Parenteral Manual

Cefoxitin sodium (NON-FORMULARY)

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Original Date: 
November 2008
Revised Date: 
December 2019
  • Semi-synthetic second generation cephalosporin for treatment of systemic infections caused by susceptible bacteria
Reconstitution and Stability: 
      2,000 mg                          19 mL              100 mg/mL
    10,000 mg                          96 mL              100 mg/mL
  • Store powder at room temperature
  • Protect powder and solution from light
  • Reconstituted solutions stable 24 hours at room temperature or 7 days in refrigerator
  • Solutions range from clear to light amber color - DO NOT use dark brown solutions

-Solutions Compatible:  dextrose solutions up to D10W, saline solutions, dextrose-saline combinations, ringer's solution, lactated ringer's

-Additives/Above Cassette Compatible:  heparin 0.1 unit/mL (room temperature for 8 hours), heparin 100 unit/mL, insulin in NS, 5% sodium bicarbonate, mannitol 2.5%, 5% and 10%, lidocaine HCL 0.5% or 1% without epinephrine for IM injections

-Y-site Compatible:  acyclovir, fluconazole, hydromorphone, linezolid, meperidine, metronidazole, morphine, ondansetron, ranitidine, TPN (amino acids/dextrose)

-Incompatible: aminoglycoside antibiotics;  administration of beta lactam and aminoglycoside antibiotics should be separated ,  filgrastrim, hetastarch, pentamidine


(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

Inject deep IM into large muscle mass
-Reconstitute  2000 mg vial with 4 mL  SteriIe Water for Inection or 0.5-1% lidocaine (without epinephrine) to a final concentration of 400 mg/mL
IV Direct YES
Usual dilution: 100 mg/mL
Infusion time:  3 - 5 minutes
IV Intermittent Infusion YES
Usual dilution:  100 mg/mL
Infusion time:  10 - 60 minutes
IV Continuous Infusion YES
Usual dilution:  100 mg/mL

(For neonatal dosages, refer to Neonatal IV Drug Manual.)


  • Mild-moderate infection:  80-100mg/kg/day IV/IM divided Q 6-8 hours
  • Severe infection:  100 - 160 mg/kg/day IV/IM divided Q 4-6 hours
  • Maximum dose:  12 g/day


  • Usual dose 1-2 g IV/IM Q 6-8 hours (IM injection painful)
  • Maximum dose:  12g/day


  • CrCL  30-50 mL/min:  Administer Q 8-12 hours
  • CrCL  10-30 mL/min:  Administer Q 12-24 hours
  • CrCL  less than 10 mL/min:  Administer Q 24-48 hours
Potential hazards of parenteral administration: 
  • Local reactions- thrombophlebitis with IV administration
                         - pain, tenderness and induration with IM administration
  • Gastrointestinal - diarrhea,nausea, vomiting
  • Hypersensitivity reactions -fever,rash, anaphylaxis
  • High doses in children have been associated with an increased incidence of eosinophilia and elevation of serum AST
  • Cross-sensitivity (5-10% of patients) has been demonstrated between penicillins and cephalosporins; patients with a reported allergy to penicillins should be observed closely for evidence of rashes, urticaria, wheezing or anaphylaxis
  • May cause false positive Coombs test
  • May produce false positive urine glucose measurement with Clinitest
  • Sodium content is 2.3 mEq per gram of cefoxitin
  • Monitor renal function, liver function and hematologic function tests

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