ed in these patients.
Colitis, diarrhea, GI disease, inflammatory bowel disease, pseudomembranous colitis, ulcerative colitis
Almost all antibacterial agents have been associated with pseudomembranous colitis (antibiotic-associated colitis) which may range in severity from mild to life-threatening. In the colon, overgrowth of Clostridia may exist when normal flora is altered subsequent to antibacterial administration. The toxin produced by Clostridium difficile is a primary cause of pseudomembranous colitis. It is known that systemic use of antibiotics predisposes patients to development of pseudomembranous colitis. Consideration should be given to the diagnosis of pseudomembranous colitis in patients presenting with diarrhea following antibacterial administration. Systemic antibiotics should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis or other GI disease. If diarrhea develops during therapy, cefotaxime should be discontinued. Following diagnosis of pseudomembranous colitis, therapeutic measures should be instituted. In milder cases, the colitis may respond to discontinuation of the offending agent. In moderate to severe cases, fluids and electrolytes, protein supplementation, and treatment with an antibacterial effective against Clostridium difficile may be warranted. Products inhibiting peristalsis are contraindicated in this clinical situation. Practitioners should be aware that antibiotic-associated colitis has been observed to occur over two months or more following discontinuation of systemic antibiotic therapy; a careful medical history should be taken.
Coagulopathy, vitamin K deficiency
All cephalosporins, including cefotaxime, may rarely cause hypothrombinemia and have the potential to cause bleeding. Cephalosporins which contain the NMTT side chain (e.g., cefoperazone, cefamandole, cefotetan) have been associated with an increased risk for bleeding. Cephalosporins should be used cautiously in elderly patients and patients with a preexisting coagulopathy (e.g., vitamin K deficiency) since these patients are at a higher risk for developing bleeding complications.
Intramuscular injections
Intramuscular injections should be administered cautiously to patients receiving cefotaxime. IM injections may cause bleeding, bruising, or hematomas due to hypothrombinemia effect secondary to cephalosporin therapy.
Infusion-related reactions
Rapid administration (< 60 seconds) of cefotaxime through a central venous catheter can result in infusion-related reactions that include potentially life-threatening arrhythmias. Avoid rapid bolus intravenous administration of cefotaxime.
Pregnancy
Cefotaxime is classified as FDA pregnancy risk category B. Cefotaxime crosses the placenta. Animal data reveal no teratogenic or fetotoxic effects; however, a slight decrease in fetal and neonatal weight was observed. There are no adequate and well-controlled studies in pregnant women. Because animal studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Cefotaxime has not been studied for use during labor and delivery. Treatment should be given only if clearly needed.
Breast-feeding
Cefotaxime is excreted in breast milk in small quantities. The manufacturer recommends that it should be used with caution during breast-feeding, considering the benefit to the mother. Rare po |
