CEFIZOX IN DEXTROSE 5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CEFIZOX IN DEXTROSE 5% IN PLASTIC CONTAINER (CEFIZOX IN DEXTROSE 5% IN PLASTIC CONTAINER).
Ceftizoxime is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death. It has broad-spectrum activity against gram-positive and gram-negative bacteria.
| Metabolism | Ceftizoxime is not significantly metabolized; it is excreted unchanged primarily via renal glomerular filtration and tubular secretion. |
| Excretion | Renal: 80–90% unchanged via glomerular filtration and tubular secretion. Biliary/fecal: <10%. |
| Half-life | 1.5–2 hours in normal renal function; extends to 20–30 hours in ESRD. Dose adjustment required for CrCl <50 mL/min. |
| Protein binding | 85% primarily to albumin. |
| Volume of Distribution | 0.2–0.3 L/kg; indicates distribution primarily in extracellular fluid. |
| Bioavailability | IM: ~100%. |
| Onset of Action | IV: Immediate; IM: 30–60 minutes. |
| Duration of Action | 6–8 hours for susceptible infections; dosing every 6–12 hours based on severity and renal function. |
1-2 g IV every 8-12 hours; maximum 12 g/day
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 50-79 mL/min: 1-2 g every 12 hours; CrCl 30-49 mL/min: 1-2 g every 18 hours; CrCl 10-29 mL/min: 1-2 g every 24 hours; CrCl <10 mL/min: 0.5-1 g every 24 hours |
| Liver impairment | No specific adjustment required; use with caution in severe hepatic impairment |
| Pediatric use | Neonates: 50 mg/kg IV every 12 hours; Infants and children: 50 mg/kg IV every 8 hours; maximum 2 g per dose |
| Geriatric use | Initiate at lower end of dosing range; adjust dose based on renal function |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CEFIZOX IN DEXTROSE 5% IN PLASTIC CONTAINER (CEFIZOX IN DEXTROSE 5% IN PLASTIC CONTAINER).
| Breastfeeding | Ceftizoxime is excreted into human breast milk in low concentrations. The milk-to-plasma (M/P) ratio is approximately 0.08–0.15. It is considered compatible with breastfeeding, as amounts ingested are unlikely to cause adverse effects in the infant. However, monitor for potential disruption of infant gastrointestinal flora or diarrhea. |
| Teratogenic Risk | Ceftizoxime is a cephalosporin antibiotic classified as FDA Pregnancy Category B. Animal studies have not demonstrated fetal risk, and there are no adequate and well-controlled studies in pregnant women. However, cephalosporins are generally considered safe in pregnancy. There is no known teratogenic risk in the first trimester; use in the second and third trimesters is also considered low risk, but caution is advised due to potential for altered pharmacokinetics. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Hypersensitivity to ceftizoxime or any cephalosporin antibiotic","Hypersensitivity to penicillins or other beta-lactam antibiotics (cross-sensitivity)"]
| Precautions | ["Hypersensitivity reactions, including anaphylaxis, may occur, especially in patients with a history of penicillin allergy.","Clostridium difficile-associated diarrhea (CDAD) may occur and range from mild diarrhea to fatal colitis.","Dosage adjustment is required in patients with renal impairment.","Prolonged use may result in superinfection with resistant organisms."] |
| Food/Dietary | No specific food interactions. Avoid alcohol due to risk of disulfiram-like reaction (nausea, vomiting, headache, flushing). |
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| Fetal Monitoring | Monitor maternal renal function, as ceftizoxime is primarily renally excreted and pregnancy-induced increases in glomerular filtration rate may affect clearance. Monitor for signs of hypersensitivity or superinfection. Fetal monitoring is not routinely required, but ultrasound may be considered if prolonged high-dose therapy is needed. |
| Fertility Effects | No specific fertility studies in humans. Animal studies have not shown impaired fertility. Ceftizoxime is not known to adversely affect reproductive function. |
| Clinical Pearls | Cefizox (ceftizoxime) is a third-generation cephalosporin with poor activity against Enterococcus and Pseudomonas aeruginosa. In dextrose 5% solution, monitor for infusion reactions, especially in patients with renal impairment. For empiric therapy of intra-abdominal infections, consider adding metronidazole for anaerobic coverage. Use with caution in penicillin-allergic patients due to ~10% cross-reactivity. |
| Patient Advice | This medication is given intravenously; report any pain, redness, or swelling at the injection site. · Notify your healthcare provider if you develop a rash, itching, or difficulty breathing, which may indicate an allergy. · Diarrhea, especially watery or bloody, may occur; contact your doctor if severe or persistent. · Avoid alcohol during treatment and for at least 48 hours after the last dose to prevent disulfiram-like reactions. · Tell your doctor if you have kidney disease, as dose adjustments may be needed. |