CEFOTAXIME AND DEXTROSE 2.4% IN PLASTIC CONTAINER
Clinical safety rating: safe
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
Cefotaxime is a third-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), disrupting peptidoglycan cross-linking, leading to cell lysis.
| Metabolism | Cefotaxime is partially metabolized in the liver to its active metabolite, desacetylcefotaxime. The deacetylation is primarily mediated by esterases. |
| Excretion | Renal: 50-60% unchanged; biliary: 20-30%; fecal: <5% |
| Half-life | 0.8-1.4 hours (normal renal function); ~2-6 hours in renal impairment; prolonged in neonates and elderly |
| Protein binding | 30-50% bound to albumin |
| Volume of Distribution | 0.2-0.4 L/kg; increased in neonates and patients with edema |
| Bioavailability | IV: 100%; IM: 90-100% |
| Onset of Action | IV: immediate; IM: 30-60 minutes |
| Duration of Action | 6-12 hours (dose-dependent); requires dosing every 6-8 hours for serious infections |
| Molecular Weight | 477.45 Da (cefotaxime base) |
1-2 g IV every 6-8 hours; maximum 12 g/day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 20-50 mL/min: 1-2 g every 8-12 hours. CrCl <20 mL/min: 1-2 g every 12-24 hours. |
| Liver impairment | No adjustment required for hepatic impairment. |
| Pediatric use | Neonates (0-7 days): 25-50 mg/kg IV every 12 hours. Infants and children (1 month-12 years): 50-100 mg/kg/day IV divided every 6-8 hours. Maximum 12 g/day. |
| Geriatric use | No specific adjustment; consider renal function and reduce dose accordingly based on CrCl. |
| 1st trimester | Generally considered safe; no evidence of teratogenicity in animal studies. Use if clearly needed. |
| 2nd trimester | Safe to use; no known risk of fetal harm. |
| 3rd trimester | Safe to use; no known risk of fetal harm or neonatal adverse effects. |
Clinical note
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
| FDA category | Human |
| Placental transfer | Cefotaxime crosses the placenta. Fetal serum concentrations are approximately 10-20% of maternal serum concentrations. |
| Breastfeeding | Cefotaxime is excreted into breast milk in low concentrations, unlikely to cause adverse effects in the infant. Use caution in infants with glucose-6-phosphate dehydrogenase deficiency or diarrhea. The American Academy of Pediatrics considers cefotaxime compatible with breastfeeding. |
■ FDA Black Box Warning
There is no FDA black box warning for cefotaxime.
| Common Effects | Diarrhea |
| Serious Effects |
History of anaphylactic reaction to cefotaxime or any cephalosporinHistory of severe hypersensitivity (e.g., anaphylaxis) to penicillins or other beta-lactam antibiotics
| Precautions | Serious hypersensitivity reactions (anaphylaxis) may occur, especially in patients with a history of penicillin allergy., Clostridioides difficile-associated diarrhea (CDAD) can occur with antibiotic use., Prolonged use may result in superinfection with non-susceptible organisms., Seizures have been reported, particularly in patients with renal impairment when doses are not adjusted., Use with caution in patients with renal impairment; dosage adjustment is necessary., Interference with laboratory tests (e.g., false-positive Coombs test, false-positive urine glucose). |
| Food/Dietary |
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| Lactation Rating | L1 (Safe) |
| Teratogenic Risk | Cefotaxime is classified as FDA Pregnancy Category B. No evidence of teratogenicity in animal studies, but adequate human studies are lacking. Crosses placenta; theoretical risk of altering fetal gut flora. Use only if clearly needed. |
| Fetal Monitoring | Monitor for maternal allergic reactions, injection site reactions, and signs of superinfection. Monitor neonatal bilirubin and glucose if used near term or in neonate. |
| Fertility Effects | No known adverse effects on fertility in animal studies. No human data available. Likely no significant impact. |
| No significant food interactions. However, avoid alcohol consumption during treatment and for 48 hours after discontinuation due to potential disulfiram-like reaction (nausea, vomiting, flushing). |
| Clinical Pearls | Cefotaxime is a third-generation cephalosporin with broad-spectrum coverage, including gram-negative bacteria. It is often used for empiric therapy in serious infections like meningitis, sepsis, and pneumonia. Note that cefotaxime has poor activity against Pseudomonas aeruginosa and some anaerobes—consider adding metronidazole if anaerobic coverage is needed. It penetrates well into the CNS, making it a first-line option for community-acquired meningitis. In patients with a history of immediate hypersensitivity to penicillins, avoid cephalosporins due to cross-reactivity risk. Reconstituted solution should be used within 24 hours if stored at room temperature or 7 days if refrigerated. Do not mix with aminoglycosides in the same solution; administer separately. |
| Patient Advice | This medication is given intravenously to treat bacterial infections. Complete the entire course even if you feel better. · Report any signs of allergic reaction such as rash, itching, swelling, or difficulty breathing immediately. · You may experience diarrhea; if it becomes severe or bloody, contact your healthcare provider. · Avoid alcohol while on this medication and for 48 hours after stopping, as it may cause a disulfiram-like reaction. · Inform your doctor about all other medicines you take, especially blood thinners or aminoglycosides. |