cefoxitin sodium: clinical use

Prescribing considerations

• Seek input from a clinician with appropriate infectious-disease expertise.
• Confirm that the likely or proven pathogen is susceptible and that more commonly prescribed antibacterials are inappropriate.
• Review beta-lactam allergy history carefully.
• Assess kidney function because renal impairment markedly prolongs elimination.
• Consider sodium content in patients requiring sodium restriction.
• Cefoxitin is not indicated for bacterial meningitis.

Contraindications and cautions

• Hypersensitivity to cefoxitin, another cephalosporin or a listed excipient.
• Previous severe hypersensitivity, such as anaphylaxis, to another beta-lactam antibacterial, including a penicillin, monobactam or carbapenem.

Monitoring

• Renal function, particularly in impairment or with aminoglycosides or loop diuretics.
• Clinical response, microbiology and emergence of non-susceptible organisms.
• Severe or persistent diarrhoea during or after treatment.
• Neurological status when renal function is reduced or encephalopathy is suspected.
• Blood count and hepatic or renal biochemistry where clinically appropriate.
• INR when clinically indicated in patients receiving oral anticoagulants.
• Interpret Coombs, glycosuria, Jaffe creatinine and certain urinary corticosteroid tests cautiously because interference can occur.

Clinical pharmacology

A second-generation cephalosporin beta-lactam. It is protein-bound, undergoes no significant metabolism and is eliminated largely unchanged through the kidneys; renal impairment substantially extends its half-life.

Formulation and product differences

• The selected product is a white or almost-white powder for intravenous injection or infusion.
• The powder contains cefoxitin sodium without additional excipients.
• Reconstituted preparations are generally intended for immediate use; compatible diluents and product-specific stability conditions must be followed.
• If another intravenous antibiotic is given concurrently, use separate syringes or infusions.

Injection

Route: Parenteral

Strengths: 1 g, 2 g