waiting for [3:<1 minute) injection is associated with potentially life-threatening arrhythmias. 230 IV Infusion Reconstitution and Dilution Reconstitute infusion bottles containing 1 or 2 g of cefotaxime with 50 100 mL of 0.9% sodium chloride injection or 5% dextrose injection to provide solutions containing 10 20 or 20 40 mg/mL, respectively. 230 May be diluted further in 50 mL to 1 L of compatible IV solution. 230 Reconstitute 10-g pharmacy bulk package according to the manufacturer s directions and then dilute further in a compatible IV solution. 230 Reconstitute ADD-Vantage vials or infusion bottles containing 1 or 2 g of cefotaxime according to the manufacturer s directions. 230 Thaw the commercially available premixed injection (frozen) at room temperature or in a refrigerator; do not thaw by immersion in a water bath or by exposure to microwave radiation. 230 A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature. 230 Discard thawed injection if an insoluble precipitate is present or if container seals or outlet ports are not intact or leaks are found. 230 Do not use in series connections with other plastic containers; such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete. 230 Rate of Administration For intermittent IV infusion, infuse over 20 30 minutes via butterfly or scalp vein-type needles. b During infusion, discontinue other IV solutions flowing through a common administration tubing or site 230 unless the solutions are known to be compatible and the flow-rate is adequately controlled. b IM Injection Inject IM deeply into a large muscle mass such as the upper outer quadrant of the gluteus maximus. 230 Use aspiration to avoid inadvertent injection into a blood vessel. 230 2-g IM doses should be divided and administered at 2 different injection sites. 230 Reconstitution Reconstitute vials containing 500 mg, 1 g, or 2 g of cefotaxime with 2, 3, or 5 mL, respectively, of sterile or bacteriostatic water for injection to provide solutions containing approximately 230, 300, or 330 mg/mL, respectively. 230 Dosage Available as cefotaxime sodium; dosage expressed in terms of cefotaxime. 230 Pediatric Patients General Dosage for Neonates IV or IM Manufacturer recommends 50 mg/kg every 12 hours for those> <1 week of age and 50 mg/kg every 8 hours for those 1 4 weeks of age. 230 366 367 Neonates 7 days of age: AAP recommends 50 mg/kg every 12 hours, regardless of weight. 275 Neonates 8 28 days of age: AAP recommends 50 mg/kg every 8 12 hours in those weighing 2 kg and 50 mg/kg every 8 hours in those weighing> 2 kg. 275 General Dosage for Infants and Children 1 Month to 12 Years of Age IV or IM 50 180 mg/kg daily given in 4 6 equally divided doses in those weighing <50 kg. 230 366 367 The higher dosage should be used for more severe or serious infections. 230 366 367 Children beyond neonatal period: AAP recommends 50 180 mg/kg daily given in 3 or 4 equally divided doses for treatment of mild to moderate infections and 200 225 mg/kg daily given in 4 or 6 equally divided doses for treatment of severe infections. 275 Children weighing> 50 kg should receive the usual adult dosage. 230 366 367 (See Adult Dosage under Dosage and Administration.) Meningitis and Other CNS Infections IV Manufacturers recommend that children 1 month to 12 years of age weighing <50 kg receive dosage at the high end of the range of 50 180 mg/kg daily. 230 366 367 Some clinicians recommend that infants and children> <18 years of age with meningitis receive 50 mg/kg IV every 6 hours. 296 Others recommend 100 150 mg/kg daily given in divided doses every 8 12 hours in neonates 7 days of age, 150 200 mg/kg daily given in divided doses every 6 8 hours in neonates 8 28 days of age, and 225 300 mg/kg daily given in divided doses every 6 8 hours in older infants and children. 365 AAP recommends up to 300 mg/kg daily given in 4 or 6 divided doses for treatment of meningitis in pediatric patients beyond the neonatal period. 275 Duration of treatment is 7 days for uncomplicated meningitis caused by susceptible H. influenzae or N. meningitidis ; 10 14 days for complicated cases or meningitis caused by S. pneumoniae ; and 21 days for meningitis caused by susceptible Enterobacteriaceae. 275 296 318 Gonorrhea and Associated Infections Disseminated Gonococcal Infection or Gonococcal Scalp Abscess in Neonates IV or IM 25 mg/kg every 12 hours for 7 days recommended by CDC and AAP; if meningitis is documented, continue for 10 14 days. 167 275 Disseminated Gonorrhea in Children 8 Years of Age or Weighing 45 kg IV CDC recommends 1 g every 8 hours; continue for 24 48 hours after improvement begins and switch to an oral regimen (cefixime) to complete 1 week of treatment. 167 Uncomplicated Urethral, Cervical, or Rectal Gonorrhea in Adolescents IM Single 500-mg dose recommended by CDC and AAP. 167 275 Lyme Disease Early Neurologic Lyme Disease IV 150 200 mg/kg daily (up to 6 g daily) given in divided doses every 6 8 hours for 14 days (range: 10 28 days) recommended by IDSA and others for early Lyme disease in children with acute neurologic manifestations (e.g., meningitis, radiculopathy). 273 351 354 Lyme Carditis IV 150 200 mg/kg daily (up to 6 g daily) given in divided doses every 6 8 hours for 14 days (range: 14 21 days) recommended by IDSA and others for those with AV heart block and/or myopericarditis associated with early Lyme disease when a parenteral regimen is indicated (e.g., hospitalized patients). 273 351 354 Parenteral regimen can be switched to an oral regimen (doxycycline, amoxicillin, cefuroxime axetil) to complete therapy when clinically indicated. 351 Lyme Arthritis IV 150 200 mg/kg daily (up to 6 g daily) given in divided doses every 6 8 hours for 14 days (range: 14 28 days) for children with evidence of neurologic disease or when arthritis has not responded to an oral regimen. 351 Late Neurologic Lyme Disease IV 150 200 mg/kg daily (up to 6 g daily) given in divided doses every 6 8 hours for 14 days (range: 14 28 days) recommended by IDSA for children with late neurologic disease affecting the CNS or peripheral nervous system. 273 351 Response to anti-infective treatment usually is slow and may be incomplete in such patients. 351 IDSA states that retreatment is not recommended unless relapse is shown by reliable objective measures. 351 Adults General Adult Dosage Uncomplicated Infections IV or IM 1 g every 12 hours. 230 366 367 Moderate to Severe Infections IV or IM 1 2 g every 8 hours. 230 366 367 Severe or Life-threatening Infections IV 2 g every 6 8 hours. 230 366 367 For life-threatening infections, 2 g every 4 hours. 230 366 367 Meningitis and Other CNS Infections IV 2 g every 6 8 hours for 7 21 days. 230 296 Some clinicians recommend 8 12 g daily in divided doses every 4 6 hours. 365 Duration of treatment is 7 days for uncomplicated meningitis caused by susceptible H. influenzae or N. meningitidis ; 10 14 days for complicated cases or meningitis caused by S. pneumoniae ; and 21 days for meningitis caused by susceptible Enterobacteriaceae. 275 296 318 Meningitis Caused by S. pneumoniae IV Initially, 350 mg/kg daily given in 4 divided doses; reduce dosage to 225 mg/kg daily given in 3 divided doses if organism is susceptible to penicillin. 327 335 GI Infections Infectious Diarrhea IV HIV-infected: 1 g every 8 hours. 412 If no clinical response after 5 7 days, consider stool culture and in vitro susceptibility testing. 412 Salmonella Gastroenteritis IV HIV-infected: 1 g every 8 hours. 412 Recommended duration is 7 14 days if CD4 + T-cells 200 cells/mm 3 ( 14 days if patient is bacteremic or infection is complicated) or 2 6 weeks if CD4 + T-cells> <200 cells/mm 3 . 412 Respiratory Tract Infections Community-acquired Pneumonia IV or IM 1 g every 6 8 hours. 269 Duration of treatment depends on the causative pathogen, illness severity at the onset of anti-infective therapy, response to treatment, comorbid illness, and complications. 269 Gonorrhea and Associated Infections Uncomplicated Urethral, Cervical, or Rectal Gonorrhea IM Single 500-mg dose recommended by CDC. 167 Manufacturers recommend single 500-mg dose for treatment of gonococcal urethritis/cervicitis in males and females and rectal gonorrhea in females and single 1-g dose for treatment of rectal gonorrhea in males. 230 366 367 Disseminated Gonorrhea IV CDC recommends 1 g every 8 hours; continue for 24 48 hours after improvement begins and switch to an oral regimen (cefixime) to complete 1 week of treatment. 167 Lyme Disease Early Neurologic Lyme Disease IV 2 g every 8 hours for 14 days (range: 10 28 days) recommended by IDSA and others for adults with acute neurologic manifestations (e.g., meningitis, radiculopathy). 273 351 354 Lyme Carditis IV 2 g every 8 hours for 14 days (range: 14 21 days) recommended by IDSA and others for adults with AV heart block and/or myopericarditis associated with early Lyme disease when a parenteral regimen is indicated (e.g., hospitalized patients). 351 354 Parenteral regimen can be switched to an oral regimen (doxycycline, amoxicillin, cefuroxime axetil) to complete therapy when clinically indicated. 351 Lyme Arthritis IV 2 g every 8 hours for 14 days (range: 14 28 days) recommended by IDSA for adults with evidence of neurologic disease or when arthritis has not responded to an oral regimen. 351 Late Neurologic Lyme Disease IV 2 g every 8 hours for 14 days (range: 14 28 days) recommended by IDSA for adults with late neurologic disease affecting the CNS or peripheral nervous system. 273 351 Response to anti-infective treatment usually is slow and may be incomplete in such patients. 351 IDSA states that retreatment is not recommended unless relapse is shown by reliable objective measures. 351 Perioperative Prophylaxis Contaminated or Potentially Contaminated Surgery IV or IM Manufacturers recommend 1 g 30 90 minutes prior to surgery. 230 Some experts recommend 1 g in most adults and 2 g in obese patients given within 60 minutes prior to surgical incision. 169 If procedure is prolonged (> 3 4 hours) or if major blood loss occurs, additional intraoperative doses may be given every 3 hours. 169 Duration of prophylaxis should be <24 hours for most procedures; 168 no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed. 168 169 Cesarean Section IV or IM Manufacturers recommend 1 g IV as soon as the umbilical cord is clamped, followed by additional 1-g IM or IV doses given 6 and 12 hours after the first dose. 230 Prescribing Limits Pediatric Patients Maximum 12 g daily for children weighing> 50 kg. 230 366 367 Adults Maximum 12 g daily. 230 366 367 Special Populations Hepatic Impairment No dosage adjustments required. 289 290 Renal Impairment Patients with Cl cr <20 mL/minute per 1.73 m 2 should receive 50% of the usual dose given at the usual time intervals. 230 Patients undergoing hemodialysis should receive 0.5 2 g as a single daily dose with a supplemental dose after each dialysis period. 265 Cautions for Claforan Contraindications Known hypersensitivity to cefotaxime or other cephalosporins. 230 Warnings/Precautions Warnings Superinfection/Clostridium difficile-associated Diarrhea and Colitis Possible emergence and overgrowth of nonsusceptible organisms, especially Enterobacter , Pseudomonas , enterococci, or Candida . 230 Careful observation of the patient is essential. 230 Institute appropriate therapy if superinfection occurs. 230 Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile . 230 342 344 345 C. difficile infection (CDI) and C. difficile -associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) reported with nearly all anti-infectives, including cefotaxime, and may range in severity from mild diarrhea to fatal colitis. 230 342 344 345 C. difficile produces toxins A and B which contribute to development of CDAD; 230 342 hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required. 230 Consider CDAD if diarrhea develops during or after therapy and manage accordingly. 230 342 344 345 Obtain careful medical history since CDAD may occur as late as 2 months or longer after anti-infective therapy is discontinued. 230 342 If CDAD is suspected or confirmed, discontinue anti-infectives not directed against C. difficile whenever possible. 230 342 Initiate appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated. 230 342 344 345 Cardiac Effects Potentially life-threatening arrhythmia reported with rapid injection (> <1 minute) through a central venous catheter. 230 Do not inject IV over> <3 minutes. 230 (See IV Injection under Dosage and Administration.) Sensitivity Reactions Hypersensitivity Reactions Possible hypersensitivity reactions, including rash (maculopapular or erythematous), pruritus, fever, eosinophilia, urticaria, anaphylaxis, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. 230 If a hypersensitivity reaction occurs, discontinue cefotaxime and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of an adequate airway and oxygen). 230 Cross-hypersensitivity Partial cross-allergenicity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins. a Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs. 230 Cautious use recommended in individuals hypersensitive to penicillins: a avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction and administer with caution in those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction. a General Precautions Selection and Use of Anti-infectives To reduce development of drug-resistant bacteria and maintain effectiveness of cefotaxime and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria. 230 When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing. 230 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy. 230 History of GI Disease Use with caution in patients with a history of GI disease, particularly colitis. 230 (See Superinfection/Clostridium difficile-associated Diarrhea and Colitis under Cautions.) Local Effects May be locally irritating to tissues. 230 Inflammation, phlebitis, and thrombophlebitis reported with IV administration; b pain, induration, and tenderness may occur at IM injection sites. 230 Perivascular extravasation responds to changing the infusion site; 230 extensive perivascular extravasation may result in tissue damage requiring surgery. 230 Regularly monitor infusion sites and change site when appropriate. 230 Hematologic Effects Possible transient neutropenia, granulocytopenia, leukopenia, eosinophilia, or thrombocytopenia. 230 Agranulocytosis may occur rarely during prolonged therapy. 230 Monitor blood cell counts if treatment lasts> 10 days. 230 CNS Effects Seizures reported with some cephalosporins, especially in patients with renal impairment who received dosages inappropriate for the degree of renal impairment. 230 If seizures occur, discontinue cefotaxime and administer anticonvulsant therapy as indicated. 230 Sodium Content Contains approximately 50.5 mg (2.2 mEq) of sodium per g of cefotaxime. 230 366 367 Specific Populations Pregnancy Category B. 230 Lactation Distributed into milk; use with caution. 230 Pediatric Use Adverse effects similar to those reported in adults. 291 Safety of the chemical components that may leach out of the plastic containing commercially available frozen cefotaxime sodium injections not established. 230 Geriatric Use No overall differences in safety or efficacy in those 65 years of age compared with younger adults, but the possibility of increased sensitivity in some geriatric individuals cannot be ruled out. 230 366 367 Substantially eliminated by kidneys; risk of toxicity may be greater in those with impaired renal function. 230 366 367 Select dosage with caution and consider monitoring renal function because of age-related decreases in renal function. 230 366 367 (See Renal Impairment under Dosage and Administration.) Hepatic Impairment Possible increased plasma half-life and clearance of cefotaxime and its major metabolite. 117 289 Renal Impairment Plasma half-life of cefotaxime and its major metabolite increased in severe renal impairment. 13 16 19 Possibility of seizures if dosage is inappropriately high for the degree of renal impairment. 230 Dosage adjustment recommended in those with Cl cr <20 mL/minute per 1.73 m 3 . 230 Common Adverse Effects Local reactions at injection sites, hypersensitivity reactions, GI effects. 230 Interactions for Claforan Specific Drugs and Laboratory Tests Drug or Test Interaction Comments Aminoglycosides Possible increased risk of nephrotoxicity. 230 In vitro evidence of additive or synergistic antibacterial activity; antagonism also reported. a Closely monitor renal function, especially if high aminoglycoside dosage is used or therapy is prolonged. 230 Administer separately; do not admix. 230 Probenecid Decreased renal clearance and increased concentrations of cefotaxime and its metabolites. b Tests for glucose Possible false-positive reactions in urine glucose tests using Clinitest , Benedict s solution, or Fehling s solution. a Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix , Tes-Tape. ) a Claforan Pharmacokinetics Absorption Bioavailability Not appreciably absorbed from GI tract; must be administered parenterally. b Following IM administration, peak serum concentrations attained within 30 minutes. 6 8 11 230 Distribution Extent Widely distributed into body tissues and fluids, including aqueous humor, bronchial secretions, 224 sputum, middle ear effusions, bone, 115 bile, 115 116 and ascitic, 117 pleural, and prostatic fluids. 9 Distributed into CSF; highest concentrations attained in those with inflamed meninges. 263 264 288 290 b Crosses the placenta 21 and is distributed into milk. 21 Plasma Protein Binding 13 38%. 2 6 11 Elimination Metabolism Partially metabolized in the liver to desacetylcefotaxime, which has antibacterial activity. 2 7 14 Desacetylcefotaxime is further metabolized into inactive metabolites in the liver. 2 7 14 18 Elimination Route Cefotaxime and its metabolites excreted principally in urine. 2 14 In adults with normal renal function, 40 60% of a dose excreted as unchanged drug; 24% excreted as the active metabolite. b Half-life Terminal serum half-life of cefotaxime and desacetylcefotaxime is 0.9 1.7 and 1.4 1.9 hours, respectively. 2 7 10 11 13 14 19 Special Populations Terminal half-lives of cefotaxime and desacetylcefotaxime may be prolonged in patients with hepatic impairment. 117 289 Terminal half-life of cefotaxime only slightly prolonged in adults with Cl cr 20 mL/minute per 1.73 m 2 . 13 16 In those with Cl cr of 10 mL/minute per 1.73 m 2 , terminal half-lives of 1.4 11.5 and 8.2 56.8 hours reported for cefotaxime and desacetylcefotaxime, respectively. 13 16 19 Stability Storage Parenteral Powder for Injection or IV Infusion 15 30 C; 230 366 367 protect from light. 230 366 367 Following reconstitution with sterile water for injection, IV solutions containing 50 or 95 mg/mL are stable for 24 hours at room temperature ( 22 C) or 7 days when refrigerated ( 5 C). 230 IV solutions reconstituted with 0.9% sodium chloride injection or 5% dextrose injection and further diluted in a compatible IV solution are stable for 24 hours at room temperature ( 22 C) or at least 5 days when refrigerated ( 5 C). 230 Following reconstitution with sterile or bacteriostatic water for injection, IM solutions containing 230 330 mg/mL are stable in their original containers for 12 hours at room temperature ( 22 C) or 10 days when refrigerated ( 5 C). 230 Powder for injection and solutions may darken. 230 For Injection, for IV Infusion Claforan ADD-Vantage vials:> <30 C; protect from light. 230 After reconstitution as directed in 0.9% sodium chloride injection or 5% dextrose injection, stable for 24 hours at 22 C; 230 do not freeze. 230 Injection (Frozen) -20 C or lower. 230 Thawed solution stable 24 hours at room temperature ( 22 C) or 7 days under refrigeration ( 5 C). 230 Do not refreeze after thawing. 230 Compatibility For information on systemic interactions resulting from concomitant use, see Interactions. Parenteral Cefotaxime sodium is most stable at a pH of 5 7 and should not be diluted with IV solutions that have a pH> 7.5 (e.g., sodium bicarbonate). 230 Solution Compatibility Compatible Dextrose 5 or 10% in water HID 230 Dextrose 5% in sodium chloride 0.2, 0.45, or 0.9% 230 Invert sugar 10% 230 Ringer s injection, lactated 230 Sodium chloride 0.9% HID Sodium lactate (1/6) M 230 Travasol 8.5% without electrolytes 230 Drug Compatibility Admixture CompatibilityHID Compatible Clindamycin phosphate Metronidazole Metronidazole HCl Verapamil HCl Variable Amikacin sulfate Gentamicin sulfate Y-site CompatibilityHID Compatible Acyclovir sodium Amifostine Aztreonam Bivalirudin Cyclophosphamide Dexmedetomidine HCl Diltiazem HCl Docetaxel Etoposide phosphate Famotidine Fenoldopam mesylate Fludarabine phosphate Granisetron HCl Hetastarch in lactated electrolyte injection (Hextend) Hydromorphone HCl Levofloxacin Lorazepam Magnesium sulfate Melphalan HCl Meperidine HCl Midazolam HCl Milrinone lactate Morphine sulfate Ondansetron HCl Pemetrexed disodium Perphenazine Propofol Remifentanil HCl Sargramostim Teniposide Thiotepa Tolazoline HCl Vinorelbine tartrate Incompatible Allopurinol sodium Azithromycin Filgrastim Fluconazole Gemcitabine HCl Hetastarch in sodium chloride 0.9% Pentamidine isethionate Variable Vancomycin HCl Actions and Spectrum Based on spectrum of activity, classified as a third generation cephalosporin. a Usually less active in vitro against susceptible staphylococci than first generation cephalosporins; has an expanded spectrum of activity against gram-negative bacteria compared with first and second generation cephalosporins. a b Usually bactericidal. a Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis. 230 a Spectrum of activity includes many gram-positive aerobic bacteria, some gram-negative aerobic bacteria, and some anaerobic bacteria; inactive against Chlamydia , fungi, and viruses. a Gram-positive aerobes: active in vitro and in clinical infections against S. pneumoniae , S. pyogenes (group A β-hemolytic streptococci), S. agalactiae (group B streptococci), S. aureus (including β-lactamase-producing strains), and some enterococci (e.g., Enterococcus faecalis ). 230 a b Also active in vitro against some viridans streptococci. 350 Oxacillin-resistant (methicillin-resistant) staphylococci and some enterococci are resistant. a b Gram-negative aerobes: active in vitro and in clinical infections against Acinetobacter , Citrobacter , Enterobacter , E. coli , H. influenzae (including ampicillin-resistant strains), H. parainfluenzae , Klebsiella , M. morganii , N. gonorrhoeae , N. meningitidis , P. mirabilis , P. vulgaris , P. rettgeri , P. stuartii , and Serratia . 230 a b Also active in vitro against Campylobacter , 222 223 Capnocytophaga , 312 314 315 Eikenella corrodens , 220 221 249 Moraxella , 232 236 240 244 Salmonella , a b Shigella , a b and Vibrio vulnificus . 292 Active against some strains of Pseudomonas aeruginosa , but less active against susceptible Ps. aeruginosa than ceftazidime. b Anaerobes and other organisms: active in vitro and in clinical infections against Bacteroides , Eubacterium , Fusobacterium , Peptococcus , Peptostreptococcus , Propionibacterium , Veillonella , and some strains of Clostridium . 230 265 a b Also active against the spirochete Borrelia burgdorferi . 265 Advice to Patients Advise patients that antibacterials (including cefotaxime) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold). 230 Importance of completing full course of therapy, even if feeling better after a few days. 230 Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefotaxime or other antibacterials in the future. 230 Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued. 230 Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose. 230 Importance of informing clinicians if an allergic reaction occurs. 230 Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs as well as any concomitant illnesses. 230 Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. 230 Importance of informing patients of other important precautionary information. 230 (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Cefotaxime Sodium Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral For injection 500 mg (of cefotaxime)* Cefotaxime Sodium for Injection Claforan Sanofi-Aventis 1 g (of cefotaxime)* Cefotaxime Sodium for Injection Claforan Sanofi-Aventis 2 g (of cefotaxime)* Cefotaxime Sodium for Injection Claforan Sanofi-Aventis 10 g (of cefotaxime) pharmacy bulk package* Cefotaxime Sodium for Injection Claforan Sanofi-Aventis For injection, for IV infusion 1 g (of cefotaxime) Claforan Sanofi-Aventis Claforan ADD-Vantage Sanofi-Aventis 2 g (of cefotaxime) Claforan Sanofi-Aventis Claforan ADD-Vantage Sanofi-Aventis * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Cefotaxime Sodium in Dextrose Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral Injection (frozen), for IV infusion 20 mg (of cefotaxime) per mL (1 g) in 3.4% Dextrose* Cefotaxime Sodium Iso-osmotic in Dextrose Injection (Galaxy [Baxter]) 40 mg (of cefotaxime) per mL (2 g) in 1.4% Dextrose* Cefotaxime Sodium Iso-osmotic in Dextrose Injection (Galaxy [Baxter]) AHFS DI Essentials. Copyright 2017, Selected Revisions September 30, 2013. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References 2. Hoechst-Roussel Pharmaceuticals Inc. Claforan (cefotaxime sodium) sterile IM IV: clinical and laboratory experience an update. Somerville, NJ; 1981 Oct. 6. Esmieu F, Guibert J, Rosenkilde HC. Pharmacokinetics of cefotaxime in normal human volunteers. J Antimicrob Chemother . 1980; 6(Suppl A):83-92. [PubMed 6252184] 7. Reeves DS, White LO, Holt HA. Human metabolism of cefotaxime. J Antimicrob Chemother . 1980; 6(Suppl A):93-101. [PubMed 6252185] 8. Neu HC, Aswapokee P, Fu KP et al. Cefotaxime kinetics after intravenous and intramuscular injection of single and multiple doses. Clin Pharmacol Ther . 1980; 27:677-85. [PubMed 6245831] 9. Grabe M, Andersson KE, Forsgren A et al. Concentrations of cefotaxime in serum, urine and tissues of urological patients. Infection . 1981; 9:154-8. 10. Luthy R, Munch R, Blaser J et al. Human pharmacology of cefotaxime (HR 756), a new cephalosporin. Antimicrob Agents Chemother . 1979; 16:127-33. [PubMed 485125] 11. Fu K, Aswapokee P, Ho I et al. Pharmacokinetics of cefotaxime. Antimicrob Agents Chemother . 1979; 16:592-7. [PubMed 526000] 12. Wise R, Baker S, Livingston R. Comparison of cefotaxime and moxalactam pharmacokinetics and tissue levels. Antimicrob Agents Chemother . 1980; 18:369-71. [PubMed 6252833] 13. Wise R, Wright N, Wills PJ. Pharmacology of cefotaxime and its desacetyl metabolite in renal and hepatic disease. Antimicrob Agents Chemother . 1981; 19:526-31. [PubMed 6264849] 14. Luthy R, Blaser J, Bonetti A et al. Comparative multiple-dose pharmacokinetics of cefotaxime, moxalactam, and ceftazidime. Antimicrob Agents Chemother . 1981; 20:567-75. [PubMed 6275776] 15. Kafetzis DA, Brater DC, Kanarios J et al. Clinical pharmacology of cefotaxime in pediatric patients. Antimicrob Agents Chemother . 1981; 20:487-90. [PubMed 6282194] 16. Wise R, Wright N. cefotaxime metabolism and renal function. Lancet . 1979; 1:1106-7. 17. Clumeck N, Vanhoof R, Valaethem Y. Cefotaxime and nephrotoxicity. Lancet . 1979; 1:835. 18. Chamberlain J, Coombes JD, Dell D et al. Metabolism of cefotaxime in animals and man. J Antimicrob Chemother . 1980; 6(Suppl A):69-78. [PubMed 6252182] 19. Fillastre JP, Leroy A, Humvert G et al. Pharmacokinetics of cefotaxime in subjects with normal and impaired renal function. J Antimicrob Chemother . 1980; 6(Suppl A):103-11. [PubMed 6252138] 20. Karimi A, Seeger K, Stolke D et al. Cefotaxime concentration of cerebrospinal fluid. J Antimicrob Chemother . 1980; 6(Suppl A):119-20. [PubMed 6252140] 21. Kafetzis DA, Lazarides CV, Siafas CA et al. Transfer of cefotaxime in human milk and from mother to fetus. J Antimicrob Chemother . 1980; 6(Suppl A):135-41. [PubMed 6252147] 39. Kobayashi Y, Morikawa Y, Huruta T et al. Clinical evaluation of cefotaxime in the treatment of purulent meningitis in children. Clin Ther . 1981; 4(Suppl A):89-110. [PubMed 6276000] 48. Neu HC, Aswapokee N, Fu KP et al. Antibacterial activity of a new 1-oxa cephalosporin compared with that of other β-lactam compounds. Antimicrob Agents Chemother . 1979; 16:141-9. [PubMed 314774] 50. Hall WH, Opfer BJ, Gerding DN. Comparative activity of the oxa-β-lactam LY127935, cefotaxime, cefoperazone, cefamandole, and ticarcillin against multiply resistant gram-negative bacilli. Antimicrob Agents Chemother . 1980; 17:273-9. [PubMed 6247970] 59. File TM, Tan JS. Enterococcal sensitivity to third generation cephalosporins. Lancet . 1981; 2:477. [PubMed 6115237] 61. Kurtz TO, Winston DJ, Hindler JA et al. Comparative in vitro activity of moxalactam, cefotaxime, cefoperazone, piperacillin, and aminoglycosides against gram-negative bacilli. Antimicrob Agents Chemother . 1980; 18:645-8. [PubMed 6255864] 64. Lang SDR, Edwards DJ, Durack DT. Comparison of cefoperazone, cefotaxime, and moxalactam (LY127935) against aerobic gram-negative bacilli. Antimicrob Agents Chemother . 1980; 17:488-93. [PubMed 6252831] 65. Barza M, Tally FP, Jacobus NV et al. In vitro activity of LY127935. Antimicrob Agents Chemother . 1979; 16:287-92. [PubMed 507785] 66. Pulliam L, Hadley WK, Mills J. In vitro comparison of third-generation cephalosporins, piperacillin, dibekacin, and other aminoglycosides against aerobic bacteria. Antimicrob Agents Chemother . 1981; 19:490-2. [PubMed 6454384] 68. Wise R, Andrews JM, Bedford KA. LY127935, a novel oxa-β-lactam: an in vitro comparison with other β-lactam antibiotics. Antimicrob Agents Chemother . 1979; 16:341-5. [PubMed 507788] 69. Masuyoshi S, Arai S, Miyamoto M et al. In vitro antimicrobial activity of cefotaxime, a new cephalosporin. Antimicrob Agents Chemother . 1980; 18:1-8. [PubMed 6251749] 70. Cherubin CE, Corrado ML, Sierra MF et al. Susceptibility of gram-positive cocci to various antibiotics, including cefotaxime, moxalactam, and N -formimidoyl thienamycin. Antimi generators
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