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Cefotaxime - Claforan ® - Renal Dosing

Usual Dosing (Adults)

[Uncomplicated]: 1 gram IV/IM q12h. 
[Moderate to severe]: 1-2 grams IV/IM q8h. 
[Severe]: 2 grams IV q6-8h. 
[Life-threatening]: 2 grams IV q4h

GUIDELINES FOR DOSAGE OF CLAFORAN
Type of Infection Daily Dose (grams) Frequency and Route
Gonococcal urethritis/
  cervicitis in males and females
0.5 0.5 gram IM (single dose)
Rectal gonorrhea in females 0.5 0.5 gram IM (single dose)
Rectal gonorrhea in males    1 1 gram IM (single dose)
Uncomplicated infections    2 1 gram every 12 hours IM or IV
Moderate to severe infections 3–6  1–2 grams every 8 hours IM or IV
Infections commonly needing
  antibiotics in higher dosage (e.g., septicemia)
6–8  2 grams every 6–8 hours IV
Life-threatening infections up to 12       2 grams every 4 hours IV

If C. trachomatis is a suspected pathogen, appropriate anti-chlamydial coverage should be added, because cefotaxime sodium has no activity against this organism.

To prevent postoperative infection in contaminated or potentially contaminated surgery, the recommended dose is a single 1 gram IM or IV administered 30 to 90 minutes prior to start of surgery.

Cesarean Section Patients: The first dose of 1 gram is administered intravenously as soon as the umbilical cord is clamped. The second and third doses should be given as 1 gram intravenously or intramuscularly at 6 and 12 hours after the first dose.

Neonates, Infants, and Children: The following dosage schedule is recommended:
Neonates (birth to 1 month):
0–1 week of age 50 mg/kg per dose every 12 hours IV
1–4 weeks of age 50 mg/kg per dose every 8 hours IV

It is not necessary to differentiate between premature and normal-gestational age infants.
Infants and Children (1 month to 12 years):
For body weights less than 50 kg, the recommended daily dose is 50 to 180 mg/kg IM or IV body weight divided into four to six equal doses. The higher dosages should be used for more severe or serious infections, including meningitis. For body weights 50 kg or more, the usual adult dosage should be used; the maximum daily dosage should not exceed 12 grams.

Renal Dosing

dialysis Dosing recommendations for this drug in renal impairment have changed over the years. Here is the most recent comments from the package insert (Nov 2012): 

Because high and prolonged serum antibiotic concentrations can occur from usual doses in patients with transient or persistent reduction of urinary output because of renal insufficiency, the total daily dosage should be reduced when CLAFORAN is administered to such patients. Continued dosage should be determined by degree of renal impairment, severity of infection, and susceptibility of the causative organism.

Although there is no clinical evidence supporting the necessity of changing the dosage of cefotaxime sodium in patients with even profound renal dysfunction, it is suggested that, until further data are obtained, the dose of cefotaxime sodium be halved in patients with estimated creatinine clearances of <20 mL/min/1.73 m2.

Note: earlier guidelines recommended interval extension, however, the newer guidelines do not mention interval changes ... just dosage reduction.

Hemodialysis

dialysis No specific guidance available per package insert except for what is listed above. 

Previous guidelines:
Hemodialysis:  500mg to 2 grams q24h, plus give a supplemental dose post-dialysis.

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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