eremia and 14 days for patients with bacteremia. A longer duration may be necessary with persistent or complicated infections. For patients with a CD4 count less than 200 cells/mm3, the duration of therapy is 2 to 6 weeks with or without bacteremia. The role of long term secondary prophylaxis is not well established, but may be considered for patients with recurrent infection and in patients with a CD4 count less than 200 cells/mm3 with severe diarrhea.
For the treatment of severe typhoid fever† due to multidrug-resistant or quinolone-resistant Salmonella typhii.
Intravenous dosage
Adults, Adolescents, Children, and Infants
80 mg/kg/day IV divided every 8 to 12 hours (Max: 4 g/day) for 10 to 14 days.
†Indicates off-label use
MAXIMUM DOSAGE
Adults
12 g/day IV/IM.
Geriatric
12 g/day IV/IM.
Adolescents
12 g/day IV/IM.
Children
50 kg or greater: 12 g/day IV/IM.
less than 50 kg: 180 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 300 mg/kg/day (Max: 12 g/day) have been used off-label for meningitis.
Infants
180 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 300 mg/kg/day have been used off-label for meningitis.
Neonates
older than 7 days: 150 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 200 mg/kg/day have been used off-label for meningitis.
7 days and younger: 100 mg/kg/day IV/IM is FDA-approved maximum; however, doses up to 150 mg/kg/day have been used off-label for meningitis.
DOSING CONSIDERATIONS
Hepatic Impairment
Cefotaxime is metabolized by the liver to an active metabolite, desacetylcefotaxime. Dosage adjustments in patients with hepatic impairment without concomitant renal insufficiency are usually not necessary since cefotaxime has a high therapeutic index. However, specific guidelines for dosage adjustment in patients with hepatic impairment are not available.
Renal Impairment
Adults
CrCl more than 20 mL/min: no dosage adjustment needed.
CrCl 20 mL/min or less: reduce recommended dose by 50%.
Pediatric patients
The following dose adjustments are based on a usual recommended dose in children of 100 to 200 mg/kg/day IV/IM divided every 8 hours.
CrCl more than 50 mL/min/1.73 m2: no dosage adjustment needed.
CrCl 30 to 50 mL/min/1.73 m2: 35 to 70 mg/kg/dose IV/IM every 8 to 12 hours.
CrCl 10 to 29 mL/min/1.73 m2: 35 to 70 mg/kg/dose IV/IM every 12 hours.
CrCl less than 10 mL/min/1.73 m2: 35 to 70 mg/kg/dose IV/IM every 24 hours.
Intermittent hemodialysis
Approximately 50% of the serum concentration of cefotaxime is removed during a standard hemodialysis session. Some clinicians recommend that 0.5 to 2 g be given as single daily doses and that a supplemental dose of cefotaxime be given after each hemodialysis session. For pediatric patients, the recommended dose is 35 to 70 mg/kg/dose IV/IM every 24 hours, given after hemodialysis on dialysis days.
Peritoneal dialysis
For adult patients, give 1 g IV/IM every 24 hours. For pediatric patients, the recommended dose is 35 to 70 mg/kg/dose IV/IM every 24 hours.
Continuous renal replacement therapy (CRRT)
For adult patients, give 1 g IV/IM every 12 hours. For pediatric patients, the recommended dose is 35 to 70 mg/kg/dose IV/IM every 12 hours.
ADMINISTRATION
Injectable Administration
Cefotaxime is administered intravenously or intramuscularly.
One gram of cefotaxime in 14 mL of sterile water for injection is isotonic.
Visually inspect parenteral products for particulate matter |
