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MEFOXIN (cefoxitin) is indicated for the treatment of serious infections caused by susceptible strains of the designated microorganisms in the diseases listed below.
- Lower respiratory tract infections, including pneumonia and lung abscess, caused by Streptococcus pneumoniae, other streptococci (excluding enterococci, e.g., Enterococcus faecalis [formerly Streptococcus faecalis]), Staphylococcus aureus (including penicillinase-producing strains), Escherichia coli, Klebsiella species, Haemophilus influenzae, and Bacteroides species.
- Urinary tract infections caused by Escherichia coli, Klebsiella species, Proteus mirabilis, Morganella morganii, Proteus vulgaris and Providencia species (including P. rettgeri).
- Intra-abdominal infections, including peritonitis and intra-abdominal abscess, caused by Escherichia coli, Klebsiella species, Bacteroides species including Bacteroides fragilis, and Clostridium species.
- Gynecological infections, including endometritis, pelvic cellulitis, and pelvic inflammatory disease caused by Escherichia coli, Neisseria gonorrhoeae (including penicillinase-producing strains), Bacteroides species including B. fragilis, Clostridium species, Peptococcus niger, Peptostreptococcus species, and Streptococcus agalactiae. MEFOXIN (cefoxitin) , like cephalosporins, has no activity against Chlamydia trachomatis. Therefore, when MEFOXIN (cefoxitin) is used in the treatment of patients with pelvic inflammatory disease and C. trachomatis is one of the suspected pathogens, appropriate anti-chlamydial coverage should be added.
- Septicemia caused by Streptococcus pneumoniae, Staphylococcus aureus (including penicillinase-producing strains), Escherichia coli, Klebsiella species, and Bacteroides species including B. fragilis.
- Bone and joint infections caused by Staphylococcus aureus (including penicillinase-producing strains).
- Skin and skin structure infections caused by Staphylococcus aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci e.g., Enterococcus faecalis [formerly Streptococcus faecalis]), Escherichia coli, Proteus mirabilis, Klebsiella species, Bacteroides species including B. fragilis, Clostridium species, Peptococcus niger, and Peptostreptococcus species.
Appropriate culture and susceptibility studies should be performed to determine the susceptibility of the causative organisms to MEFOXIN (cefoxitin) . Therapy may be started while awaiting the results of these studies.
In randomized comparative studies, MEFOXIN (cefoxitin) and cephalothin were comparably safe and effective in the management of infections caused by gram-positive cocci and gram-negative rods susceptible to the cephalosporins. MEFOXIN (cefoxitin) has a high degree of stability in the presence of bacterial beta-lactamases, both penicillinases and cephalosporinases.
Many infections caused by aerobic and anaerobic gram-negative bacteria resistant to some cephalosporins respond to MEFOXIN (cefoxitin) . Similarly, many infections caused by aerobic and anaerobic bacteria resistant to some penicillin antibiotics (ampicillin, carbenicillin, penicillin G) respond to treatment with MEFOXIN (cefoxitin) . Many infections caused by mixtures of susceptible aerobic and anaerobic bacteria respond to treatment with MEFOXIN (cefoxitin) .
If there are signs of infection, specimens for culture should be obtained for identification of the causative organism so that appropriate treatment may be instituted.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of MEFOXIN (cefoxitin) and other antibacterial drugs, MEFOXIN (cefoxitin) should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
DOSAGE AND ADMINISTRATION
The usual adult dosage range is 1 gram to 2 grams every six to eight hours. Dosage should be determined by susceptibility of the causative organisms, severity of infection, and the condition of the patient (see Table 1 for dosage guidelines).
If C. trachomatis is a suspected pathogen, appropriate anti-chlamydial coverage should be added, because cefoxitin sodium has no activity against this organism.
MEFOXIN (cefoxitin) may be used in patients with reduced renal function with the following dosage adjustments:
In adults with renal insufficiency, an initial loading dose of 1 gram to 2 grams may be given. After a loading dose, the recommendations for maintenance dosage (Table 2) may be used as a guide.
When only the serum creatinine level is available, the following formula (based on sex, weight, and age of the patient) may be used to convert this value into creatinine clearance. The serum creatinine should represent a steady state of renal function.
|Males:|| Weight (kg) x (140-age)
72 x serum creatinine (mg/100 mL)
|Females:||0.85 x above value|
In patients undergoing hemodialysis, the loading dose of 1 to 2 grams should be given after each hemodialysis, and the maintenance dose should be given as indicated in Table 2.
Antibiotic therapy for group A beta-hemolytic streptococcal infections should be maintained for at least 10 days to guard against the risk of rheumatic fever or glomerulonephritis. In staphylococcal and other infections involving a collection of pus, surgical drainage should be carried out where indicated.
The recommended dosage in pediatric patients three months of age and older is 80 to 160 mg/kg of body weight per day divided into four to six equal doses. The higher dosages should be used for more severe or serious infections. The total daily dosage should not exceed 12 grams.
At this time no recommendation is made for pediatric patients from birth to three months of age (see PRECAUTIONS).
In pediatric patients with renal insufficiency, the dosage and frequency of dosage should be modified consistent with the recommendations for adults (see Table 2).
Effective prophylactic use depends on the time of administration. MEFOXIN (cefoxitin) usually should be given one-half to one hour before the operation, which is sufficient time to achieve effective levels in the wound during the procedure. Prophylactic administration should usually be stopped within 24 hours since continuing administration of any antibiotic increases the possibility of adverse reactions but, in the majority of surgical procedures, does not reduce the incidence of subsequent infection.
For prophylactic use in uncontaminated gastrointestinal surgery, vaginal hysterectomy, or abdominal hysterectomy, the following doses are recommended:
2 grams administered intravenously just prior to surgery (approximately one-half to one hour before the initial incision) followed by 2 grams every 6 hours after the first dose for no more than 24 hours. Pediatric Patients (3 months and older):
30 to 40 mg/kg doses may be given at the times designated above.
Cesarean section patients
For patients undergoing cesarean section, either a single 2 gram dose administered intravenously as soon as the umbilical cord is clamped OR a 3-dose regimen consisting of 2 grams given intravenously as soon as the umbilical cord is clamped followed by 2 grams 4 and 8 hours after the initial dose is recommended. (See CLINICAL STUDIES.)
Table 1 - Guidelines for Dosage of MEFOXIN (cefoxitin)
|Type of Infection||Daily Dosage||Frequency and Route|
|Uncomplicated forms+ of infections such as pneumonia, urinary tract infection, cutaneous infection||3-4 grams||1 gram every 6-8 hours IV|
|Moderately severe or severe infections||6-8 grams||1 gram every 4 hoursor2 grams every 6-8 hours IV|
|Infections commonly needing antibiotics in higher dosage (e.g., gas gangrene)||12 grams||2 grams every 4 hoursor3 grams every 6 hours IV|
|+ Including patients in whom bacteremia is absent or unlikely.|
Table 2 - Maintenance Dosage of MEFOXIN (cefoxitin) in Adults with Reduced Renal Function
|Renal Function|| Creatinine
|Mild impairment||50-30||1-2||every 8-12 hours|
|Moderate impairment||29-10||1-2||every 12-24 hours|
|Severe impairment||9-5||0.5-1||every 12-24 hours|
|Essentially no function||< 5||0.5-1||every 24-48 hours|
Table 3 - Preparation of Solution for Intravenous Administration
|Strength||Amount of Diluent to be Added (mL)++|| Approximate
|1 gram Vial||10||10.5||95|
|2 gram Vial||10 or 20||11.1 or 21.0||180 or 95|
|1 gram Infusion Bottle||50 or 100||50 or 100||20 or 10|
|2 gram Infusion Bottle||50 or 100||50 or 100||40 or 20|
|10 gram Bulk||43 or 93||49 or 98.5||200 or 100|
|++ Shake to dissolve and let stand until clear.|
Preparation Of Solution
Table 3 is provided for convenience in constituting MEFOXIN (cefoxitin) for intravenous administration.
One gram should be constituted with at least 10 mL, and 2 grams with 10 or 20 mL, of Sterile Water for Injection, Bacteriostatic Water for Injection, 0.9 percent Sodium Chloride Injection, or 5 percent Dextrose Injection. These primary solutions may be further diluted in 50 to 1000 mL of the diluents listed under the Vials and Bulk Packages portion of the COMPATIBILITY AND STABILITY section.
For Bulk Packages
The 10 gram bulk packages should be constituted with 43 or 93 mL of Sterile Water for Injection, Bacteriostatic Water for Injection, 0.9 percent Sodium Chloride Injection, or 5 percent Dextrose Injection. CAUTION: THE 10 GRAM BULK STOCK SOLUTION IS NOT FOR DIRECT INFUSION. These primary solutions may be further diluted in 50 to 1000 mL of the diluents listed under the Vials and Bulk Packages portion of the COMPATIBILITY AND STABILITY section.
Benzyl alcohol as a preservative has been associated with toxicity in neonates. While toxicity has not been demonstrated in pediatric patients greater than three months of age, in whom use of MEFOXIN (cefoxitin) may be indicated, small pediatric patients in this age range may also be at risk for benzyl alcohol toxicity. Therefore, diluent containing benzyl alcohol should not be used when MEFOXIN (cefoxitin) is constituted for administration to pediatric patients in this age range.
For Infusion Bottles
One or 2 grams of MEFOXIN (cefoxitin) for infusion may be constituted with 50 or 100 mL of 0.9 percent Sodium Chloride Injection, or 5 percent or 10 percent Dextrose Injection.
For ADD-Vantage®‡ Vials
See separate INSTRUCTIONS FOR USE OF MEFOXIN (cefoxitin) IN ADD-Vantage® VIALS. MEFOXIN (cefoxitin) in ADD-Vantage® vials should be constituted with ADD-Vantage® diluent containers containing 50 mL or 100 mL of either 0.9 percent Sodium Chloride Injection or 5 percent Dextrose Injection. MEFOXIN (cefoxitin) in ADD-Vantage® vials is for IV use only.
MEFOXIN (cefoxitin) may be administered intravenously after constitution.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.
The intravenous route is preferable for patients with bacteremia, bacterial septicemia, or other severe or life-threatening infections, or for patients who may be poor risks because of lowered resistance resulting from such debilitating conditions as malnutrition, trauma, surgery, diabetes, heart failure, or malignancy, particularly if shock is present or impending.
For intermittent intravenous administration, a solution containing 1 gram or 2 grams in 10 mL of Sterile Water for Injection can be injected over a period of three to five minutes. Using an infusion system, it may also be given over a longer period of time through the tubing system by which the patient may be receiving other intravenous solutions. However, during infusion of the solution containing MEFOXIN (cefoxitin) , it is advisable to temporarily discontinue administration of any other solutions at the same site.
For the administration of higher doses by continuous intravenous infusion, a solution of MEFOXIN (cefoxitin) may be added to an intravenous bottle containing 5 percent Dextrose Injection, 0.9 percent Sodium Chloride Injection, or 5 percent Dextrose and 0.9 percent Sodium Chloride Injection. BUTTERFLY®‡ or scalp vein-type needles are preferred for this type of infusion.
Solutions of MEFOXIN (cefoxitin) , like those of most beta-lactam antibiotics, should not be added to aminoglycoside solutions (e.g., gentamicin sulfate, tobramycin sulfate, amikacin sulfate) because of potential interaction. However, MEFOXIN (cefoxitin) and aminoglycosides may be administered separately to the same patient.
&Dgger; Registered trademark of Abbott Laboratories, Inc.
Compatibility And Stability
Vials and Bulk Packages
MEFOXIN (cefoxitin) , as supplied in vials or the bulk package and constituted to 1 gram/10 mL with Sterile Water for Injection, Bacteriostatic Water for Injection, (see PREPARATION OF SOLUTION), 0.9 percent Sodium Chloride Injection, or 5 percent Dextrose Injection, maintains satisfactory potency for 6 hours at room temperature or for one week under refrigeration (below 5°C).
These primary solutions may be further diluted in 50 to 1000 mL of the following diluents and maintain potency for an additional 18 hours at room temperature or an additional 48 hours under refrigeration:
0.9 percent Sodium Chloride Injection
5 percent or 10 percent Dextrose Injection
5 percent Dextrose and 0.9 percent Sodium Chloride Injection
5 percent Dextrose Injection with 0.2 percent or 0.45 percent saline solution
Lactated Ringer's Injection
5 percent Dextrose in Lactated Ringer's Injection
5 percent Sodium Bicarbonate Injection
M/6 sodium lactate solution
Mannitol 5% and 10%
MEFOXIN (cefoxitin) , as supplied in infusion bottles and constituted with 50 to 100 mL of 0.9 percent Sodium Chloride Injection, or 5 percent or 10 percent Dextrose Injection, maintains satisfactory potency for 24 hours at room temperature or for 1 week under refrigeration (below 5°C).
MEFOXIN (cefoxitin) is supplied in single dose ADD-Vantage® vials and should be prepared as directed in the accompanying INSTRUCTIONS FOR USE OF MEFOXIN (cefoxitin) IN ADD-Vantage® VIALS using ADD-Vantage® diluent containers containing 50 mL or 100 mL of either 0.9 percent Sodium Chloride Injection or 5 percent Dextrose Injection. When prepared with either of these diluents, MEFOXIN (cefoxitin) maintains satisfactory potency for 24 hours at room temperature.
After the periods mentioned above, any unused solutions should be discarded.
Sterile MEFOXIN (cefoxitin) is a dry white to off-white powder supplied in vials and infusion bottles containing cefoxitin sodium as follows:
No. 3356 — 1 gram cefoxitin equivalent
NDC 0006-3356-45 in trays of 25 vials.
No. 3357 — 2 gram cefoxitin equivalent
NDC 0006-3357-53 in trays of 25 vials.
No. 3388 — 10 gram cefoxitin equivalent
NDC 0006-3388-67 in trays of 6 bulk bottles.
No. 3548 — 1 gram cefoxitin equivalent
NDC 0006-3548-45 in trays of 25 ADD-Vantage® vials.
No. 3549 — 2 gram cefoxitin equivalent
NDC 0006-3549-53 in trays of 25 ADD-Vantage® vials.
Special storage instructions
MEFOXIN (cefoxitin) in the dry state should be stored between 2-25°C (36-77°F). Avoid exposure to temperatures above 50°C. The dry material as well as solutions tend to darken, depending on storage conditions; product potency, however, is not adversely affected.
MERCK& COv INC., Whitehouse Station, NJ 08889, USA. Issued October 2006. FDA Rev date: 9/17/2007
Last reviewed on RxList: 10/2/2007
This monograph has been modified to include the generic and brand name in many instances.
Additional Mefoxin Information
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