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Cefotaxime

  • Description and indication for use

    Cefotaxime is a semisynthetic, third-generation cephalosporin.  It is active against both Gram +ve and Gram -ve organisms.  It is used in the treatment of infection when sensitivity testing indicates susceptibility.  It is combined with Amoxycillin for treatment of meningitis until the organism is identified and sensitivity is confirmed.

    Dose

    IV and IM:    

    50 mg/kg/dose.

    VLBW 12 hourly 
    Term  
       Week 1 12 hourly 
       Week 2 to 4 8 hourly 
       >4 weeks 6 hourly 

    Reconstitution/Dilution

    Vial = 1g.

    IV:

    Add 9.6 mL of water for injection to vial = 1 g in 10 mL is equivalent to 100 mg/mL.

    May be further diluted with sodium chloride 0.9% to 50 mg/mL.

    IM:

    Add 3.6 mL of water for injection = 1 g in 4 mL is equivalent to 250 mg/mL.

    Reconstituted solution is stable for 24 hours when stored under refrigeration.

    Route and method of administration

    IV:

    100 mg/mL or 50 mg/mL solution given slowly over at least 3-5 minutes.   

    IM:

    250 mg/mL solution.  Not Recommended, but may be useful for larger babies with no IV access.

    Side effects

    Hypersensitivity (not commonly seen in neonates).

    Phlebitis.

    Diarrhoea.

    Nephrotoxicity 

    Leukopenia, eosinophilia, granulocytopaenia.

    Special precautions

    CAUTION in patients with renal impairment.

    Contraindications

    Hypersensitivity to cephalosporins.

    Incompatibilities

    Cefotaxime must not be mixed together with the following drugs:

    Sodium bicarbonate, aminoglycosides (gentamicin, amikacin and tobramycin), doxapram, fluconazole, aminophylline.

    Drug interactions

    Aminoglycosides Nephrotoxicity of both drugs may be increased.  However, Cefotaxime is sometimes used together with Aminoglycosides as there is evidence of a synergistic effect when used in combination.  Careful monitoring of Aminoglycoside levels should reduce incidence/severity of Nephrotoxicity. 

    Nursing responsibilities

    Observe site for phlebitis.

    Record volume on IV fluid chart - large volume drug.

Disclaimer:  This Drug information was designed for use by PIPER Neonatal. Whilst great care has been taken to check the information is accurate, it is possible that errors may have been missed. Furthermore, dosage schedules are continually being revised and new side effects recognised. For these reasons, the reader is strongly advised to consult the drug companies' printed information before administering any of the drugs recommended in this book.
Most drugs in this document are appropriate only for specialist use in hospitals.  A number of drugs should only be used in consultation with the appropriate Paediatric subspecialist. 

Note: The electronic version of this guideline is the version currently in use.  Any printed version cannot be assumed to be current. Printed copies of this document are valid for