Cefotaxime

Class: Third-Generation Cephalosporin

Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death.

Indications

• Sepsis and bacteremia
• Meningitis (bacterial)
• Lower respiratory tract infections (pneumonia, bronchitis)
• Urinary tract infections
• Skin and soft tissue infections
• Gonorrhea
• Intra-abdominal infections (often with metronidazole)

Dosage

• Children: 50 mg/kg/dose every 6–8 hours (Meningitis: 200 mg/kg/day divided every 6–8 hrs, Max 12 g/day)
• Adults: 1–2 g every 8–12 hours (Meningitis/Severe infections: up to 2 g every 4–6 hours, Max 12 g/day)

Major Side Effects

• Diarrhea, nausea, vomiting
• Allergic reactions (rash, urticaria, anaphylaxis)
• Injection site pain/phlebitis
• Elevated liver enzymes
• Rare: Hematologic disorders (leukopenia, thrombocytopenia, eosinophilia)

Contraindications

• Known hypersensitivity to cephalosporins
• History of severe immediate hypersensitivity to penicillins (cross-reactivity risk)

Compatible Fluids

• 0.9% Sodium Chloride
• 5% Dextrose
• Ringer’s Lactate (use immediately after preparation)

Route of Administration

• Intravenous (IV)
• Intramuscular (IM)

Type of Administration

• IV bolus (slow injection over 3–5 min)
• IV infusion (30–60 min)
• Deep IM injection

Special Precautions

• Adjust dose in renal impairment (especially if CrCl < 20 mL/min)
• Use cautiously in patients with history of allergy to beta-lactams
• Monitor for C. difficile-associated diarrhea
• Concurrent use with aminoglycosides increases nephrotoxicity risk