Drug reference

Cefotaxime

Cephalosporin · Antibacterial

CephalosporinAntibacterial

CDSCO approvedSchedule H

EXCRETION

—

not curated

INTERACTIONS

—

none in our sources

PREGNANCY

Not known to be harmful

FDA category + note

Mechanism

Cefotaxime, a third-generation cephalosporin and beta-lactam antibiotic, inhibits bacterial cell wall synthesis. It achieves this by covalently binding to and inactivating penicillin-binding proteins (PBPs), which are transpeptidases essential for peptidoglycan cross-linking. This disruption in cell wall construction leads to a structurally unstable cell wall, increased osmotic pressure, bacterial lysis, and ultimately cell death.

Indications

Meningococcal septicaemia (as an alternative in penicillin allergy)Suspected bacterial meningitis without non-blanching rash (as an alternative in penicillin allergy if urgent transfer to hospital is not possible)Meningitis with non-blanching rash or meningococcal septicaemia (as an alternative in penicillin allergy before urgent transfer to hospital)Initial empirical therapy for meningitis of unknown aetiology in adults and children 3 months-50 years (in hospital)Endocarditis caused by Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella species (HACEK micro-organisms) if amoxicillin-resistant (used with low-dose gentamicin)Community-acquired pneumoniaMeningitisUrinary tract infectionsStreptococcal endocarditisEmpiric treatment of suspected bacterial meningitis in patients at risk for L. monocytogenesAerobic gram-negative and some gram-positive bacteria (potent action)Meningitis caused by gram-negative bacilli (attains relatively high CSF levels)Life-threatening resistant/hospital-acquired infectionsSepticaemiasInfections in immunocompromised patientsTyphoid fever (alternative to ceftriaxone)PPNG urethritis (single dose therapy with probenecid)Spontaneous bacterial peritonitis (SBP)Moderate/severe leptospirosis

Dosing

Adult: Gonorrhoea: 500 mg IM single dose. Standard infections: 1 g every 12h IV/IM. Severe infections/meningitis: 2 g every 6-8h IV. Emergency meningitis: 8 g daily in 4 divided doses, up to 12 g daily.
Pediatric: 1 month-11 years: 50 mg/kg IV for single dose. Neonates: consult specialist.
Renal adjustment: Reduce dose in severe renal impairment
Max dose: 12 g daily (emergency meningitis)

Pharmacokinetics

Half-life

about 1 h

Protein binding

penetration into CSF is good

Metabolism

Cefotaxime is partially converted to desacetyl cefotaxime.

Contraindications

Cephalosporin hypersensitivity
Caution in penicillin allergy (cross-reactivity ~1%)

Side effects

Common

ThrombocytosisDiarrhoeaInjection site reactionsGastrointestinal side effects (e.g., diarrhea)

Serious

C. difficile colitis
Acute kidney injury
Seizures (high doses)
Encephalopathy
Hypersensitivity reactions (rash to anaphylaxis)
Serum sickness
Stevens-Johnson syndrome
Nephropathy
Hematologic reactions (neutropenia, prolonged use)
Neurotoxicity (seizure, high doses, renal impairment)

Pregnancy & lactation

Pregnancy

Not known to be harmful

Drug interactions

Aminoglycosides

Moderate

Database

Increased risk of acute kidney injury

Monitor renal function (serum creatinine, BUN, urine output) closely, especially in patients with pre-existing renal impairment or those receiving high doses. Adjust aminoglycoside dose if necessary.

Furosemide

Moderate

Database

Increased risk of acute kidney injury.

Monitor renal function closely, especially in patients with pre-existing renal impairment or when high doses of either drug are used.

Source: DDInter

Loop Diuretics (e.g., Furosemide)

Moderate

Database

Increased risk of acute kidney injury, particularly when co-administered with aminoglycosides.

Monitor renal function closely, especially in patients with pre-existing renal impairment or those receiving high doses of either drug. Avoid concomitant use with aminoglycosides if possible.

Oral Anticoagulants (e.g., Warfarin)

Moderate

Database

Increased INR and bleeding risk.

Monitor INR closely, especially at the start and end of cefotaxime therapy. Adjust warfarin dose as needed. Educate patient on signs of bleeding.

Probenecid

Moderate

Database

Increased and prolonged plasma concentrations of cefotaxime

This interaction is sometimes used therapeutically to enhance cefotaxime levels. If not desired, monitor for increased cefotaxime side effects. No dose adjustment of cefotaxime is usually required unless toxicity is observed.

Source: DDInter

Sodium Picosulfate/magnesium Citrate

Moderate

Database

Reduced efficacy of bowel preparation.

Avoid concurrent use if possible. If unavoidable, monitor for adequate bowel preparation.

Typhoid Vaccine (live Oral)

Moderate

Database

Reduced efficacy of the typhoid vaccine

Administer the typhoid vaccine at least 24 hours after the last dose of cefotaxime, or delay vaccination until antibiotic therapy is completed. Consult vaccine guidelines for specific recommendations.

Warfarin

Moderate

Database

Increased INR, increased risk of bleeding.

Monitor INR closely, especially at the start and end of cefotaxime therapy. Adjust warfarin dose as needed.

Source: DDInter

4 additional low-confidence interactions hidden — those rows lack a documented mechanism or management plan in our sources.