MEFOXIN IN DEXTROSE 5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for MEFOXIN IN DEXTROSE 5% IN PLASTIC CONTAINER (MEFOXIN IN DEXTROSE 5% IN PLASTIC CONTAINER).
Cefoxitin is a cephamycin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death. It is active against a broad spectrum of gram-positive and gram-negative aerobic and anaerobic bacteria.
| Metabolism | Cefoxitin is not significantly metabolized; it is primarily excreted unchanged by the kidneys via glomerular filtration and tubular secretion. |
| Excretion | Renal: 85% unchanged via glomerular filtration and tubular secretion. Biliary: <1%. Fecal: <1%. |
| Half-life | Terminal elimination half-life: 0.7-1.1 hours (normal renal function). In anuria: 13-23 hours. Clinical context: Dosing interval adjustment required for CrCl <50 mL/min. |
| Protein binding | ~73% bound to serum albumin. |
| Volume of Distribution | 0.13-0.27 L/kg (approximates extracellular fluid volume). Clinical meaning: Low distribution, primarily in extracellular space. |
| Bioavailability | IV: 100% (bioavailability not applicable). No oral formulation. |
| Onset of Action | IV: Immediate; peak serum concentrations achieved by end of infusion. IM: Not applicable (IV use only). |
| Duration of Action | 4-8 hours (bactericidal levels maintained). Clinical note: Prolonged in renal impairment. |
1-2 g IV every 6-8 hours (Cefoxitin).
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 30-50 mL/min: 1-2 g IV every 8-12 hours; CrCl 10-29 mL/min: 1-2 g IV every 12-24 hours; CrCl <10 mL/min: 1-2 g IV every 24-48 hours. |
| Liver impairment | No dose adjustment required for Child-Pugh A or B. For Child-Pugh C, use with caution and monitor; no specific dosing guidelines. |
| Pediatric use | Neonates: 20-40 mg/kg/dose IV every 12 hours; Infants and children: 20-40 mg/kg/dose IV every 6-8 hours. Maximum 12 g/day. |
| Geriatric use | Adjust dose based on renal function; may require lower doses or extended intervals due to age-related decline in CrCl. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for MEFOXIN IN DEXTROSE 5% IN PLASTIC CONTAINER (MEFOXIN IN DEXTROSE 5% IN PLASTIC CONTAINER).
| Breastfeeding | Cefoxitin is excreted into human breast milk in low concentrations (M/P ratio approximately 0.1-0.3). It is considered compatible with breastfeeding due to poor oral bioavailability in infants. However, monitor for potential diarrhea or allergic reaction in the nursing infant. |
| Teratogenic Risk | Cefoxitin is a beta-lactam antibiotic classified as FDA Pregnancy Category B. Animal studies have not demonstrated fetal risk, but no adequate and well-controlled studies in pregnant women exist. First trimester: No evidence of teratogenicity; use only if clearly needed. Second and third trimesters: Considered safe; crosses placenta but no known adverse fetal effects. |
■ FDA Black Box Warning
No black box warning.
| Serious Effects |
["Hypersensitivity to cefoxitin or any cephalosporin","Hypersensitivity to other beta-lactam antibiotics (e.g., penicillins) with severe reactions"]
| Precautions | ["Hypersensitivity reactions including anaphylaxis","Clostridium difficile-associated diarrhea","Renal impairment: dose adjustment required","Prolonged use may result in superinfection","Coagulation abnormalities","Seizures (especially with high doses in renal impairment)"] |
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| Fetal Monitoring | Monitor maternal renal function and CBC with differential during prolonged therapy. In neonates exposed in utero, monitor for signs of infection (e.g., hypothermia, poor feeding). No specific fetal monitoring required beyond routine obstetrical care. |
| Fertility Effects | No known adverse effects on fertility or reproductive performance in animal studies. Human data lacking; not expected to impair fertility. |