cefotaxime

Cefotaxime is a parenteral third-generation cephalosporin antibiotic used to treat a range of moderate to severe bacterial infections. It is administered by intravenous or intramuscular injection and has minimal oral bioavailability. Cefotaxime works by inhibiting bacterial cell wall synthesis through binding to penicillin-binding proteins, producing a bactericidal effect. It penetrates inflamed meninges, allowing its use in meningitis.

Spectrum and activity are broader for many Gram-negative organisms than for Gram-positives. It is active against Neisseria meningitidis, Haemophilus influenzae, Moraxella catarrhalis, and enteric Gram-negative rods such as Escherichia coli, Klebsiella species, and Proteus mirabilis. It also covers certain Streptococcus species, including Streptococcus pneumoniae and group A streptococci. It has limited activity against Enterococcus and little to no activity against Bacteroides fragilis and other anaerobes, and it is not active against Pseudomonas aeruginosa. Resistance can occur with beta-lactamase–producing organisms.

Pharmacokinetics and administration: cefotaxime is primarily eliminated by the kidneys, with a half-life of about 1–2 hours in individuals with normal renal function, necessitating dose adjustment in renal impairment. It distributes well into many tissues and fluids, including cerebrospinal fluid when meninges are inflamed.

Clinical uses include severe pneumonia, meningitis, intra-abdominal and gynecologic infections, septicemia, and other serious infections caused by susceptible organisms. Dosing is typically 1–2 g every 4–6 hours for adults, with higher doses for meningitis or severe infections. Rodent dose ranges in neonates and children differ and require specialist guidance.

Adverse effects are generally mild but can include hypersensitivity reactions, rash, diarrhea, and superinfections. As with other cephalosporins, there is a risk of Clostridioides difficile infection. Cefotaxime is considered relatively safe in pregnancy and lactation.

Brand names include Claforan and generic formulations.