Gentamicin + Cefoxitin

Lexi-Comp Online Interaction Monograph

Title Aminoglycosides / Cephalosporins (2nd Generation)

Risk Rating C: Monitor therapy

Summary Cephalosporins (2nd Generation) may enhance the nephrotoxic effect of

Aminoglycosides. Severity Moderate Reliability Rating Fair: Reported in the prescribing
information

Patient Management Increase monitoring for evidence of nephrotoxicity in patients receiving

both an aminoglycoside and a cephalosporin antibiotic.

Aminoglycosides Interacting Members Amikacin; Gentamicin (Systemic); Kanamycin;

Neomycin; Streptomycin; Tobramycin (Systemic)

Cephalosporins (2nd Generation) Interacting Members Cefaclor; Cefminox; CefoTEtan;

Cefotiam; CefOXitin; Cefprozil; Cefuroxime; Flomoxef

Discussion Several studies have identified concurrent cephalosporin treatment as a risk factor for
aminoglycoside nephrotoxicity and/or reported a higher incidence of nephrotoxicity with
concurrent cephalosporin and aminoglycoside.1,2,3 The prescribing information for several
cephalosporins similarly caution that concurrent use with an aminoglycoside may increase the
risk for aminoglycoside nephrotoxicity.4,5,6,7,8

Conversely, an older review of this issue concluded that, other that two older cephalosporins that
are not available anymore, concurrent cephalosporin treatment was not associated with an
increased risk of aminoglycoside nephrotoxicity.9

The mechanism for this apparent interaction is not certain. Cephalosporins may exert a
nephrotoxic effect of their own, leading to an additive effect with the aminoglycosides. However,
the degree to which most currently available cephalosporins are nephrotoxic apart from a
concurrent aminoglycoside is unclear.

Footnotes
1. Krcmery V Jr, Fuchsberger P, Gocar M, et al, Nephrotoxicity of Aminoglycosides,
Polypeptides and Cephalosporins in Cancer Patients, Chemotherapy, 1991, 37(4):287-91.
[PubMed 1790727]
2. Bertino JS Jr, Booker LA, Franck PA, et al, Incidence of and Significant Risk Factors for
Aminoglycoside-Associated Nephrotoxicity in Patients Dosed by Using Individualized
Pharmacokinetic Monitoring, J Infect Dis, 1993, 167(1):173-9. [PubMed 8418164]
3. Zhang Q, Matsumura Y, Teratani T, et al, The Application of an Institutional Clinical Data
Warehouse to the Assessment of Adverse Drug Reactions (ADRs). Evaluation of
Aminoglycoside and Cephalosporin Associated Nephrotoxicity, Methods Inf Med, 2007,
46(5):516-22. [PubMed 17938772]
4. Prescribing information. Claforan (cefotaxime). Bridgewater, NJ: sanofi-aventis U.S. LLC,
September 2011.
5. Prescribing information. Fortaz (ceftazidime). Research Triangle Park, NC: GlaxoSmithKline,
August 2010.
6. Prescribing information. Maxipine (cefepime). Princeton, NJ: Bristol-Myers Squibb Company,
March 2009.
7. Prescribing information. Mefoxin (cefoxitin). Whitehouse Station, NJ: Merck & Co., Inc.,
October 2006.
8. Prescribing information. Cefotan (cefotetan). Wilmington, DE: AstraZeneca Pharmaceuticals
LP, 01/04.
9. Zhanel GG, Cephalosporin-Induced Nephrotoxicity: Does It Exist? DICP, 1990, 24(3):262-
5. [PubMed 2180220]

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