Cefotetan

Indications

Cefotetan is used for: Bone and joint infections, Gynaecological infections, Intra-abdominal infections, Lower respiratory tract infections, Skin and skin structure infections, Urinary tract infections, Prophylaxis of surgical infections, Pelvic inflammatory disease

Adult Dose

Intramuscular, Intravenous Bone and joint infections, Gynaecological infections, Intra-abdominal infections, Lower respiratory tract infections Adult: Usual dose: 1-2 g 12 hourly for 5-10 days depending on the severity of the infection. Severe: 2 g 12 hourly. Life threatening infections: 3 g 12 hourly up to max 6 g daily. All doses to be given by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes. Skin and skin structure infections Adult: Mild to moderate: 1 g 12 hourly. Severe: 2 g 12 hourly. K. pneumoniae infections: 1-2 g 12 hourly. All doses to be given for 5-10 days by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes. Urinary tract infections Adult: 1-4 g daily for 5-10 days depending on the severity of the infection by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes. Intravenous Prophylaxis of surgical infections Adult: 1-2 g 30-60 minutes before the procedure or when the umbilical cord is clamped in caesarean section. Pelvic inflammatory disease Adult: In combination with doxycycline: 2 g 12 hourly for 5-10 days.

Child Dose

Renal Dose

ESRD patient on haemodialysis: One quarter of the usual dose 24 hourly on days between dialysis and half of the usual dose on the day of dialysis. CrCl (mL/min) Dosage <10 Usual dose 48 hourly or one quarter of the usual dose 12 hourly. 10-30 Usual dose 24 hourly or half of the usual dose 12 hourly.

Administration

IV Preparation (for powder) Solution: add 10 mL diluent to 1 g vial; withdraw 10.5 mL (95 mg/mL) IV Administration Intermittent infusion over 20-60 min Do not administer with other drugs Canadian (but not US) formulations allow for IV inj or deep IM

Contra Indications

Hypersensitivity to cefotetan and other cephalosporins. History of cephalosporin associated haemolytic anaemia.

Precautions

Patient with history of penicillin allergy, gastrointestinal disease (e.g. colitis), risk factors for INR elevation (e.g. malnourished or cancer patient). Renal and hepatic impairment. Pregnancy and lactation.

Pregnancy-Lactation

Pregnancy Category: B Lactation: excreted in breast milk, use caution

Interactions

Enhanced nephrotoxic effect with aminoglycosides. Increased serum concentration with probenecid. May enhance the anticoagulant effect of vitamin K antagonists (e.g. warfarin). May diminish the therapeutic effect of Na picosulfate, BCG, typhoid and cholera vaccines.

Adverse Effects

Side effects of Cefotetan : 1-10% Diarrhea (1%) Hepatic enzyme elevation (1%) Hypersensitivity reaction (1%) <1% Prolongation of bleeding time Neutropenia Thrombocytopenia Immune-mediated hemolytic anemia

Mechanism of Action

Cefotetan is a 2nd generation cephalosporin which inhibits bacterial cell wall biosynthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn prevents the final transpeptidation step of peptidoglycan synthesis, thus arresting cell wall assembly resulting in bacterial cell death.