Ceftizoxime

General

• Type: 3rd generation Cephalosporin
• Dosage Forms: powder for injection, premixed frozen solution
• Dosage Strengths: 500mg, 1g, 2g; 1g/50mL, 2g/50mL
• Routes of Administration: IV, IM
• Common Trade Names: Cefizox

Adult Dosing

General

• Uncomplicated: 500mg IM/IV q12h
• Moderate-Severe: 1-2g IM/IV q8-12h
• Life Threatening: 3-4g IV q8h
• Max: 12g/day

UTI, Uncomplicated

• 500mg IM/IV q12h

PID (Pelvic Inflammatory Disease)

• 2g IV q8h (often used in combination with doxycycline)

Gonorrhea, Uncomplicated

• 500mg IM x1

Pediatric Dosing

General (>6 Months)

• 50mg/kg/dose IM/IV q6-8h
• Max: 200mg/kg/day (not to exceed adult maximum)

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl 50-79: 500mg-1.5g q8h
    • CrCl 5-49: 250mg-1g q12h
    • CrCl <5: 500mg q48h or 250mg q24h
    • Hemodialysis: give supplement after dialysis
    • Peritoneal dialysis: see CrCl <5
  • Pediatric
    • Renal impairment requires adjustment; follow adult proportions based on GFR
• Hepatic
  • No adjustment defined

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile
• Pseudomembranous colitis
• Hemolytic anemia
• Seizures

Common

• Diarrhea
• Rash / Pruritus
• Nausea and Vomiting
• Injection site pain/phlebitis
• Eosinophilia
• Thrombocytosis
• Elevated Transaminases

Pharmacology

• Half-life: 1.7h
• Metabolism: Not metabolized
• Excretion: Urine (Unchanged)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
• Note: Notable among 3rd generation cephalosporins for having some activity against anaerobes (B. fragilis).

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	S
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	I
	Enterobacter sp, AmpC pos	R
	Serratia sp	S
	Serratia marcescens	S
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	I
	Citrobacter diversus	S
	Citrobacter sp.	I
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	I
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	S
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)