CEFOXITIN AND DEXTROSE IN DUPLEX CONTAINER
Clinical safety rating: safe
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
Cefoxitin is a cephamycin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), disrupting peptidoglycan cross-linking. It is resistant to many beta-lactamases.
| Metabolism | Cefoxitin is not extensively metabolized; it undergoes deacylation by esterases in the liver to inactive metabolites. Primarily excreted unchanged in urine via glomerular filtration and tubular secretion. |
| Excretion | Renal: 85-90% unchanged via glomerular filtration and tubular secretion; biliary: <5%; fecal: <1% |
| Half-life | Terminal elimination half-life: 0.7-1.1 hours (normal renal function); prolonged to 5-13 hours in severe renal impairment (CrCl <10 mL/min) |
| Protein binding | 65-75% bound to serum albumin |
| Volume of Distribution | 0.15-0.25 L/kg; approximates extracellular fluid volume, low tissue penetration |
| Bioavailability | Not applicable (parenteral only); IV administration yields 100% bioavailability |
| Onset of Action | Intravenous: immediate (within minutes) for susceptible bacteria |
| Duration of Action | 6-8 hours (dose-dependent); requires q6-8h dosing due to short half-life |
| Molecular Weight | 427.45 Da |
1-2 g IV every 6-8 hours. Maximum 12 g/day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 30-50 mL/min: 1-2 g every 8-12 hours. CrCl 10-29 mL/min: 1-2 g every 12-24 hours. CrCl <10 mL/min: 0.5-1 g every 24-48 hours. |
| Liver impairment | No dose adjustment required for hepatic impairment. |
| Pediatric use | Infants and children: 80-160 mg/kg/day IV divided every 4-6 hours. Neonates: 80-100 mg/kg/day IV divided every 6-8 hours. |
| Geriatric use | Dose adjustment based on renal function; consider decreased clearance and increased risk of bleeding. |
| 1st trimester | Cefoxitin crosses the placenta. Animal studies have not shown fetal harm, but adequate human studies in first trimester are lacking. Use only if clearly needed. |
| 2nd trimester | No evidence of teratogenicity. Considered safe based on animal data and limited human experience. Use when benefit outweighs risk. |
| 3rd trimester | Generally considered safe. May be used for intrapartum prophylaxis (e.g., cesarean section). No known adverse fetal effects. |
Clinical note
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
| FDA category | Human |
| Placental transfer | Cefoxitin readily crosses the placenta. Fetal serum concentrations are approximately 50-100% of maternal serum concentrations after intravenous administration. |
■ FDA Black Box Warning
Cefoxitin contains no black box warning.
| Common Effects | Diarrhea |
| Serious Effects |
Hypersensitivity to cefoxitin or other cephalosporinsHypersensitivity to penicillin (cross-sensitivity)Severe immediate hypersensitivity reactions to beta-lactams
| Precautions | Serious and occasionally fatal hypersensitivity reactions (anaphylaxis) may occur, especially in patients with penicillin allergy, Clostridium difficile-associated diarrhea (CDAD) may occur and range from mild diarrhea to fatal colitis, Prolonged use may result in superinfection with nonsusceptible organisms, Dosage adjustment required in renal impairment (creatinine clearance <50 mL/min), May cause false-positive glucose test with copper reduction methods (Clinitest) and false-positive direct Coombs test |
| Food/Dietary |
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| Breastfeeding |
| Cefoxitin is excreted into breast milk in low concentrations (less than 1% of maternal dose). It is unlikely to cause adverse effects in nursing infants due to poor oral bioavailability. However, theoretical risks of alteration of infant gut flora and diarrhea exist. Use with caution, especially in neonates with jaundice or glucose-6-phosphate dehydrogenase deficiency. |
| Lactation Rating | L2 (Safe) |
| Teratogenic Risk | Cefoxitin is a beta-lactam cephalosporin. Animal studies have not shown teratogenic effects, and there are no adequate well-controlled studies in pregnant women. However, cephalosporins are generally considered low risk in pregnancy. Use in pregnancy only if clearly needed. No specific fetal risks have been identified in any trimester. |
| Fetal Monitoring | No specific fetal monitoring is required. Standard maternal monitoring for antibiotic therapy, including renal function, signs of hypersensitivity, and gastrointestinal side effects. For prolonged therapy, periodic monitoring of liver enzymes and complete blood counts is recommended. |
| Fertility Effects | No adverse effects on fertility or reproductive performance have been reported in animal studies. No human data are available. |
| No significant food interactions. Maintain adequate hydration unless fluid restricted. |
| Clinical Pearls | Cefoxitin is a cephamycin antibiotic with activity against anaerobes including Bacteroides fragilis. It is often used for surgical prophylaxis, especially in colorectal surgery. Administer IV over 30-60 minutes. Dose adjustment required for renal impairment (CrCl <50 mL/min). Monitor for hypersensitivity reactions, as cross-allergy with penicillins may occur. The DUPLEX container is a dual-chamber system; activate by squeezing and mixing before use; do not use if leaks or particulate matter present. |
| Patient Advice | This medication is given intravenously to treat or prevent infections. · Tell your healthcare provider if you are allergic to penicillins, cephalosporins, or other antibiotics. · Report any signs of allergic reaction: rash, hives, difficulty breathing, swelling. · Inform your doctor if you have kidney problems, as dose adjustments may be needed. · Diarrhea may occur; contact your doctor if it becomes severe or persistent. · This medication may cause dizziness; avoid driving if affected. |