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cefotetan (Cefotan)
Tradename: Cefotan. 2nd generation cephalosporin.
Indications:
1) treatment of moderate to serious mixed anaerobic & aerobic infections
a) lower respiratory tract infections
- pneumonia
b) intra-abdominal infections
- pelvic inflammatory disease [6]
c) urogenital infections
- endometritis
d) osteomyelitis, infectious arthritis
e) skin or soft tissue infections
2) prophylaxis for perioperative infection [6] Contraindiactions:
- infections caused by:
a) Enterococcus
b) methicillin-resistant Staphylococcus aureus (MRSA)
c) Pseudomonas aeruginosa (PELVIC_INFLAMMATORY_DISEASE PROPHYLAXIS_FOR_PERIOPERATIVE_INFECTION)
Dosage: 1-2 g IV/IM every 12 hours.
Pharmacokinetics:
1) eliminated unchanged in the urine
-> 20% eliminated in the bile [5]
2) distributed well to most tissues & body fluids
3) poor CSF penetration
4) 1/2life 3.5 hours (13-25 hours ESRD)
Dosage adjustment in renal failure:
creatinine clearance dose
> 30 mL/min 1-2 g IV every 12 hours
10-29 mL/min 1-2 g IV every 24 hours
< 9 mL/min 0.5-1 g IV every 24 hours
1 g IV after hemodialysis
Antimicrobial activity:
Gram positive
- Streptococcus
- Streptococcus group A
- Streptococcus group B
- Streptococcus group C
- Streptococcus group G
- Streptococcus pneumonia
- Streptococcus viridans, milleri
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
Gram negative
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Escherichia coli
- Klebsiella species
- Enterobacter species (+/-)
- Serratia species
- Salmonella species
- Shigella species
- Proteus mirabilis
- Proteus vulgaris
- Providencia species
- Morganella species
- Citrobacter species (+/-)
- Aeromonas species
- Yersinia enterocolitica (+/-)
Anaerobes
- Bacteroides fragilis (+/-)
- Bacteroides melaninogenicus
- Clostridium difficile
- Clostridium species
- Peptostreptococcus species
- Fusobacterium [6]
Adverse effects:
1) bleeding secondary to coagulopathy (in elderly)
a) check PT before & during therapy
b) consider alternate pharmaceutical if coagulopathy
2) increased liver function test
3) hemolytic anemia (may be fatal)
4) hypersensitivity reactions
5) headache
Drug interactions:
1) coadministration with alcohol may produce a disulfiram-like reaction
2) cefotetan may enhance the effect of warfarin & heparin
Mechanism of action: inhibition of bacterial cell wall synthesis.
Interactions
drug interactions
drug adverse effects of cephalosporins
General
cephalosporin, 2nd generation
Properties
MISC-INFO: elimination route KIDNEY
1/2life 3.5 HOURS
protein-binding 76-90%
pregnancy-category B
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook. Isselbacher et al (eds),
McGraw-Hill Inc. NY, 1995, pg 162
- Sanford Guide to antimicrobial therapy 1997
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Geriatric Dosage Handbook, 6th edition, Selma et al eds,
Lexi-Comp, Cleveland, 2001
- Deprecated Reference