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Uses

Bone and Joint Infections

Treatment of bone and joint infections caused by susceptible S. aureus (including penicillinase-producing strains).

Gynecologic Infections

Treatment of gynecologic infections (including endometritis, pelvic cellulitis, pelvic inflammatory disease [PID]) caused by susceptible S. agalactiae (group B streptococci), E. coli, Neisseria gonorrhoeae, Bacteroides (including B. fragilis), Clostridium, Peptococcus niger, or Peptostreptococcus.

Cefoxitin (or cefotetan) in conjunction with doxycycline considered a regimen of choice by CDC and others when a parenteral regimen is indicated for PID. Because cefoxitin (like cephalosporins) is not active against Chlamydia, concomitant use of a drug active against Chlamydia (e.g., doxycycline) is necessary when these organisms are suspected pathogens.

Intra-abdominal Infections

Treatment of intra-abdominal infections (including peritonitis and intra-abdominal abscess) caused by susceptible E. coli, Klebsiella, Bacteroides (including B. fragilis), or Clostridium.

Respiratory Tract Infections

Treatment of lower respiratory tract infections (including pneumonia and lung abscess) caused by susceptible Staphylococcus aureus (including penicillinase-producing strains), Streptococcus pneumoniae, or other streptococci (except enterococci), Haemophilus influenzae, Escherichia coli, Klebsiella, or Bacteroides.

Septicemia

Treatment of septicemia caused by susceptible S. aureus (including penicillinase-producing strains), S. pneumoniae, E. coli, Klebsiella, or Bacteroides (including B. fragilis).

Skin and Skin Structure Infections

Treatment of skin and skin structure infections caused by susceptible S. aureus (including penicillinase-producing strains), S. epidermidis, S. pyogenes (group A β-hemolytic streptococci), or other streptococci (except enterococci), E. coli, Klebsiella, P. mirabilis, Bacteroides (including B. fragilis), Clostridium, P. niger, or Peptostreptococcus.

Urinary Tract Infections (UTIs)

Treatment of UTIs caused by susceptible E. coli, Klebsiella, Morganella morganii, P. mirabilis, P. vulgaris, or Providencia (including P. rettgeri).

Gonorrhea

Has been used for treatment of uncomplicated gonorrhea†. CDC considers IM† cefoxitin an alternative regimen for treatment of uncomplicated cervical, urethral, or rectal gonorrhea in adults and adolescents; does not appear to offer any advantage over IM ceftriaxone.

Perioperative Prophylaxis

Perioperative prophylaxis in women undergoing gynecologic and obstetric surgery (e.g., vaginal, abdominal, or laparoscopic hysterectomy, cesarean section). A preferred agent for vaginal, abdominal, or laparoscopic hysterectomy; cefazolin generally preferred for high-risk cesarean section or second trimester abortion.

Perioperative prophylaxis in patients undergoing GI surgery (e.g., colorectal surgery, nonperforated appendectomy). A preferred agent for colorectal surgery and nonperforated appendectomy; may provide better coverage against anaerobes than cefazolin in high-risk patients undergoing biliary tract or esophageal or gastroduodenal surgery.

Perioperative prophylaxis and postoperative treatment in patients undergoing surgery involving perforated abdominal viscus†. A preferred regimen (with or without gentamicin).

Dosage and Administration

Administration

Administer by IV injection or infusion. Also has been given by IM injection†.

IV route preferred in patients with bacteremia, septicemia, or other severe or life-threatening infections, or in patients with lowered resistance resulting from debilitating conditions (e.g., malnutrition, trauma, surgery, diabetes, heart failure, malignancy), particularly with shock.

Premixed frozen cefoxitin injection in dextrose should be used only for IV infusion.

For solution and drug compatibility information, see Compatibility under Stability.

IV Injection

Reconstitution

Reconstitute vials containing 1 or 2 g of cefoxitin with 10 mL or 10 or 20 mL, respectively, of sterile water for injection to provide solutions containing approximately 95 or 180 or 95 mg/mL, respectively. Shake to dissolve; let stand until clear.

Rate of Administration

Inject appropriate dose of reconstituted solution directly into a vein over a 3- to 5-minute period or slowly into the tubing of a compatible IV solution.

IV Infusion

Other IV solutions flowing through a common administration tubing or site should be discontinued while cefoxitin is infused.

Reconstitution

Reconstitute vials containing 1 or 2 g of cefoxitin with 10 mL or 10–20 mL, respectively, of sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection to provide solutions containing approximately 95 or 95–180 mg/mL, respectively. Further dilute the reconstituted solutions in 50 mL to 1 L of a compatible IV solution.

Reconstitute 10-g pharmacy bulk package with 43 or 93 mL of sterile or bacteriostatic water for injection, 0.9% sodium chloride injection, or 5% dextrose injection and then further dilute in 50 mL to 1 L of a compatible IV solution.

Thaw the commercially available premixed injection (frozen) at room temperature (25°C) or in a refrigerator (2–8°C); do not force thaw by immersion in a water bath or by exposure to microwave radiation. A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature. Discard thawed injection if an insoluble precipitate is present or if container seals or outlet ports are not intact. The injection should not be used in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.

Rate of Administration

Administer by intermittent or continuous IV infusion.

IM Injection

Administer IM injections deeply into a large muscle, such as the upper outer quadrant of the gluteus maximus. Use aspiration to ensure needle is not in a blood vessel.†

Reconstitution

IM injections are prepared by adding 2 mL of sterile water for injection or 0.5 or 1% lidocaine hydrochloride injection (without epinephrine) to each g of cefoxitin to provide solutions containing approximately 400 mg/mL.†

Dosage

Available as cefoxitin sodium; dosage expressed in terms of cefoxitin.

Pediatric Patients

General Pediatric Dosage

IV

Children ≥3 months of age: 80–160 mg/kg daily given in 4–6 equally divided doses.

AAP recommends 80–100 mg/kg daily given in 3–4 equally divided doses for mild to moderate infections or 80–160 mg/kg daily given in 4–6 equally divided doses for severe infections in children >1 month of age.

Perioperative Prophylaxis

IV

Children ≥3 months of age: Manufacturer recommends 30–40 mg/kg given at induction of anesthesia (within 0.5–1 hour prior to incision), followed by 30–40 mg/kg every 6 hours for up to 24 hours.

Some clinicians recommend additional doses during the procedure (e.g., every 2–3 hours), especially if surgery is prolonged >4 hours or major blood loss occurs. In most cases, postoperative doses are unnecessary and may increase the risk of toxicity and bacterial superinfection.

Adults

General Adult Dosage

Uncomplicated Infections (Bacteremia Absent or Unlikely)

IV

1 g every 6–8 hours.

Moderately Severe or Severe Infections

IV

1 g every 4 hours or 2 g every 6–8 hours.

Infections Requiring Higher Dosage (e.g., Gangrene)

IV

2 g every 4 hours or 3 g every 6 hours.

Gonorrhea

IM

2 g as a single dose given with oral probenecid (1 g).†

Pelvic Inflammatory Disease

IV

2 g every 6 hours; used in conjunction with IV or oral doxycycline (100 mg every 12 hours). Cefoxitin may be discontinued 24 hours after clinical improvement occurs and oral doxycycline (100 mg every 12 hours) continued to complete 14 days of treatment.

IM

2 g as a single dose given with oral probenecid (1 g); followed by a 14-day regimen of oral doxycycline (100 mg twice daily) with or without oral metronidazole (500 mg twice daily).†

Perioperative Prophylaxis

Gynecologic and Obstetric Surgery

IV

1 or 2 g given at induction of anesthesia (within 0.5–1 hour prior to incision) for hysterectomy or as soon as umbilical cord is clamped for cesarean section.

Some clinicians recommend additional doses during the procedure (e.g., every 2–3 hours), especially if surgery is prolonged >4 hours or major blood loss occurs.

Manufacturer states 2 g can be given every 6 hours after the procedure for up to 24 hours. In most cases, postoperative doses are unnecessary and may increase the risk of toxicity and bacterial superinfection.

GI Surgery

IV

1–2 g given at induction of anesthesia (within 0.5–1 hour prior to incision).

Some clinicians recommend additional doses during the procedure (e.g., every 2–3 hours), especially if surgery is prolonged >4 hours or major blood loss occurs.

Manufacturer states 2 g can be given every 6 hours after the procedure for up to 24 hours. In most cases, postoperative doses are unnecessary and may increase the risk of toxicity and bacterial superinfection.

Contaminated or Dirty Surgery Involving Ruptured Abdominal Viscus

IV

1 or 2 g every 6 hours; used with or without IV gentamicin (1.5 mg/kg every 8 hours). Continue postoperatively for about 5 days.†

Prescribing Limits

Pediatric Patients

Maximum 12 g daily.

Adults

Maximum 12 g daily.

Special Populations

Dosage in Renal Impairment

Dosage adjustments necessary in those with Cl_cr ≤50 mL/minute.

Adults with Cl_cr ≤50 mL/minute: Give an initial loading dose of 1–2 g followed by maintenance dosage based on Cl_cr (see Table).

Adults undergoing hemodialysis: Give a loading dose of 1–2 g after each dialysis period followed by maintenance dosage based on Cl_cr (see Table).

Pediatric patients with renal impairment: Make dosage adjustments similar to those recommended for adults.

Geriatric Patients

Cautious dosage selection because of age-related decreases in renal function. (See Renal Impairment under Dosage and Administration.)