Neonatal Drug Therapy Manual

Cefotaxime

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

Updated March 5, 2024 - 2:34pm

Alternate Name(s): 
Claforan
Classification: 
Cephalosporin Antibiotic
Original Date: 
June 1996
Revised Date: 
October 2022
Indications: 
  • Severe infections due to beta lactamase resistant Gram (-) organisms
  • Alternative to erythromycin or ceftriaxone for infants exposed to N gonnorrhea
Administration: 
  • IV Direct: over 3 - 5 minutes
  • IV intermittent infusion: over 15 - 30 minutes
  • IM, not recommended to exceed 0.5 mL per injection site
Dosage: 

< 1.2 kg: 150 mg/kg/day divided Q12H

> 1.2 kg:

  •  0 - 7 days : 150 mg/kg/day divided Q12H
  • > 7 days: 200 mg/kg/day divided Q6H

​Confirmed meningitis: 200 - 300 mg/kg/day divided Q6-8H

 

IV/IM dosing for infants exposed to N gonorrhea (alternative during erythromycin eye ointment backorder):

  • One dose of 100 mg/kg (for term and preterm infants)

 

Dosage adjustment required in renal impairment.  Refer to available references or clinical pharmacist for dosage adjustment.

Side Effects: 
  • Hematologic: transient neutropenia, leukopenia, eosinophilia, thrombocytopenia
  • Hepatic: transient elevation of liver enzymes
  • Local: phlebitis
  • Renal: transient elevation of BUN and serum creatinine
Parameters to Monitor: 
  • CBC with differential
  • Liver function tests
  • BUN and serum creatinine
Reconstitution and Stability: 

CHEO:

  • Cefotaxime 1 g vial (IV doses < 200 mg)
    • Add 9.6 mL SWFI
    • Take 4 mL (400 mg) and add to 16 mL D5W
    • Final concentration: 20 mg/mL
  • Cefotaxime 1 g vial (IV doses > 200 mg)
    • Add 9.6 mL SWFI
    • Final concentration: 100 mg/mL

  • IM: Cefotaxime 1 g vial

    Add 3 mL SWFI

    Final concentration: 300 mg/mL

 

TOH:

  • IV: Cefotaxime 1 g vial 
    • Add 9.6 mL SWFI
    • ​Take 4 mL (400 mg) and add to 16 mL D5W

    • Final concentration: 20 mg/mL

  • IM: Cefotaxime 1 g vial

    • Add 3 mL SWFI

    • Final concentration: 300 mg/mL

Compatibility: 

- Solutions Compatible: D5W, D10W, 0.9% NaCl, dextrose-saline combinations

- Y-site Compatible: acyclovir, calcium gluconate, caffeine, dexmedetomidine, famotidine, fentanyl, heparin,  hydromorphone, KCl, metronidazole, midazolam, milrinone, morphine, SMOF, TPN

Incompatible: azithromycin, fluconazole, pantoprazole, vancomycin

Notes: 

Contains 2.2 mmol of sodium per gram of cefotaxime

References: 

- Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015

- Canadian Paediatric Society. Guidelines for the management of suspected and confirmed meningitis in Canadian children older than one month of age. Paediatric Child Health 2014; 19 (3):141-6.

- American Society on Health-System Pharmacists (ASHP). Handbook on Injectable drugs. 19th Edition. Bethesda: American Society of Health-System Pharmacists; 2017

-The Canadian Paediatric Society Position Statement on Preventing ophthalmia neonatorum, accessed July 2022. 

 

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