Dose:     50 mg/kg IV, IM

Frequency: Q 12 hours if < 1 week, Q 8 hours if  1-4 weeks
                      Dose Adjustment if < 1500 grams or > 4 weeks  
                      Dose Adjustment for renal failure  

Indications: Cefotaxime is a third generation cephalosporin that has been shown to be active against the majority of beta-lactamase producing bacteria. Its activity against most gram negative bacteria is superior to that of gentamicin. Listeria and Enterococci are resistant. Cefotaxime should not be used alone to treat Pseudomonas aeruginosa. Cefotaxime has been shown to eradicate Staph. epidermidis during clinical trials of neonatal sepsis.  The advantage in using cefotaxime is its excellent CSF penetration; however it should be avoided in treating meningitis caused by streptococcus faecalis, Pseudomonas aeruginosa, and Bacteroides fragilis. It does not produce the biliary slugging seen with ceftriaxone. Further comments on cefotaxime.

Toxicity:    Most adverse effects are minor in nature and include diarrhea, rash, fever, or local skin reactions. Cefotaxime has not been associated with platelet dysfunction or bleeding diathesis. Although thrombocytosis, elevations in serum SGOT and SGPT, eosinophilia, and leukopenia have been reported to occur in adults receiving cefotaxime, studies to date in neonates have not demonstrated any hepatic, hematological, or any other adverse clinical effects (de Louvois. Pediatr Pharmacology 1982; 2:275). We have seen one infant develop a urticarial rash on the face and upper extremities within an hour of receiving cefotaxime. Adverse reactions associated with cephalosporins.

Preparation:

IV: Will be prepared in pharmacy to provide 400 mg/4 ml and sent to the NICU in a 5 ml vial (final concentration will be 100 mg/ml. If more than 400 mg is required, a 1 gram vial (100 mg/ml concentration) is also available. The drug is stable for 7 days from the time of initial reconstitution, but 24 hours after vial is punctured. Refrigerate. Infuse over 3 to 5 minutes by IV push (IV push policy). Currently the Diebold has a 1 gram vial. To reconstitute add 9.6 ml of sterile water for injection to the vial. The resulting clear to yellow solution has a concentration of 100 mg/ml.

IM: Add 5 ml of sterile water to a 2 gram vial to give a 2 gram/6 ml concentration (330 mg/ml). Refrigerate, stable 24 hours.

Compatibility: Compatible with filter and TPN.   Also compatible with D5W, D10W, D5 with sodium chloride, LR, and NS. Cefotaxime is compatible with acyclovir, aztreonam, famotidine, lorazepam, magnesium sulfate, midazolam, morphine, propofol, and tolazoline.  Incompatible with allopurinol, amikacin, aminophylline, doxapram, filgrastim, fluconazole, gentamicin, sodium bicarbonate, tobramycin, and vancomycin.