KRISTI WRAY DRUG NAME CLASS/FAMILY MECHANISM OF ACTION Generic: cefoxitin sodium Trade Name: Mefoxin ANTIBIOTIC; SECOND-GENERATION

CEPHALOSPORIN Semisynthetic, broad-spectrum beta-lactam antibiotic classified as secondgeneration cephalosporin; structurally and pharmacologically related to cephalosporins and penicillins. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms, thus making it bactericidal. It shows enhanced activity against a wide variety of gram-negative organisms and is effective for mixed aerobic-anaerobic infections. Infections caused by susceptible organisms in the lower respiratory tract, urinary tract, skin and skin structures, bones and joints; also intra-abdominal endocarditis, gynecologic infections, septicemia, uncomplicated gonorrhea, and perioperative prophylaxis in prosthetic arthroplasty or cardiovascular surgery. May be cephalosporin of choice for mixed aerobic-anaerobic infections (e.g., Bacteroides fragilis). Possible infection from surgery.

INDICATIONS

WHY IS YOUR PATIENT GETTING THIS MEDICINE ROUTES PATIENT DOSAGE COMMON DOSAGE

IV, IM 1gm IV q6h Moderate to Severe Infections Adult: IV/IM 12 g q68h, up to 12 g/day Child (older than 3 mo): IV/IM 80160 mg/kg/day in 46 divided doses (max: 12 g/day) Surgical Prophylaxis Adult: IV/IM 2 g 3060 min before surgery, then 2 g q6h for 24 h Child: IV/IM 3040 mg/kg 3060 min before surgery, then 3040 mg q6h for 24 h Cesarean Surgery Adult: IV/IM 2 g after clamping umbilical cord

PHARMACOKINETICS

FOR IV MEDS, COMPATIBILITY WITH IV DRIPS AND OR SOLUTIONS

Renal Impairment Dosage Adjustment CrCl 3050 mL/min: 12 g q812h; 1029 mL/min: 12 g q1224h; 59 mL/min: 0.51 g q1224h; greater than 5 mL/min: 0.51 g q2448h Hemodialysis Dosage Adjustment: Dose of 1 2 g post dialysis Peak: 2030 min after IM; 5 min after IV. Distribution: Poor CNS penetration even with inflamed meninges; widely distributed in body tissues including pleural, synovial, and ascitic fluid and bile; crosses placenta. Elimination: 85% unchanged in urine in 6 h, small amount in breast milk. Half-Life: 4560 min. Intravenous IV administration to neonates, infants and children: Verify correct IV concentration and rate of infusion/injection with physician. Prepare: Direct:

Rconstitue each 1 g with 10 mL sterile water, D5W, or NS. Intermittent: Following reconstitution, dilute 12 g in 50100 mL of D5W or NS. Continuous: Dilute large doses in 1000 mL of D5W or NS. Administer: Direct: Give over 35 min. Intermittent: Give over 15 min Continuous: Give at a rate determined by the volume of solution. Reconstituted solution may become discolored (usually light yellow to amber) if exposed to high temperatures; however, potency is not affected. Solution may be cloudy immediately after reconstitution; let stand and it will clear.

Incompatibilities: Solution/additive: AMINOGLYCOSIDES, ranitidine. Y-site: AMINOGLYCOSIDES, cisatracurium, fenoldopam, filgrastim, hetastarch, lansoprazole, pentamidine, vancomycin. After reconstitution, solution is stable for 24 h at 25 C (77 F); 7 days when refrigerated at 4 C (39 F), or 30 wk when frozen at 20 C (4 F). LAB VALUE ALTERATIONS CAUSE BY THIS MED Cefoxitin causes false-positive (black-brown or green-brown color) urine glucose reaction with copper reduction reagents such as Benedict's or Clinitest, but not with enzymatic glucose oxidase reagents (Clinistix, TesTape). With high doses, falsely elevated serum and urine creatinine (with Jaffe reaction) reported. Falsepositive direct Coombs' test (may interfere with cross-matching procedures and hematologic studies) has also been reported. Hypersensitivity to cephalosporins and related antibiotics. History of sensitivity to penicillin or other allergies, particularly to drugs; impaired renal function; coagulopathy; GI disease, colitis; pregnancy ( category B). Drug: Probenecid decreases renal elimination of cefoxitin. Body as a Whole: Drug fever, eosinophilia, superinfections, local reactions: pain, tenderness, and induration (IM site), thrombophlebitis (IV site). GI: Diarrhea, pseudomembranous colitis. Skin: Rash, exfoliative dermatitis, pruritus, urticaria. Urogenital: Nephrotoxicity, interstitial nephritis.

CONTRAINDICATIONS/P RECAUTIONS

INTERACTIONS ADVERSE/SIDE EFFECTS

KRISTI WRAY IMP NURS RESPONSIBILITIES Determine previous hypersensitivity to cephalosporins, penicillins, and other drug allergies before therapy is initiated. Lab tests: Perform culture and sensitivity testing prior to therapy; periodic renal function tests. Inspect injection sites regularly. Report evidence of inflammation and patient's complaint of pain. Monitor I&O rates and pattern: Nephrotoxicity occurs most frequently in patients older than 50 y, in patients with impaired renal function, the debilitated, and in patients receiving high doses or other nephrotoxic drugs. Be alert to S&S of superinfections ( see Appendix F"). This condition is most apt to occur in older adult patients, especially when drug has been used for prolonged period. Report onset of diarrhea (may be dose related). If severe, pseudomembranous colitis (see Signs & Symptoms, Appendix F) must be ruled out. Older adult patients are especially susceptible. Report promptly S&S of superinfection ( see Appendix F"). Report watery or bloody loose stools or severe diarrhea. Report severe vomiting or stomach pain. Report infusion site swelling, pain, or redness.

PT/FAMILY TEACHING