Allopathy
Prescription Required
Schedule H
U.S., U.K., Germany, Japan , Malaysia, India, China
Cefoxitin belongs to the pharmacological class of Second-generation cephalosporin antibiotics.
Cefoxitin has been approved to relieve symptoms and also for the treatment and maintenance of Bite wounds, Gonococcal infections, uncomplicated, Mycobacterial infection, Pelvic inflammatory disease, Surgical prophylaxis
Cefoxitin is a second-generation cephalosporin antibiotic that is administered intravenously or intramuscularly. It is rapidly and completely absorbed after IM administration and has a bioavailability of nearly 100%. The drug has a relatively long half-life of 1.5 to 2 hours and is eliminated primarily through renal excretion. The pharmacokinetics of cefoxitin are linear over a dose range of 1 to 12 grams, and the drug achieves therapeutic concentrations in various tissues and body fluids, including the respiratory tract, bone, bile, cerebrospinal fluid, and pleural and synovial fluids.
The common side effects involving the use of Cefoxitin are nausea, headache, vomiting, rashes or itching at the site of injection, itching, diarrhea, headache, upset stomach, etc.
Cefoxitin is available in the form of Injection, Infusion, Premixed Solution for Injection
Cefoxitin is approved in the U.S., U.K., Germany, Japan, Malaysia, India, and China.
Cefoxitin belongs to the pharmacological class of Second-generation cephalosporin antibiotics.
Cefoxitin is a cephalosporin antibiotic that works by inhibiting bacterial cell wall synthesis. Specifically, it binds to and inhibits the activity of penicillin-binding proteins (PBPs) located on the bacterial cell wall, which are responsible for the final stages of peptidoglycan synthesis. This inhibition leads to the disruption of the bacterial cell wall, ultimately resulting in bacterial cell death. Additionally, cefoxitin also exhibits some degree of bactericidal activity by interfering with bacterial cell membrane permeability and inhibiting cell division.
Cefoxitin has been approved to relieve symptoms and also for the treatment and maintenance of Bite wounds, Gonococcal infection, uncomplicated, Mycobacterial infection, Pelvic inflammatory disease, Surgical prophylaxis
The Cmax (peak plasma concentration) of cefoxitin is achieved within 30 to 60 minutes after intravenous administration. The Tmax (time to reach peak plasma concentration) is 30 to 60 minutes after intravenous administration.
The onset of action of cefoxitin is rapid, with antibacterial activity occurring within 30 minutes of administration. The duration of action of cefoxitin is approximately 4 to 6 hours, after which time the drug is metabolized and eliminated from the body. However, the duration of action can vary depending on the specific infection being treated, the severity of the infection, and the patient's individual response to the drug.
Cefoxitin is found to be available in the form of injection, infusion, and a premixed solution for injection.
Cefoxitin can be used in the following treatment:
● Bite wounds
● Gonococcal infection, uncomplicated
● Mycobacterial infection
● Pelvic inflammatory disease
● Surgical prophylaxis
Cefoxitin can help to relieve symptoms and also for the treatment and maintenance of Bite wounds, Gonococcal infection, uncomplicated, Mycobacterial infection, Pelvic inflammatory disease, Surgical prophylaxis
Cefoxitin is approved for use in the following clinical indications:
● Bite wounds
● Gonococcal infection, uncomplicated
● Mycobacterial infection
● Pelvic inflammatory disease
● Surgical prophylaxis
Animal bite wounds (off-label use):
IV: 1 g every 6 to 8 hours (Ref).
Uncomplicated gonococcal infection (infection of the cervix, rectum, or urethra) (alternative agent) (off-label use):
Note: Cefoxitin should only be used if ceftriaxone is unavailable, given a lack of contemporary efficacy data (Ref).
IM: 2 g as a single dose plus oral probenecid. It should be given in combination with treatment for chlamydia if it has not been excluded (Ref). When treatment failure is suspected (e.g., detection of N. gonorrhoeae after treatment without additional sexual exposure), consult an infectious diseases specialist. Report failures to the CDC through state and local health departments (Ref).
Mycobacterial infection (nontuberculous, rapidly growing) (off-label use):
Patients without cystic fibrosis: 2 to 4 g two to three times daily or 200 mg/kg/day in 3 divided doses (maximum daily dosage: 12 g/day) as part of an appropriate combination regimen (Ref).
Patients with cystic fibrosis: 200 mg/kg/day in 3 divided doses (maximum daily dosage: 12 g/day) as part of an appropriate combination regimen (Ref).
Duration of therapy: The optimal duration of therapy is unknown, but generally the duration of parenteral therapy is ≤12 weeks depending on the severity of infection, tolerability, and other patient-specific factors, followed by long-term oral maintenance therapy. Consult an infectious diseases specialist for specific recommendations (Ref).
Pelvic inflammatory disease:
Inpatients: IV: 2 g every 6 hours in combination with doxycycline. Total duration of therapy (which may include oral step-down therapy) is 14 days; oral therapy can usually be initiated within 24 to 48 hours of clinical improvement (Ref).
Outpatients: IM: 2 g as a single dose plus oral probenecid, followed by oral doxycycline and metronidazole for 14 days (Ref).
Surgical prophylaxis (perioperative prophylaxis):
IV: 2 g within 60 minutes prior to surgical incision. Doses may be repeated in 2 hours if the procedure is lengthy or if there is excessive blood loss (Ref).
Dosage Adjustments in Kidney Patients:
The initial dose, also known as the loading dose, is 1 to 2 grams, followed by ongoing maintenance dosing as per the patient's creatinine clearance (CrCl).
For patients with a CrCl of 30 to 50 mL/minute, the maintenance dosage is 1 to 2 grams every 8 to 12 hours. If the patient's CrCl is between 10 to 29 mL/minute, the maintenance dose should be 1 to 2 grams every 12 to 24 hours. For those with a CrCl of 5 to 9 mL/minute, the recommended maintenance dose is 0.5 to 1 gram every 12 to 24 hours. In patients with a CrCl less than 5 mL/minute, the recommended maintenance dose is 0.5 to 1 gram every 24 to 48 hours.
For patients undergoing hemodialysis, a loading dose of 1 to 2 grams should be given after each hemodialysis session, followed by maintenance doses based on their CrCl as noted above.
Dosage Adjustments in Hepatic Impairment Patients:
No dosage adjustments are needed for hepatic Impairment.
Dosage Adjustments in Pediatric Patients:
Infections within the abdomen:
Note: Cefoxitin is not recommended for the initial treatment of intra-abdominal infections due to the increasing resistance of anaerobic bacteria, such as the Bacteroides fragilis group. Other options are preferred .
Infants, Children, and Adolescents:
Limited data is available for infants under 3 months of age:
IV: 80 to 160 mg/kg/day, divided every 4 to 8 hours; maximum dose: 2,000 mg/dose. For severe, complicated, or undrained infections, use doses on the higher end of the range (i.e., 160 mg/kg/day). Treatment duration should be 4 to 7 days, unless source control is inadequate. In some circumstances, such as acute or gangrenous appendicitis without perforation, therapy should be limited to ≤24 hours .
Mycobacterial infection, pulmonary infection in patients with or without cystic fibrosis:
Limited data is available:
Infants, Children, and Adolescents:
IV: 150 mg/kg/day, divided every 6 to 8 hours; maximum daily dose: 12 g/day. The duration of parenteral therapy is generally 4 to 12 weeks, depending on clinical response, followed by transition to oral and/or inhaled therapy. Total antibiotic treatment duration is ≥12 months after culture conversion .
Pelvic inflammatory disease:
Children ≥45 kg and Adolescents:
Mild to moderate (outpatient management):
IM: 2,000 mg as a single dose, in combination with a single dose of probenecid, followed by 14 days of oral therapy with doxycycline and metronidazole.
Severe (inpatient management):
IV: 2,000 mg every 6 hours in combination with doxycycline; once the patient has clinically improved (typically within 24 to 48 hours), they may transition to oral therapy with doxycycline and metronidazole to complete a total of 14 days of therapy .
Peritonitis, prophylaxis in patients undergoing gastrointestinal or genitourinary procedures:
Limited data is available:
Infants, Children, and Adolescents:
IV: 30 to 40 mg/kg administered 30 to 60 minutes before the procedure; maximum dose: 2,000 mg/dose .
Surgical prophylaxis:
Infants, Children, and Adolescents:
Limited data is available for infants under 3 months of age:
IV: 40 mg/kg within 60 minutes prior to surgery; may repeat the dose in 2 hours for prolonged procedures or excessive blood loss; maximum dose: 2,000 mg/dose .
Powder for injection: 1 g, 2 g, and 10 g
Powder for injection (in vials): 1 g and 2 g
Powder for reconstitution: 10 g
Injection solution (in vials): 1 g and 2 g
Available as Injection, Infusion, Premixed Solution for Injection
Avoid high acid foods like citrus fruits as well as juices like orange and grapefruit, soda and chocolates.
Alcohol intake may lead to nausea,vomiting as well as headache
Multivitamins and antacids contain minerals primarily magnesium calcium aluminum iron or zinc which binds to the antibiotic and also refrain it from working. Spacing them at least for two hours after Cefoxitin administration is recommended.
Cefoxitin may be contraindicated under the following conditions:
● In patients who have a known hypersensitivity to cefoxitin, other cephalosporins, or any component of the formulation. Patients who have a history of severe allergic reactions, such as anaphylaxis, to beta-lactam antibiotics, including penicillins, should be closely monitored when taking cefoxitin, as they may be at an increased risk of an allergic reaction.
● In patients with a history of colitis, inflammatory bowel disease, or pseudomembranous colitis, as the use of cefoxitin may worsen these conditions.
● Cefoxitin should not be used to treat meningitis or other central nervous system infections, as it does not penetrate the blood-brain barrier adequately.
● Cefoxitin should be used with caution in patients with a history of gastrointestinal disease, particularly colitis, as it may cause a superinfection of the bowel by resistant organisms.
● Patients with impaired renal function may require a dose adjustment or close monitoring when taking cefoxitin, as it is primarily eliminated by the kidneys. Similarly, patients with impaired hepatic function should be monitored closely when taking cefoxitin.
The physician should closely monitor the patients and keep pharmacovigilance as follows:
General: Before initiating therapy with Cefoxitin, it is important to inquire about any previous hypersensitivity reactions to Cefoxitin, cephalosporins, penicillin, or other drugs. Caution should be exercised when administering Cefoxitin for oral suspension to patients with a history of allergic reactions, particularly to drugs. There is some evidence of partial cross-allergenicity between cephalosporins and penicillins, so special care is required in patients who have had allergic reactions to these drugs. If an allergic reaction to Cefoxitin for oral suspension occurs, treatment should be stopped, and appropriate standard agents (e.g., epinephrine, antihistamines, corticosteroids) should be administered as necessary.
As with other antibiotics, the use of Cefoxitin for oral suspension may lead to the overgrowth of Candida and other non-susceptible organisms (e.g., enterococci and Clostridium difficile), which may require treatment interruption. Repeated assessment of the patient's condition is critical. If superinfection occurs during treatment, appropriate measures should be taken. If an organism becomes resistant during antibiotic therapy, Cefoxitin for oral suspension should be discontinued, and another appropriate antibiotic should be prescribed.
Clostridium difficile-Associated Disease : CDAD, a type of Clostridium difficile-associated disease, has been reported with the use of many antibacterial agents, including Cefoxitin for oral suspension. Symptoms of CDAD may include mild diarrhea to fatal colitis. In patients who develop diarrhea, colitis, pseudomembranous colitis, toxic megacolon, or perforation of the colon following administration of any antibacterial agent, CDAD should be considered. CDAD may occur up to 2 months after administration of antibacterial agents. The use of antibacterial agents may alter the normal flora of the colon and permit the overgrowth of Clostridium difficile, which produces toxins that contribute to the development of CDAD. If the diagnosis of CDAD is suspected or confirmed, appropriate therapeutic measures should be taken. In mild cases of CDAD, discontinuing antibacterial agents not directed against Clostridium difficile may be effective. In moderate to severe cases, fluid and electrolyte management, protein supplementation, and treatment with an antibacterial agent effective against Clostridium difficile should be considered. In severe cases, surgical intervention may be necessary.
Alcohol Warning
There is a moderate interaction between alcohol and Cefoxitin. It is generally recommended to avoid drinking alcohol while taking Cefoxitin because it may increase the risk of side effects such as dizziness, drowsiness, and gastrointestinal upset. Additionally, alcohol may also impair the body's ability to fight infections, which may reduce the effectiveness of Cefoxitin in treating bacterial infections.
Breast Feeding Warning
Low concentrations of cefoxitin are excreted in human milk, so caution should be exercised when administering the drug to nursing mothers.
Pregnancy Warning
Pregnancy Category B
Reproductive studies conducted in rats and mice using parenteral doses of cefoxitin ranging from one to seven and a half times the maximum recommended human dose did not show any teratogenic or fetal toxic effects, although a slight reduction in fetal weight was observed. However, there are no adequate and well-controlled studies in pregnant women, and the use of this drug during pregnancy should only be considered if it is clearly necessary, as animal reproduction studies do not always predict human response.
Food Warning
No sufficient scientific evidence is traceable regarding the use and safety of Cefoxitin in concurrent use with any particular food.
The adverse reactions related to Cefoxitin can be categorized as follows:
Common:
● Diarrhea
● Nausea
● Vomiting
● Rash
● Pain or inflammation at the injection site
● Headache
● Dizziness
● Abdominal pain
● Fever
● Increased white blood cell count
Less Common :
● Allergic reactions, including anaphylaxis
● Blood disorders, such as anemia or leukopenia
● Elevated liver enzymes
● Pseudomembranous colitis
● Stevens-Johnson syndrome
● Thrombocytosis
Rare :
● Seizures
● Hypotension
● Superinfection
● Renal failure
● Pancreatitis
● Hemolytic anemia
● Jaundice
The clinically relevant drug interactions of Cefoxitin is briefly summarized here:
Aminoglycosides: Cefoxitin may enhance the nephrotoxicity and ototoxicity of aminoglycosides.
Probenecid: Probenecid can decrease the renal excretion of cefoxitin, leading to an increased risk of toxicity.
Warfarin: Cefoxitin may increase the anticoagulant effect of warfarin by inhibiting its metabolism, leading to an increased risk of bleeding.
Oral Contraceptives: Cefoxitin may decrease the effectiveness of oral contraceptives, leading to an increased risk of pregnancy.
Methotrexate: Cefoxitin can increase the toxicity of methotrexate by inhibiting its renal clearance.
Chloramphenicol: Cefoxitin can decrease the clearance of chloramphenicol, leading to an increased risk of toxicity.
Loop Diuretics: Cefoxitin can enhance the nephrotoxicity of loop diuretics, leading to an increased risk of renal failure.
The following are the side effects involving Cefoxitin :
● Nausea
● Vomiting
● Diarrhea
● Abdominal pain
● Skin rash
● Itching
● Hives
● Headache
● Dizziness
● Fever
● Injection site reactions, such as pain, swelling, and redness
Pregnancy
Pregnancy Category B
Reproductive studies conducted in rats and mice using parenteral doses of cefoxitin ranging from one to seven and a half times the maximum recommended human dose did not show any teratogenic or fetal toxic effects, although a slight reduction in fetal weight was observed. However, there are no adequate and well-controlled studies in pregnant women, and the use of this drug during pregnancy should only be considered if it is clearly necessary, as animal reproduction studies do not always predict human response.
Nursing Mothers: Low concentrations of cefoxitin are excreted in human milk, so caution should be exercised when administering the drug to nursing mothers.
Pediatric Use: The safety and efficacy of cefoxitin in pediatric patients from birth to 3 months of age have not been established, and higher doses of the drug in pediatric patients aged 3 months and above have been linked to an increased incidence of eosinophilia and elevated SGOT.
Geriatric Use: In clinical studies, no significant differences were observed in safety or effectiveness between elderly patients (aged 65 and over) and younger patients. However, since cefoxitin is primarily excreted by the kidneys, the risk of toxic reactions may be higher in patients with impaired renal function, particularly in elderly patients who are more likely to have decreased renal function. Therefore, careful dose selection and monitoring of renal function may be necessary in this patient population.
Physicians should be knowledgeable and vigilant about the treatment and identification of overdosage of Cefoxitin.
Overdosage of cefoxitin can lead to an increased risk of adverse effects such as gastrointestinal symptoms (nausea, vomiting, and diarrhea), hypersensitivity reactions, and central nervous system (CNS) toxicity.
There is no specific antidote for cefoxitin overdose. Treatment is generally supportive and symptomatic, with a focus on maintaining vital signs and managing any associated symptoms. In cases of severe overdose or hypersensitivity reactions, hospitalization and intensive care may be required.
Gastric lavage and administration of activated charcoal may be considered to prevent further absorption of cefoxitin in cases of recent ingestion. However, the benefit of these measures is uncertain, and they should only be used if the patient is seen within a short time of ingestion and is at risk of severe toxicity.
Hemodialysis and peritoneal dialysis are not effective in removing cefoxitin from the body and are not recommended as treatment for cefoxitin overdose.
If an allergic reaction occurs, immediate discontinuation of the drug and administration of epinephrine, antihistamines, and corticosteroids may be necessary.
Pharmacodynamics
Cefoxitin is a cephamycin antibiotic that is typically classified with second-generation cephalosporins. Its antimicrobial activity extends to a wide range of gram-negative bacteria, including anaerobes. The presence of a methoxy group in the 7a position confers upon cefoxitin a remarkable degree of stability against beta-lactamases produced by gram-negative bacteria, such as both penicillinases and cephalosporinases.
Pharmacokinetics
Absorption: Cefoxitin is rapidly absorbed after intramuscular injection, with a bioavailability of approximately 90%. After intravenous administration, cefoxitin is immediately and completely bioavailable.
Distribution: Cefoxitin has a moderate volume of distribution, indicating that it is distributed widely throughout the body. The plasma protein binding of cefoxitin is low, at around 20%.
Metabolism: Cefoxitin is not extensively metabolized in the body. It is primarily excreted unchanged in the urine.
Elimination: The elimination half-life of cefoxitin is around 1 hour in adults with normal renal function. However, in patients with impaired renal function, the half-life may be prolonged. Cefoxitin is primarily eliminated by the kidneys, with approximately 80-90% of an administered dose excreted unchanged in the urine.
1. H C Neu 1.Cefoxitin: an overview of clinical studies in the United States.Rev Infect Dis. 1979 Jan-Feb;1(1):233-9. doi: 10.1093/clinids/1.1.233.
2. R V McCloskey.Results of a clinical trial of cefoxitin, a new cephamycin antibiotic.Antimicrob Agents Chemother. 1977 Nov;12(5):636-41. doi: 10.1128/AAC.12.5.636.
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