Cefoxitin

These indications are based on manufacturer information for both originator and generic products. For product specific registered indications, please refer to product specific manufacturer information

Registered South African indications:

• Peritonitis and other intra-abdominal and intrapelvic infections
• Gynaecological infections
• Septicaemia
• Endocarditiis
• Urinary tract infections , including uncomplicated gonorrhoea
• Respiratory tract infections
• Bone and joint infections
• Skin and soft tissue infections
• Prevention of post-operative infections

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment
• History of penicillin allergy
• Prolonged use
• History of gastrointestinal disease e.g. colitis
• History of seizure disorder
• Children
• High levels of the drug

Forms avail. in SA and covered in this monograph: inj

Infections caused by: Gram positive aerobic cocci (excluding: Enterococci spp., Methicillin resistant staphylococci); Gram negative aerobic bacilli (excluding: Pseudomonas, Listeria monocytogenes, Enterobacter cloacae)

General dosing range

• IV/IM: 1-2g, 8hrly; Max: 12g/24hrs

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NOTE: IM injection is painful

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Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

Uncomplicated gonorrhoea (additional agent required)

• IM: 2g as single dose

Prophylaxis of post-operative infections

• IV: 2g, pre-operatively

THEN 

• IM/IV: 2g, 6hrly (For a total of 3 doses)

Gas gangrene

• IV: 2-3g, 4-6hrly; Max: 12g/24hrs

Intra-abdominal infection
Community acquired pneumonia

• IV: 2g, 6hrly; Treatment duration: 4-7 days

Pelvic inflammatory disease (additional agent required)

• IV: 2g, 6hrly for 24-48hrs

OR

• IM: 2g as single agent

Urinary tract infection
Skin and soft tissue infections

• IV: 1g, 6-8hrly; Max: 4g/24hrs

Paed. forms avail. in SA and covered in this monograph: inj

Infections caused by: Gram positive aerobic cocci (excluding: Enterococci spp., Methicillin resistant staphylococci); Gram negative aerobic bacilli (excluding: Pseudomonas, Listeria monocytogenes, Enterobacter cloacae)

General dosing range

Younger than 2 years

• Not established for use

Older than 2 years

• IV/IM: 20-40mg/kg, 6-8hrly; Max: 12g/24hrs

Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

Prophylaxis of post-operative infections

• IV: 30-40mg/kg, pre-operatively

THEN 

• IM/IV: 30-40mg/kg, 6hrly (for a total of 3 doses); Treatment duration: 24hrs

Pregnancy

• Caution; no evidence of risk in studies
• Studies in animals have not any harmful effects of cefoxitin to the foetus
• No data for human pregnancy studies are available. Cefoxitin should be given in pregnancy on when there is a clear need

Breastfeeding

• Caution
• Cefoxitin is excreted in breast milk in very small amounts
• Caution is recommended when administering cefoxitin to breastfeeding women

Renal Impairment

• Caution; dose adjustment recommended

Adult dosages:

CrCl (ml/min)	Maintenance Dose (g)
Loading dose: No adjustment necessary
30 - 50	1-2g, 8-12hrly
10 - 29	1-2g, 12-24hrly
5 - 9	0.5-1g, 12-24hrly
<5	0.5-1g, 24-48 hrly
Hemodialysis	1-2g after each hemodialysis; Maintenance dose: Adjust according to CrCl

 Paediatric dosages: (recommendations are based on doses of 20-40mg/kg/dose 6hrly)

GFR (ml/min)	Dose (mg/kg/dose)
>50	No adjustment necessary
30-50	20-40mg/kg,  8hrly
10-29	20-40mg/kg, 12hrly
<10	20-40mg/kg, 24hrly
Intermittent hemodialysis (20-50% dialyzable)	20-40mg/kg, 24hrly
Peritoneal dialysis	20-40mg/kg, 24hrly
Continuous renal replacement therapy	20-40mg/kg, 8hrly

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Gastrointestinal Disorders

• Nausea and vomiting
• Diarrhoea
• Pseudomembranous colitis

Hepatobiliary Disorders

• Increased alanine aminotransferase
• Increased aspartate aminotransferase
• Increased lactate dehydrogenase
• Increased serum alkaline phosphatase
• Jaundice
• Hepatitis

Genitourinary Disorders

• Increased serum creatinine
• Increased blood urea

Skin and Subcutaneous Tissue Disorders

• Thrombophlebitis
• Induration
• Injection site reactions
• Maculopapular rash
• Urticaria
• Pruritis 

Immune, Blood and Lymphatic System Disorders

• Eosinophilia
• Fever
• Anaphylaxis
• Allergic reactions
• Transient leukopaenia
• Neutropaenia
• Thrombocytopaenia
• Agranulocytosis
• Haemolytic anaemia
• Azotaemia

• Sodium picosulfate
• Cholera vaccine
• Typhoid vaccine
• Bacillus Calmette–Guérin vaccine

None routine. Specific cases may require

• Renal function
• Prothrombin time

Cefoxitin is similar to a second generation cephalosporin, and is a bactericidal broad spectrum semi-synthetic beta-lactam antibiotic. The cephamycin is characterised by a methoxy group which is responsible for its resistance to degradation by bacterial beta-lactamases.

Spectrum of activity: Gram positive aerobic cocci (excluding: Enterococci spp., Methicillin resistant staphylococci); Gram negative aerobic bacilli (excluding: Pseudomonas, Listeria monocytogenes, Enterobacter cloacae)

Injection (per vial) 1g

• Adco-Cefoxitin (Adcock)
• Aspen Cefoxitin (Pharmacare)