Cefotaxime

Abstract

Cefotaxime is well established as an effective and well tolerated antibacterial drug for 3 times daily parenteral treatment of a variety of moderate to severe infections in hospitalised patients. Its frequency of administration has recently been reassessed with a 12-hourly regimen. Comparative studies in hospitalised patients with nosocomial or community-acquired lower respiratory tract infections, demonstrate the similar clinical and bacteriological efficacy of twice daily cefotaxime 1 or 2 g and the same daily dose of ceftriaxone, usually administered once daily. Cefotaxime 2 g twice daily was also similar in efficacy to ceftriaxone 2 g once daily. Retrospective and post-marketing studies also reveal the similar efficacy of cefotaxime administered twice and 3 times daily, and pharmacoeconomic studies suggest that total direct costs of treatment with cefotaxime compared is similar to that with other third generation cephalosporins in currently used dosage regimens. When administered twice daily, cefotaxime is, thus, an effective antibacterial agent for the treatment of hospitalised patients outside the intensive care unit with a variety of mild to moderate non-CNS infections caused by susceptible organisms. When appropriately administered twice daily there is potential to lower the cost of antibacterial treatment without compromising efficacy.

Population pharmacokinetics of cefotaxime in intensive care patients

“…The half-life in healthy volunteers is reported to be around 1 h, with 80% of an intravenous dose excreted in urine whereas 20% is recovered in faeces following biliary excretion. Cefotaxime is partially metabolised to desacetylcefotaxime, a metabolite with antibacterial activity reported to be two to 16 times less than that of cefotaxime depending on bacterial species [3].…”

β‐Lactam Antibiotics

“…As usual, as a group, the pharmacokinetic parameters differ in these patients from those observed in healthy adults. During the first month of life, about 75% of the total bodyweight is water, leading to Table 5.1.5 Selected pharmacokinetic data for b-lactam antibiotics after oral administration (data adapted from Price, 1970;Barza and Weinstein, 1976;Meyers et al, 1983;Drusano et al, 1984;Wise, 1990;Kinzig et al, 1992;Nathwani and Wood, 1993;Barradell and Bryson, 1994;Mattie, 1994;Rains et al, 1995;Perry and Brogden, 1996;Brogden and Spencer, 1997;MacGregor and Graziani, 1997;Mouton et al, 2000;Majumdar et al, 2002;Matthews and Lancaster, 2009 a C max values for IV/IM-administered antibiotics relate to maximum plasma concentration after infusion; plasma levels were generally two-to fourfold lower after IM doses. b After oral administration of the prodrug pivmecillinam; half-life of prodrug in whole blood G10 minutes at pH 7.4 and 37 C (Roholt et al, 1975).…”