Ceftizoxime Sodium

Pronunciation: (SEFF-tih-ZOX-eem SO-dee-uhm)Class: Antibiotic, Cephalosporin

Trade Names:Cefizox- Powder for Injection 500 mg (2.6 mEq sodium/g)- Powder for Injection 1 g (2.6 mEq sodium/g)- Powder for Injection 2 g (2.6 mEq sodium/g)- Powder for Injection 10 g (2.6 mEq sodium/g)- Injection 1 g as sodium- Injection 2 g as sodium

Pharmacology

Inhibits mucopeptide synthesis in bacterial cell wall.

Pharmacokinetics

Distribution

Ceftizoxime is 30% protein bound. It achieves therapeutic levels in various body fluids (eg, CSF in those with inflamed meninges) and body tissues. It is excreted in human milk in low concentrations.

Metabolism

Ceftizoxime is not metabolized.

Elimination

The t ½ is about 1.7 h. Ceftizoxime is excreted unchanged by the kidneys in 24 h.

Special Populations

Renal Function Impairment

The t ½ is prolonged. Dosage adjustment is recommended.

Indications and Usage

Treatment of infections of lower respiratory tract, urinary tract, skin and skin structures, bone and joint; treatment of intra-abdominal infections, pelvic inflammatory disease, gonorrhea, septicemia, and meningitis caused by susceptible microorganisms.

Contraindications

Hypersensitivity to cephalosporins.

Dosage and Administration

Adults

IV/IM 1 to 2 g every 8 to 12 h (life-threatening infections: IV up to 2 g every 4 h or 3 to 4 g every 8 h).

Children older than 6 mo of age

IV/IM 50 mg/kg every 6 to 8 h up to 200 mg/kg/day (max, 12 g/day).

General Advice

When giving by IM route, inject deeply into large muscle (eg, upper outer quadrant of gluteus muscle or lateral thigh); massage well. For amounts greater than 2 g, divide dose and administer in different muscle masses.
Reconstituted solution should be light yellow to amber. Do not administer if solution is cloudy or precipitate is present.
When giving by IV route, administer slowly over 3 to 5 min using direct (bolus) injection. Change IV sites every 48 to 72 h.
When drug is administered by intermittent IV infusion, reconstituted solution can be further diluted with 50 to 100 mL of sodium chloride 0.9% or D5W and infused over 30 min.

Storage/Stability

Completely thaw frozen preparations at room temperature before use. Do not introduce additives. After thawing, solution is stable for 24 h at room temperature or for 10 days if refrigerated. Do not refreeze.
Store sterile powder at room temperature and protect from light.
Reconstituted solution is stable for 96 h if refrigerated and 24 h when stored at room temperature.

Drug Interactions

Aminoglycosides

Increased risk of nephrotoxicity.

Probenecid

Inhibition of renal excretion of ceftizoxime.

Incompatibility

Aminoglycosides

Do not add aminoglycosides to ceftizoxime solutions because inactivation of both drugs may result; administer at separate sites if concurrent therapy is indicated.

Laboratory Test Interactions

May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix , Tes-tape ); false-positive test results for proteinuria with acid and denaturization-precipitation tests; false-positive direct Coombs test results in certain patients (eg, those with azotemia); false elevations in urinary 17-ketosteroid values.

Adverse Reactions

GI

Nausea; vomiting; diarrhea; anorexia; abdominal pain or cramps; flatulence; colitis, including pseudomembranous colitis.

Genitourinary

Pyuria; renal function impairment; dysuria; reversible interstitial nephritis; hematuria; toxic nephropathy.

Hematologic

Eosinophilia; neutropenia; lymphocytosis; leukocytosis; thrombocytopenia; decreased platelet function; anemia; aplastic anemia; hemorrhage.

Hepatic

Hepatic function impairment; abnormal LFT results.

Miscellaneous

Hypersensitivity, including Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis; candidal overgrowth; serum sickness–like reactions (eg, skin rashes, polyarthritis, arthralgia, fever); phlebitis; thrombophlebitis and pain at injection site.

Precautions

Monitor

Response to therapy

Monitor patient's response to therapy. Notify health care provider if infection does not appear to improve or worsens.

Adverse reactions

Monitor patient for GI, DERM, and general body adverse reactions, and signs of superinfection. Inform health care provider if noted and significant. Immediately report severe diarrhea, diarrhea containing blood or pus, or severe abdominal cramping.

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Safety and efficacy in infants younger than 6 mo of age not established. In infants, consider benefits relative to risks.

Hypersensitivity

Reactions range from mild to life-threatening. Administer drug with caution to penicillin-sensitive patients because of possible cross-reactivity.

Renal Function

Use drug with caution in patients with baseline renal function impairment. Dosage adjustment based on renal function may be required.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible micro-organisms.

Pseudomembranous colitis

Consider in patients who develop diarrhea.

Overdosage

Symptoms

Seizures.

Patient Information

Remind patient to check body temperature daily. If fever persists for more than a few days or if high fever (higher than 102°F) or shaking chills are noted, notify health care provider immediately.
Advise patient to maintain normal fluid intake while using this medication.
Instruct diabetic patient to use enzyme-based tests (eg, Clinistix , Testape ) for monitoring urine glucose because drug may give false results with other tests.
Advise patient to report these symptoms to health care provider: nausea, vomiting, diarrhea, sore throat, bruising, bleeding, hives, bone or joint pain.
Instruct patient to report signs of superinfection: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
Warn patient that diarrhea that contains blood or pus may be a sign of serious disorders. Tell patient to seek medical care and not to treat at home.
Instruct patient to seek emergency care immediately if wheezing or difficulty in breathing occurs.
Advise patient to avoid ingesting alcohol.