Cefotaxime
CLAFORAN
Pronunciation: sef-oe-TAX-eem
What it isThird-generation PBP-inhibiting cephalosporin; meningitis, pneumonia, and sepsis.
Why this oneUnlike ceftriaxone it does not chelate calcium, so it is the third-generation agent for neonates.
What limits itFrequent dosing and renal adjustment. No pseudomonal cover; supply has been intermittent.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Gonococcal urethritis/cervicitis; rectal gonorrhea (female) | Adults | 0.5 g IM single dose | 0.5 g IM single dose | |
| Rectal gonorrhea (male) | Adults | 1 g IM single dose | 1 g IM single dose | |
| Uncomplicated infections | Adults | 1 g q12h IM or IV | 1 g q12h | 12 g/day |
| Moderate–severe infections | Adults | 1–2 g q8h IM or IV | 1–2 g q8h | 12 g/day |
| Higher-dose infections (e.g. septicemia) | Adults | 2 g q6–8h IV | 2 g q6–8h | 12 g/day |
| Life-threatening infections | Adults | 2 g q4h IV | 2 g q4h | 12 g/day |
| Perioperative prophylaxis | Adults | 1 g IM/IV 30–90 min pre-op | 1 g single dose | |
| General infections | Neonates 0–1 wk | 50 mg/kg/dose q12h IV | 50 mg/kg/dose q12h | |
| General infections | Neonates 1–4 wk | 50 mg/kg/dose q8h IV | 50 mg/kg/dose q8h | |
| General infections (<50 kg) | Infants/children 1 mo–12 y | 50–180 mg/kg/day IM/IV divided into 4–6 doses | 50–180 mg/kg/day divided 4–6× | 12 g/day |
Renal Dose reduction required in renal impairment (per full prescribing PRECAUTIONS; specifics not detailed in this label section)
Hepatic Undefined
Instructions
- IM or IV after reconstitution; IM doses of 2 g divided across different sites
- Do not admix with aminoglycoside solutions — administer separately
- GABHS infection: treat ≥10 days; max 12 g/day
Available strengths
- inj 500, 1000, 2000 mg
Cautions
- Hypersensitivity/anaphylaxis; cross-reactivity in penicillin-allergic patients
- Pseudomembranous colitis
- Life-threatening arrhythmias with rapid (<60 sec) bolus via central catheter
- Encephalopathy with high doses in renal insufficiency; seizures reported
- Positive Coombs; granulocytopenia/neutropenia
Adverse reactions
- Local injection-site reactions (pain, induration, phlebitis)
- Rash, pruritus, fever, eosinophilia
- Colitis, diarrhea, nausea, vomiting
- Transient AST/ALT/LDH/ALP and BUN elevations; neutropenia/leukopenia
Pregnancy No animal embryotoxicity/teratogenicity; crosses placenta; use only if clearly needed
Lactation Undefined
Cost
Cefotaxime (CLAFORAN)
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 500 mg | inj | per unit | not offered | |
| 1000 mg | inj | per unit | not offered | |
| 2000 mg | inj | per unit | not offered |
NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Cefotaxime is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.
NO BOXED WARNINGS
Principal riskFrequent dosing and renal adjustment