MEFOXIN IN SODIUM CHLORIDE 0.9% IN PLASTIC CONTAINER
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Cefoxitin is a cephamycin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death.
| Metabolism | Cefoxitin is not significantly metabolized; primarily excreted unchanged in urine via glomerular filtration and tubular secretion. |
| Excretion | Renal: ~85% unchanged; biliary/fecal: ~15% as active metabolite and unchanged drug. |
| Half-life | Terminal elimination half-life: 0.7–1.1 hours in normal renal function; prolonged to 5–10 hours in severe renal impairment (CrCl <10 mL/min). |
| Protein binding | 73% (primarily albumin). |
| Volume of Distribution | 0.13–0.22 L/kg; indicates distribution mainly into extracellular fluid. |
| Bioavailability | IM: ~100%. |
| Onset of Action | IV: immediate; IM: within 15–30 minutes. |
| Duration of Action | 6–8 hours for susceptible organisms; may require more frequent dosing in severe infections. |
| Molecular Weight | 427.45 |
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 hours; CrCl 10-29 mL/min: 1-2 g every 12 hours; CrCl <10 mL/min: 1-2 g every 24-48 hours. |
| Liver impairment | No adjustment required for hepatic impairment. |
| Pediatric use | 3 months to 12 years: 80-160 mg/kg/day IV divided every 6-8 hours. Maximum 12 g/day. |
| Geriatric use | Based on renal function; CrCl 30-50 mL/min: 1-2 g every 8 hours; CrCl 10-29 mL/min: 1-2 g every 12 hours; CrCl <10 mL/min: 1-2 g every 24-48 hours. |
| 1st trimester | Cefoxitin crosses the placenta. Animal studies show no teratogenicity, but human data are limited. Use only if clearly needed. |
| 2nd trimester | No known fetal risk based on available data. Considered compatible with pregnancy when clinically indicated. |
| 3rd trimester | Generally considered safe; no known adverse effects on the fetus or neonate. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Cefoxitin crosses the placenta, achieving maternal-fetal serum ratios of approximately 1:0.5–1.0 at term. |
| Breastfeeding | Cefoxitin is excreted into breast milk in low concentrations. It is considered compatible with breastfeeding; however, diarrhea or allergic reactions in the infant are possible. Monitor infant for gastrointestinal disturbances. |
| Lactation Rating | L2 (Probably Compatible) |
| Teratogenic Risk | Cefoxitin is a second-generation cephalosporin classified as FDA Pregnancy Category B. No evidence of teratogenicity in animal studies. Inadequate human data; risk cannot be ruled out. First trimester: unlikely to cause major malformations based on limited data. Second and third trimesters: no documented fetal harm. However, use only if clearly needed. |
| Fetal Monitoring | Monitor maternal renal function (creatinine, BUN) and liver function tests periodically, especially in prolonged therapy. Monitor for signs of superinfection (oral thrush, vaginal candidiasis) and diarrhea (antibiotic-associated colitis). No specific fetal monitoring required. |
| Fertility Effects | No known adverse effects on fertility in animal studies. Limited human data; no evidence of impaired fertility or reproductive performance. Theoretical risk of alterations in gut flora with prolonged use, but not established. |
■ FDA Black Box Warning
No FDA black box warning.
| Common Effects | fluid replacement |
| Serious Effects |
Hypersensitivity to cefoxitinHypersensitivity to cephalosporinsHistory of severe immediate hypersensitivity reaction to penicillins or other beta-lactams
| Precautions | Hypersensitivity reactions including anaphylaxis, Clostridium difficile-associated diarrhea (CDAD), Prolonged use may result in superinfection, Dose adjustment required in renal impairment, May cause false-positive urine glucose tests with copper reduction methods, Use with caution in patients with history of gastrointestinal disease |
| Food/Dietary | No significant food interactions. However, alcohol should be avoided to prevent disulfiram-like reactions (rare). Maintain adequate hydration. |
| Clinical Pearls | MEFOXIN (cefoxitin) is a cephamycin antibiotic with activity against anaerobes, including Bacteroides fragilis. Use for surgical prophylaxis, intra-abdominal infections, and pelvic inflammatory disease. Note that it has poor activity against Pseudomonas and Enterococci. Administer 1-2 g IV every 6-8 hours; dose adjustment required in renal impairment (CrCl <50 mL/min). May cause false-positive urine glucose with Clinitest but not with glucose oxidase methods. Can prolong prothrombin time; monitor INR in patients on warfarin. |
| Patient Advice | Complete the full course of antibiotics even if you feel better. · Report any severe diarrhea, rash, or difficulty breathing to your healthcare provider. · This medication is given intravenously; do not mix with other drugs in the same IV line without consulting a pharmacist. · If you have a history of allergic reactions to penicillins or cephalosporins, inform your doctor. · Monitor for signs of bleeding (easy bruising, dark stools) if you are taking blood thinners. |
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