cefoxitin
Regulatory sources consulted
Approved indications
- Complicated urinary infections and pyelonephritis in adults and adolescents; it may be useful in selected intra-abdominal and gynecologic infections.
Contraindications
Absolute
- Hypersensitivity to cefoxitin or cephalosporins, or a history of a severe immediate reaction to another beta-lactam.
Clinical warnings
- Major warning · It may cause severe hypersensitivity or anaphylaxis. Review any history of immediate beta-lactam reactions before use and discontinue if an allergic reaction occurs. — CIMA/AEMPS, ficha técnica 84251
- Major warning · It may cause Clostridioides difficile-associated diarrhea during or after treatment; assess significant diarrhea and avoid antiperistaltic drugs if colitis is suspected. — CIMA/AEMPS, ficha técnica 84251
- Major warning · Accumulation, especially in renal impairment, may cause encephalopathy and seizures; adjust the regimen and monitor neurologic status. — CIMA/AEMPS, ficha técnica 84251
Drug interactions
- HighOral anticoagulants
Mechanism: The antibiotic and infection may increase INR or bleeding risk.
Recommendation: Monitor INR and bleeding during and shortly after treatment.
CIMA/AEMPS, ficha técnica 84251
- ModerateProbenecid
Mechanism: It reduces renal tubular secretion and may increase and prolong antibiotic exposure.
Recommendation: Avoid the combination unless deliberately indicated and monitor toxicity.
CIMA/AEMPS, ficha técnica 84251
- HighAminoglycosides and other nephrotoxic drugs
Mechanism: The combination may increase nephrotoxicity.
Recommendation: Avoid the combination when possible and monitor renal function.
CIMA/AEMPS, ficha técnica 84251
Adverse events
Common (≥1%)
Nausea, diarrhea, and rash
Rare but serious
Anaphylaxis, C. difficile colitis, and severe cytopenias
Pregnancy and lactation
Use during pregnancy only when clearly indicated. Small amounts pass into milk; monitor the infant for diarrhea, candidiasis, or sensitization and assess continuation according to the product.
Recent literature (PubMed)
The stability of gut microbiota is essential for the host's health. Parabacteroides spp., core members of the human gut microbiota, have an average abundance of 1.27% in humans of 12 populations. Parabacteroides have recently been reported to have a close relationship with host health (e.g. metabolic syndrome, inflammatory bowel disease and obesity). Parabacteroides have the physiological characteristics of carbohydrate metabolism and secreting short chain fatty acids. However, antimicrobial resistance of Parabacteroides to antibiotics (such as clindamycin, moxifloxacin and cefoxitin) should not be ignored. In this review, we primarily focus on Parabacteroides distasonis, Parabacteroides goldsteinii, Parabacteroides johnsonii and Parabacteroides merdae and discuss their relationships with host disease, diet and the prevention or induction of diseases. Pa. distasonis and Pa. goldsteinii may be viewed as potential next generation probiotic candidates due to their protective effects on inflammation and obesity in mice. We also discuss the potential therapeutic application of Parabacteroides spp. in maintaining host-intestine homeostasis. The cephalosporins are a family of bactericidal antibiotics structurally related to penicillin which were first derived from the fungus, Cephalosporum acremonium. Their basic structure is similar to penicillin with a thiazolidine and beta-lactam ring, which has a variable side chain. Cephalosporins bind to the penicillin-binding proteins on bacteria and inhibit synthesis of the bacterial cell wall, causing cell lysis particularly in rapidly growing organisms. Their differences in activity relate to the range of penicillin-binding proteins that they inhibit. They have a broader activity than the standard penicillins, but are also sensitive to some extent to beta-lactamase. Five generations of cephalosporins have been developed with varying antibacterial activity. Cephalosporins are indicated for infections with susceptible organisms of
Surgical antibiotic prophylaxis is an important measure to prevent postoperative surgical site infections. Current guideline recommendations do not treat obesity specifically, although it can affect pharmacokinetics and pharmacodynamics. The objective of this review was to synthesize current evidence on the need for obesity-related dosing adjustments in surgical antibiotic prophylaxis. MEDLINE and Cochrane Library were searched for studies investigating antibiotic prophylaxis dosing in surgical patients with obesity. Outcomes of interest were pharmacokinetic parameters such as plasma and interstitial fluid concentrations, area under the concentration time curve in plasma and in interstitial fluid, and other pharmacokinetic measures. Thirty studies investigating cefazolin, cefoxitin, cefuroxime, piperacillin/tazobactam, meropenem, ertapenem, metronidazole, vancomycin, ciprofloxacin, and gentamicin were included in this analysis. Except for metronidazole, cefoxitin, and gentamicin, there is currently no evidence suggesting the need for dosing adjustments.
The incidence of postendoscopic retrograde cholangiopancreatography (ERCP) infections is reported to be up to 18% in patients with biliary obstruction. Antibiotic prophylaxis may reduce the risk of infectious complications after ERCP; however, the clinical value of prophylactic antibiotics in ERCP remains controversial. We conducted a double-blind, placebo-controlled, randomized trial to investigate whether the use of prophylactic antibiotics would reduce infectious complications after ERCP in patients with biliary obstruction. We randomly assigned patients in a 1:1 ratio to receive either a single dose of 1 g intravenous cefoxitin or normal saline as a placebo 30 minutes before undergoing ERCP. The primary outcome was the incidence of infectious complications after ERCP. We enrolled 378 patients, and 189 patients were assigned to each group. The risk of infectious complications after ERCP was 2.8% (5 of 176 patients) in the antibiotic prophylaxis group and 9.8% (17 of 173 patients) in the placebo group (risk ratio, 0.29; 95% confidence interval [CI], 0.11-0.74, P = 0.0073). The incidence rates of bacteremia were 2.3% (4 of 176 patients) and 6.4% (11 of 173 patients), respectively (risk ratio, 0.36; 95% CI, 0.12-1.04; P = 0.0599). The incidence rate of cholangitis was 1.7% (3 of 176 patients) in the antibiotic prophylaxis group and 6.4% (11 of 173 patients) in the placebo group (risk ratio, 0.27; 95% CI, 0.08-0.87; P = 0.0267). Antibiotic prophylaxis before ERCP in patients with biliary obstruction resulted in a significantly lower risk of infectious complications, especially cholangitis, than placebo ( ClinicalTrials.gov trial number NCT02958059).