Cefotetan

General
  • Type: Second generation cephalosporin
  • Dosage Forms: injectable solution, powder for injection
  • Dosage Strengths: injectable solution: 20mg/mL, 40mg/mL; powder for injection: 1g, 2g, 10g
  • Routes of Administration: IV, IM
  • Common Trade Names: Cefotan

Adult Dosing

Infection
  • Mild to Moderate, Bacterial
    • 1-2 g IM/IV q12h
      • Max: 4 g/day
  • Severe to Life Threatening, Bacterial
    • 2-3 g IV q 12h
      • Max: 6 g/day

UTI, uncomplicated
  • 500 mg IM/IV q12h

PID, severe

Prophylaxis
  • Surgical:
    • 2 g IV x1
  • Postcesarean:
    • 2 g IV x1

Pediatric Dosing

Infection, bacterial
  • 40-80 mg/kg/day IM/IV divided q12h
    • Max: 4 g/day or 6 g/day in life-threatening infection

PID, severe

Prophylaxis
  • Surgical, >1yo
    • 40 mg/kg IV x1

Special Populations
  • Pregnancy: B
  • Lactation: May use while breastfeeding
  • Renal Dosing
    • Adult
      • CrCl 10-30: Give q 24h
      • CrCl <10: Give q 48h
      • HD: Decrease usual dose 50% on dialysis days and 75% non-dialysis days
      • PD: 1 g q24h
    • Pediatric
      • CrCl 10-30: Give q 24h
      • CrCl <10: Give q 48h
      • HD: Decrease usual dose 50% on dialysis days and 75% non-dialysis days
      • PD: No supplement
  • Hepatic Dosing
    • Adult
      • Not defined
    • Pediatric
      • Not defined

Contraindications
  • Allergy to class/drug
  • Hemolytic anemia, cephalosporin-associated
  • Caution:
    • Hypersensitivity to penicillin
    • Elderly
    • Concurrent nephrotoxic agent
    • Renal impairment
    • Hepatic impairment
    • Seizure disorder
    • Malignancy
    • Malnutrition
    • GI disorder hx
    • Recent abx-associated C. diff colitis


Adverse Reactions

Serious

Common

Pharmacology
  • Half-life: 3-4.6h (10h with moderate renal impairment)
  • Metabolism: Minimal
  • Excretion: Urine primarily (51-81% unchanged)
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumX1
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisI
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeI
N. meningitidisI
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negI
Enterobacter sp, AmpC posR
Serratia spS
Serratia marcescensX1
Salmonella spX1
Shigella spX1
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.S
Citrobacter freundiiR
Citrobacter diversusI
Citrobacter sp.I
Aeromonas spS
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaI
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisI
Prevotella melaninogenicaS
Clostridium difficileX1
Clostridium (not difficile)S
Fusobacterium necrophorumX1
Peptostreptococcus sp.S

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  1. Sanford Guide to Antimicrobial Therapy 2014
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