Cefotaxime
Cefotaxim Navamedic · Claforan
Broad coverage of pneumococci, Haemophilus, meningococci, and most Enterobacterales, with good CNS penetration — making this the standard choice for community-acquired bacterial meningitis and severe sepsis of unknown origin. The price is ecological: cephalosporins are one of the strongest drivers of Clostridioides difficile and ESBL-producing enteric bacteria, and should therefore be stepped down to a narrower alternative as soon as culture results allow.
Inactive against enterococci, Listeria, Pseudomonas, and most intestinal anaerobes. In suspected Listeria meningitis — immunosuppressed patients or those over 50 years of age — ampicillin must be added, otherwise the patient receives no effective treatment for the actual pathogen.
Dosing in adults
| Indication | Regimen | Comment |
|---|---|---|
| Sepsis of unknown origin | 1–2 g iv × 3 | first dose within one hour; 2 g × 3 in septic shock |
| Severe community-acquired pneumonia | 1 g iv × 3 | combined with macrolide or quinolone at CRB-65 score 3–4 |
| Bacterial meningitis | 3 g iv × 4 | high dose required; betamethasone given before or with first dose |
| Pyelonephritis and urosepsis | 1 g iv × 3 | step down according to culture results after 48 hours |
| Spontaneous bacterial peritonitis | 2 g iv × 3 | combined with albumin |
No dose adjustment down to eGFR 10 ml/min — the volume of distribution is unchanged and the half-life rarely exceeds 2,5 hours. At eGFR below 10 ml/min and on dialysis the maintenance dose is halved while the dosing interval is maintained. The loading dose is always given unreduced, even in anuria.
No dose adjustment in isolated hepatic failure. In combined hepatic and renal failure, dose according to renal function.
50–100 mg/kg/day divided into 3–4 doses. In meningitis 200 mg/kg/day divided into 4 doses, maximum 12 g per day.
Avoid as a routine choice when benzylpenicillin or another narrow-spectrum alternative is adequate — cephalosporin pressure is the single strongest modifiable risk factor for Clostridioides difficile and ESBL on a hospital ward. Also avoid in previous anaphylaxis to penicillin; cross-reactivity with third-generation cephalosporins is low but not zero, and in confirmed anaphylaxis a different class should be chosen.
Pharmacokinetics
- t½
- 1 hour (active metabolite 1,5 hours)
- BIOAVAIL.
- Parenteral only
- PROTEIN BINDING
- Approximately 40 %
- METABOLISM
- Deacetylation to desacetylcefotaxime
- EXCRETION
- Renal, approximately 60 % unchanged
- CNS PENETRATION
- Good with meningeal inflammation
- PK/PD
- Time-dependent, T > MIC
- Vd
- Approximately 0,3 l/kg