Cefotaxime

A third-generation cephalosporin with enhanced activity against Gramve species in comparison with second-generation cephalosporins. It is not active against Pseudomonas aeruginosa, enterococci or Bacteroides spp. Use is increasingly being compromised by the emergence of Gramve strains expressing extended spectrum beta-lactamases (ESBLs) and chromosomal beta-lactamase producers.

Uses:
Surgical prophylaxis, although first- and second-generation cephalosporins are usually preferred
Acute epiglottitis due to Haemophilus influenzae
Empiric therapy of meningitis
Intra-abdominal infections including peritonitis
Community-acquired and nosocomial pneumonia
Urinary tract infections
Sepsis of unknown origin

Contraindications:
Hypersensitivity to cephalosporins
Serious penicillin hypersensitivity (10% cross-sensitivity)
Porphyria

Administration:
• IV: 1 g 12 hourly, increased in life-threatening infections (e.g. meningitis) to 3 g 6 hourly

Reconstitute with 10 ml WFI, given over 3–5 min

Infection	Dose (g)	Interval (h)
Mild–moderate	1	12
Moderate–serious	2	8
Life-threatening	3	6

Adverse effects:

Hypersensitivity

Transient ↑ LFTs

Clostridium difficile-associated diarrhoea

Cautions:

Concurrent use of nephrotoxic drugs (aminoglycosides, loop diuretics)

Severe renal impairment (halve dose)

False +ve urinary glucose (if tested for reducing substances)

False +ve Coombs’ test

Organ failure:

Renal: In severe renal impairment (<10 ml/min): 1 g every 8-12 hours

Renal replacement therapy:

No further dose modification is required during renal replacement therapy