Cephalosporins類抗生素 (三四代)

Bacteremia/Septicemia: caused by E. coli, Klebsiella species, S. marcescens, S. aureus and Streptococcus species
Bone or joint infections: caused by S. aureus, Streptococcus species, and Proteus mirabilis
CNS infections: including meningitis and ventriculitis; caused by N. meningitidis, H. influenzae, S. pneumoniae, K. pneumoniae, and E. coli
Genitourinary infections: including urinary tract infections (UTIs); caused by S. epidermidis, S. aureus, Citrobacter species, Enterobacter species, E. coli, Klebsiella species, P. mirabilis, Proteus vulgaris, Providencia stuartii, Morganella morganii, Providencia rettgeri, and S. marcescens
Gynecologic infections: including pelvic inflammatory disease, endometritis, and pelvic cellulitis; caused by S. epidermidis, Streptococcus species, Enterobacter species, Klebsiella species, E. coli, P. mirabilis, Bacteroides species, Clostridium species, anaerobic cocci, and Fusobacterium species
Intra-abdominal infection, mild to moderate, community-acquired: including peritonitis; caused by Streptococcus species, E. coli, Klebsiella species, Bacteroides species, anaerobic cocci, P. mirabilis, and Clostridium species
Lower respiratory tract infections: including pneumonia; caused by S. pneumoniae, S. pyogenes, S. aureus, E. coli, Klebsiella species, H. influenzae, H. parainfluenzae, P. mirabilis, S. marcescens, and Enterobacter species
Skin and skin structure infections: caused by S. aureus, S. epidermidis, S. pyogenes, Acinetobacter species, E. coli, Citrobacter species, Enterobacter species, Klebsiella species, P. mirabilis, P. vulgaris, M. morganii, P. rettgeri, S. marcescens, Bacteroides species, and anaerobic cocci
Surgical prophylaxis: in surgical procedures (eg, abdominal or vaginal hysterectomy, GI and GU tract surgery) that may be classified as contaminated or potentially contaminated

Cefotaxime sodium, a semisynthetic, broad spectrum cephalosporin, exhibits its bactericidal activity by inhibiting cell wall synthesis in a wide range of gram-positive and gram-negative microorganisms

Time to peak, serum:
(IM) Within 30 minutes
Distribution:
1. Widely to body tissues and fluids including aqueous humor, ascitic and prostatic fluids, bone; penetrates CSF best when meninges are inflamed
2. Protein binding: 31-50%
Metabolism:
Partially hepatic to active metabolite, desacetylcefotaxime
Half-life elimination:
1. Cefotaxime: (Infants ≤1500 g) 4.6 hours; (Infants >1500 g) 3.4 hours; (Children) 1.5 hours; (Adults) 1-1.5 hours; prolonged with renal and/or hepatic impairment
2. Desacetylcefotaxime: 1.3 to 1.9 hours; prolonged with renal impairment
Excretion:
Urine (~60% as unchanged drug and metabolites)

Hypersensitivity to cefotaxime sodium or to any cephalosporin

B

Enters breast milk/use caution

Injection site pain, injection site phlebitis, rash, diarrhea, vomiting

Brain abscess (empiric treatment):
(IV) 2 g every 4 to 6 hours in combination with other antimicrobial therapy as warranted (eg, metronidazole)
Cesarean section:
(IM, IV) 1 g IV as soon as the umbilical cord is clamped, then 1 g IV or IM at 6 and 12 hours after the first dose.
Intra-abdominal infection, mild to moderate, community-acquired:
1. Cholecystitis, acute:
(IV) 2 g every 8 hours, continue for 1 day; addition of anaerobic therapy (eg, metronidazole) is recommended if biliary-enteric anastomosis is present
2. Other intra-abdominal infections (eg, perforated appendix, diverticulitis, intra-abdominal abscess):
(IV) 2 g every 8 hours in combination with metronidazole. Total duration 4 to 5 days following adequate source control
Meningitis, bacterial:
(IV) 2 g every 4 to 6 hours; for empiric therapy, use in combination with other appropriate agents
Pneumonia, community-acquired: In patients without risk factors for Pseudomonas aeruginosa:
(IV) 1-2 g every 8 hours as part of an appropriate combination regimen; total duration is a minimum of 5 days
Sepsis:
(IV) 2 g every 6 to 8 hours
Septic arthritis:
1. Neisseria gonorrhoeae: (IV) 1 g every 8 hours in combination with a single dose of azithromycin; duration 7 to 14 days
2. Susceptible gram-negative bacilli: (IV) 2 g every 8 hours; duration is 3 to 4 weeks, including oral step-down therapy
Spontaneous bacterial peritonitis, treatment: For patients without sepsis or risk for multidrug resistance
(IV) 2 g every 8 hours; duration 5 to 7 days

100-200 mg/kg/day given in 2-4 doses (50 mg/kg for neonates)

Dosage adjustment: according to ClCr ml/min:
ClCr > 50 ml/min: 0.5 - 2 g Q8-12H
ClCr 10-50 ml/min: 0.5 - 2 g Q12-24H
ClCr < 10 ml/min: 0.5 - 2 g Q24H

There are no dosage adjustments provided in the manufacturer's labeling.