binding proteins (PBPs) which blocks the final transpeptidation step of bacterial peptidoglycan cell wall synthesis, resulting in the inhibition of bacterial cell wall synthesis. It possesses a high degree of stability against β-lactamases due to the presence of a 7-α methoxy group in its β-lactam ring. Pharmacokinetics: Absorption: Time to peak plasma concentration: Within 20-30 minutes (IM). Distribution: Widely distributed to body tissues and fluids including ascitic, pleural, and synovial fluids, and in bile; poorly penetrates into CSF even with inflamed meninges. Crosses the placenta; enters breast milk (in small concentrations). Plasma protein binding: 65-80%. Excretion: Via urine (85% as unchanged drug). Elimination half-life: 41-60 minutes.
Chemical Structure
Cefoxitin Source: National Center for Biotechnology Information. PubChem Database. Cefoxitin, CID=441199, https://pubchem.ncbi.nlm.nih.gov/compound/Cefoxitin (accessed on Jan. 21, 2020)
Storage
Intact vials: Store between 2-25°C. Protect from light. Reconstituted solutions: Stable for 6 hours when stored at 30°C. Storage and stability recommendations may vary among individual products or between countries. Refer to specific product guidelines.
J01DC01 - cefoxitin ; Belongs to the class of second-generation cephalosporins. Used in the systemic treatment of infections.
References
Anon. Cefoxitin Sodium. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 18/02/2022.Anon. Cefoxitin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/01/2022.Buckingham R (ed). Cefoxitin Sodium. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/01/2022.Cefovex 1 g Powder for Injection (Sannovex Pharmaceutical Distributor). MIMS Philippines. http://www.mims.com/philippines. Accessed 03/01/2022.Cefoxitin Sodium Powder, for Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/01/2022.Joint Formulary Committee. Cefoxitin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/01/2022.Renoxitin 1 g Powder for Solution for Injection/Infusion (Renascience Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 03/01/2022.Renoxitin 2 g Powder for Solution for Injection/Infusion (Renascience Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 03/01/2022.
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