Cefotetan: Indications, dosage, and side effects

Cefotetan is a second generation cephalosporin that inhibits bacterial cell wall synthesis. It is indicated for the treatment of the following bacterial infections:

  • Bone and joint infections caused by:
    • Staphylococcus aureus.
  • Gynecologic infections (except Chlamydia (Chlamydophila) for which an appropriate therapy should be added) caused by:
    • Penicillinase- and non-penicillinase-producing strains S. aureus
    • Staphylococcus epidermidis
    • Streptococcus spp. excluding enterococci
    • Streptococcus agalactiae
    • Escherichia coli
    • Proteus mirabilis
    • Neisseria gonorrhoeae
    • Bacteroides spp. excluding Bacteroides distasonis, Bacteroides ovatus, Bacteroides thetaiotaomicron
    • Fusobacterium spp., and
    • gram-positive anaerobic cocci including Peptococcus and Peptostreptococcus spp.
  • Intra-abdominal infections caused by:
    • E. coli
    • Klebsiella spp. including K. pneumoniae
    • Streptococcus spp. excluding enterococci
    • Clostridium spp.
  • Lower respiratory tract infections caused by:
    • Streptococcus pneumoniae
    • penicillinase- and non-penicillinase-producing strains of S. aureus
    • Haemophilus influenzae including ampicillin-resistant strains
    • Klebsiella spp. including K. pneumoniae
    • E. coli
    • P. mirabilis
    • Serratia marcescens.
  • For the treatment of gram-positive or gram-negative sepsis or in patients with other serious infections often with concomitant aminoglycosides.
  • Skin and soft tissue infections caused by:
    • Penicillinase- and non-penicillinase-producing strains of S. aureus
    • Staphylococcus epidermidis
    • Streptococcus pyogenes
    • Streptococcus spp. excluding enterococci
    • E. coli
    • K. pneumoniae
    • Peptococcus niger
    • Peptostreptococcus spp.
  • For perioperative Surgical prophylaxis in contaminated or potentially contaminated procedures like a cesarean section, abdominal or vaginal hysterectomy, transurethral surgery, biliary tract surgery, and Gastrointestinal surgery.
  • Treatment of Urinary tract infections caused by:
    • E. coli
    • Klebsiella spp. including K. pneumoniae
    • P. mirabilis and other Proteus spp. including Proteus vulgaris, Providencia rettgeri, and Morganella morganii.

Cefotetan Dose in Adults

Use in the treatment of Susceptible infections:

  • Usual dose: 1 - 2 gms Intramuscular or Intravenous twice daily.
  • For life-threatening infections use 3 gms Intravenous twice daily to a maximum daily dose of 6 gms.
  • A maximum dose of 4 gms/day should be used if administered via the intramuscular route.

Note: Not recommended for the treatment of community-acquired intra-abdominal infections due to high rates of B. fragilis group resistance.


Use in treatment of Pelvic inflammatory disease:

Use in the treatment of Skin and skin structure infections:

  • Mild to moderate infections:

Note: K. pneumoniae infections should be treated with 1 or 2 g intravenous or intramuscular twice daily.

  • 1 g intramuscular or intravenous twice daily or
  • 2 g intravenous every 24 hours
  • Severe infections:
    • 2 g intravenous twice daily

As perioperative for Surgical prophylaxis:

  • 2 gms Intravenous within one hour prior to surgery.
  • The dose may be repeated after 6 hours in lengthy procedures and if there is excessive blood loss.
  • Manufacturer’s labeling:
    • 1 to 2 g Intravenous 30 - 60 minutes prior to surgery.

Use in treatment of Urinary tract infection:

    • 500 mg Intramuscular or Intravenous twice daily or 1 to 2 g every 12 -  24 hours.

Cefotetan Dose in Childrens

General dosing for susceptible infection:

  • Infants, Children, and Adolescents:
    • Mild to moderate infections:
      • 30 mg/kg/dose IM or IV twice daily to a maximum single dose of 2,000 mg
    • Severe infections:
      • 50 mg/kg/dose as IM or IV twice daily to a maximum dose of 3,000 mg/dose.

Use in the treatment of complicated Intraabdominal infections:

  • Infants, Children, and Adolescents:
    • 20 to 40 mg/kg/dose intravenous twice daily.

Note: It is not recommended for the treatment of community-acquired intra-abdominal infections due to high rates of B. fragilis group resistance.


Cefotetan dose in Pelvic inflammatory disease:

  • Adolescents:
    • 2,000 mg intravenous twice daily in combination with doxycycline.

For the prophylaxis of Peritonitis in patients receiving peritoneal dialysis undergoing gastrointestinal or genitourinary procedures:

  • Infants, Children, and Adolescents:
    • 30 to 40 mg/kg intravenous administered 30 to 60 minutes before the procedure to a maximum dose of 2,000 mg/dose.

Dose in Surgical prophylaxis:

  • Children and Adolescents:
    • 40 mg/kg intravenous one hour before the procedure to a maximum dose of 2000 mg. A re-dose may be required after 6 hours in lengthy surgical procedures

Pregnancy Risk Factor C

  • However, it has not been tested in pregnant women. Animal reproduction studies have not shown any adverse effects on fetuses.
  • It crosses the placental boundary and reaches therapeutic levels in the cord serum and amniotic fluid.
  • It is recommended for use during cesarean deliveries.

Cefotetan use duringBreastfeeding:​​​​​​​

  • A nursing woman should be aware that it can be excreted in small amounts into breastmilk.

Cefotetan dosage in patients with renal impairment:

  • CrCl of more than 30 mL/minute:
    • Dosage adjustment is necessary.
  • CrCl of 10 -30 mL/minute:
    • Administer usual dose once a day or half the usual dose administered twice daily
  • CrCl less than 10 mL/minute:
    • Administer usual dose every second day or 25% of the usual dose administered twice daily.
  • End-stage renal disease (ESRD) on intermittent hemodialysis:
    • 5 - 20% of the drug is dialyzable. Administer 25% of the usual dose once a day on days between dialysis and 50% the usual dose on the day of dialysis (administer the dose after dialysis).

Alternate recommendations (American Association of Family Physicians):

  • GFR of more than 50 mL/minute/1.73 m²:
    • Dosage adjustment is not necessary.
  • GFR of 10 - 50 mL/minute/1.73 m²:
    • Administer once daily.
  • GFR of less than 10 mL/minute/1.73 m²:
    • Administer the dose every 48 hours.
  • Peritoneal dialysis:
    • 1 gm every once daily.
  • Continuous renal replacement therapy:
    • Administer once daily

Cefotetan Dose in Liver Disease:

The manufacturer has not recommended any dose adjustment in patients with liver disease.

Common Side effects Of Cefotetan Include:

  • Gastrointestinal:
    • Diarrhea
  • Hepatic:
    • Increased serum transaminases
  • Hypersensitivity:
    • Hypersensitivity reaction

Contraindication to Cefotetan include:

  • Allergy to cefotetan, other cephalosporins, or any component of the formulation.
  • Hemolytic anemia has been documented in the past with the use of cephalosporins.

Warnings and Precautions​​​​​​​

  • Coagulopathy (Elevated iNR):
    • A rise in INR can lead to coagulopathy, which may be a sign of a condition called "coagulopathy".
    • This is especially true for patients who are nutritionally poor or have hepatic impairment.
  • Hemolytic anemia
    • Immune-mediated hemolytic anemia may occur with cephalosporins that may be fatal if not diagnosed early.
    • The drug should be stopped and patients should be treated immediately.
  • Allergy reactions:
    • Cefotetan may cause allergic reactions. It should be used with caution in patients with a history of hypersensitivity reactions to cephalosporin or penicillins
  • Superinfection
    • Ceftriaxone treatment for longer periods (over 2 months) can lead to superinfections, including fungal or bacterial superinfections. 
    • C. difficile-associated diarrhea, (CDAD), and pseudomembranous collitis can occur.
  • Gastrointestinal Disease:
    • Patients who have had colitis or a gastrointestinal condition should be cautious about taking the drug.
  • Renal impairment
    • Patients with impaired renal function should be cautious when taking the drug. 

Cefotetan: Drug Interaction

Note: Drug Interaction Categories:

  • Risk Factor C: Monitor When Using Combination
  • Risk Factor D: Consider Treatment Modification
  • Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).

Alcohol (Ethyl) CefoTEtan can increase the toxic/adverse effects of Alcohol (Ethyl).
Aminoglycosides Cephalosporins (2nd generation) can increase the nephrotoxic effects of Aminoglycosides.
BCG Vaccine (Immunization) Antibiotics can decrease the therapeutic effects of BCG Vaccine (Immunization).
Carbocisteine CefoTEtan could increase the toxic/adverse effects of Carbocisteine. Specifically, cefotetan may enhance adverse effects of alcohol that is present in liquid formulations of carbocisteine-containing products.
Lactobacillus & Estriol Antibiotics can reduce the therapeutic effects of Lactobacillus or Estriol.
Probenecid May increase serum Cephalosporins.
Vitamin K antagonists (eg warfarin) Cephalosporins can increase the anticoagulant effects of Vitamin K Antagonists.

Risk Factor D (Regard therapy modification)

 
RifAMPin Cephalosporins (N-methylthiotetrazole [NMTT] Side Chain Containing) may enhance the adverse/toxic effect of RifAMPin. The risk of bleeding is increased. Management: If possible, avoid concomitant use rifampin and cephalosporins containing an Nmethylthiotetrazole side chain. Monitor prothrombin times and other coagulation tests closely, and give vitamin K as required.
Sodium Picosulfate Antibiotics can reduce the therapeutic effects of Sodium Picosulfate. Patients who are currently using or have just finished using antibiotics should consider using an alternative product to cleanse the bowel before undergoing a colonoscopy.
Typhoid Vaccine The therapeutic effects of Typhoid vaccine may be diminished by antibiotics. The only affected strain is the live attenuated Ty21a. Patients being treated with systemic antibiotics should avoid vaccination with live attenuated Typhoid vaccine (Ty21a). This vaccine should not be used until at least three days after the cessation or discontinuation of antibacterial agent treatment.

Risk Factor X (Avoid Combination)

 
BCG (Intravesical). The therapeutic effects of BCG (Intravesical) may be diminished by antibiotics
Cholera Vaccine Cholera Vaccine may be less effective if taken with antibiotics. Treatment: Cholera vaccine should be avoided in patients who have received systemic antibiotics.

 

Monitoring Parameters:

Monitor the following parameters periodically with a prolonged therapy:

How to administer Cefotetan?

It may be administered as a deep intramuscular injection into a large muscle or injected as an intravenous injection directly over 3 - 5 minutes or as an infusion over 30 minutes.

Mechanism of action of Cefotetan:

Cefotetan

  • This is a second-generation cephalosporin. It inhibits the formation bacterial proteins and prevents peptidoglycan formation by binding to penicillin-binding protein eventually leading to cell lysis via autolytic enzymes.

It is very populardistributedTo body tissues and fluids such as bile, gallbladder and skin, kidneys and tonsils. 88% of the drug can be found in urine.protein-bound. The half-life eliminationPatients with mildly impaired renal function may experience a delay of up to 4.6 hours. TheTime to achieve peak serum concentrationIt takes between 1 and 3 hours to recover from intramuscular injections. It isexcretedPrimarily via urine as an unchanged drug (50 to 80%).

International Brands of Cefotetan:

  • Apacef
  • Apatef
  • Ceftenon
  • Darvilen
  • Kuptamete
  • Maxtetan
  • Trixosporin
  • Yamatetan
  • Cefotan

Cefotetan Brands in Pakistan:

No brands available in Pakistan

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