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Medication Safety Issues
Sound-alike/look-alike issues:
Ceftizoxime may be confused with cefotaxime, ceftazidime, cefuroxime
Pronunciation
(sef ti ZOKS eem)
U.S. Brand Names
Index Terms
Generic Available
No
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of susceptible bacterial infections, mainly respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic, as well as septicemia; active against many gram-negative bacilli (not Pseudomonas), some gram-positive cocci (not Enterococcus), and some anaerobes
Pregnancy Risk Factor
B
Pregnancy Considerations
Teratogenic effects have not been observed in animal studies; therefore, ceftizoxime is classified as pregnancy category B. Ceftizoxime crosses the placenta and is found in the cord blood and amniotic fluid in amounts that are higher than the maternal serum. The maternal peak concentrations at term are similar to those in nonpregnant volunteers.
Lactation
Enters breast milk (small amounts)/use caution
Breast-Feeding Considerations
Very small amounts of ceftizoxime are excreted in breast milk. The manufacturer recommends that caution be exercised when administering ceftizoxime to nursing women. Nondose-related effects could include modification of bowel flora.
Contraindications
Hypersensitivity to ceftizoxime, any component of the formulation, or other cephalosporins
Warnings/Precautions
Concerns related to adverse effects:
• Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment; modify dosage in severe impairment.
Adverse Reactions
1% to 10%:
Central nervous system: Fever
Dermatologic: Rash, pruritus
Hematologic: Eosinophilia, thrombocytosis
Hepatic: Alkaline phosphatase increased, transaminases increased
Local: Pain, burning at injection site
<1%: Anaphylaxis, diarrhea, nausea, vomiting, injection site reactions, phlebitis, paresthesia, numbness, bilirubin increased, BUN increased, creatinine increased, anemia, leukopenia, neutropenia, thrombocytopenia, vaginitis
Reactions reported with other cephalosporins: Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, pseudomembranous colitis, angioedema, hemolytic anemia, candidiasis, encephalopathy, asterixis, neuromuscular excitability, seizure, serum-sickness reactions, renal dysfunction, interstitial nephritis, toxic nephropathy, cholestasis, aplastic anemia, hemolytic anemia, pancytopenia, agranulocytosis, colitis, prolonged PT, hemorrhage, superinfection
Drug Interactions
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Uricosuric Agents: May decrease the excretion of Cephalosporins. Risk C: Monitor therapy
Storage
Reconstituted solution is stable for 24 hours at room temperature and 96 hours when refrigerated. For I.V. infusion in NS or D5W, solution is stable for 24 hours at room temperature, 96 hours when refrigerated, or 12 weeks when frozen. After freezing, thawed solution is stable for 24 hours at room temperature or 10 days when refrigerated.
Compatibility
Stable in D51/4NS, D51/2NS, D5NS, D5W, D10W, LR, NS, sodium bicarbonate 5%.
Y-site administration: Compatible: Acyclovir, allopurinol, amifostine, amphotericin B cholesteryl sulfate complex, aztreonam, docetaxel, doxorubicin liposome, enalaprilat, esmolol, etoposide, famotidine, fludarabine, foscarnet, gatifloxacin, gemcitabine, granisetron, hydromorphone, labetalol, linezolid, melphalan, meperidine, morphine, ondansetron, propofol, ranitidine, remifentanil, sargramostim, teniposide, thiotepa, vinorelbine. Incompatible: Filgrastim. Variable (consult detailed reference): Cisatracurium, promethazine, vancomycin.
Compatibility when admixed: Compatible: Clindamycin, metronidazole.
Mechanism of Action
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Pharmacodynamics/Kinetics
Distribution: Vd: 0.35-0.5 L/kg; widely into most body tissues and fluids including gallbladder, liver, kidneys, bone, sputum, bile, pleural and synovial fluids; has good CSF penetration
Protein binding: 30%
Half-life elimination: 1.6 hours; Clcr <10 mL/minute: 25 hours
Time to peak, serum: I.M.: 0.5-1 hour
Excretion: Urine (as unchanged drug)
Dosage
Usual dosage range:
Children ?6 months: I.M., I.V.: 150-200 mg/kg/day divided every 6-8 hours (maximum: 12 g/24 hours)
Adults: I.M., I.V.: 1-4 g every 8-12 hours
Indication-specific dosing:
Adults:
Gonococcal:
Disseminated infection: I.M., I.V.: 1 g every 8 hours
Uncomplicated: I.M.: 1 g as single dose
Life-threatening infections: I.V.: 2 g every 4 hours or 4 g every 8 hours
Dosing adjustment in renal impairment: Adults:
Clcr 50-79 mL/minute: Administer 500-1500 mg every 8 hours.
Clcr 5-49 mL/minute: Administer 250-1000 mg every 12 hours.
Clcr 0-4 mL/minute: Administer 500-1000 mg every 48 hours or 250-500 mg every 24 hours.
Moderately dialyzable (20% to 50%)
Continuous arteriovenous hemofiltration: Dose as for Clcr 10-50 mL/minute.
Administration: I.M.
Inject deep I.M. into large muscle mass.
Administration: I.V.
Inject direct I.V. over 3-5 minutes. Infuse intermittent infusion over 30 minutes.
Administration: I.V. Detail
pH: 6-8 (reconstituted solution); 5.5-8.0 (frozen premixed infusion solution)
Monitoring Parameters
Observe for signs and symptoms of anaphylaxis during first dose
Test Interactions
Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction
Dietary Considerations
Sodium content of 1 g: 60 mg (2.6 mEq)
Patient Education
Do not take any new medication during therapy unless approved by prescriber. This medication is administered by infusion or injection. Report immediately any redness, swelling, burning, or pain at injection/infusion site; itching or hives; or difficulty swallowing or breathing. Maintain adequate hydration unless instructed to restrict fluid intake. May cause false test results with Clinitest®; use of another type of glucose testing is preferable. Report rash; breathing or swallowing difficulty; persistent diarrhea, nausea, vomiting, or abdominal pain; changes in urinary pattern or pain on urination; opportunistic infection (eg, vaginal itching or drainage, sores in mouth, blood in stool or urine, unusual fever or chills); CNS changes (eg, irritability, agitation, nervousness, insomnia, hallucinations); or other adverse reactions. Breast-feeding precaution: Consult prescriber if breast-feeding.
Geriatric Considerations
Adjust dose for renal function in the elderly.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins
Mental Health: Effects on Psychiatric Treatment
May rarely cause neutropenia; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Assess results of culture/sensitivity tests and patient's allergy history prior to therapy. Assess other pharmacological or herbal products patient may be taking for potential interactions. Assess results of laboratory tests (prothrombin times), therapeutic response, and adverse effects (eg, hemolytic anemia, hypoprothrombinemia, and bleeding) regularly during therapy. Advise patients with diabetes about use of Clinitest® (may cause false-positive test). Teach patient possible side effects/appropriate interventions and adverse symptoms to report (eg, opportunistic infection, hypersensitivity reactions).
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Infusion [premixed iso-osmotic solution]:
Cefizox®: 1 g (50 mL); 2 g (50 mL)
Injection, powder for reconstitution:
Cefizox®: 1 g, 2 g, 10 g [DSC]
References
Deeter RG, Weinstein MP, Swanson KA, et al, “Crossover Assessment of Serum Bactericidal Activity and Pharmacokinetics of Five Broad-Spectrum Cephalosporins in the Elderly,” Antimicrob Agents Chemother, 1990, 34(6):1007-13.
Donowitz GR and Mandell GL, “Beta-Lactam Antibiotics,” N Engl J Med, 1988, 318(7):419-26, 318(8):490-500.
Klein NC and Cunha BA, “Third-Generation Cephalosporins,” Med Clin North Am, 1995, 79(4):705-19.
Marshall WF and Blair JE, “The Cephalosporins,” Mayo Clin Proc, 1999, 74(2):187-95.
International Brand Names
Lexi-Comp.com
Last full review/revision July 2009
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