Foxitane

Indications

Cefoxitin is an antibiotic injection from the cephalosporin family (a cephamycin). It is used in hospital to treat and prevent bacterial infections, especially those involving anaerobic bacteria (germs that live without oxygen), such as:

• Prevention of infection during abdominal, bowel, gynaecological and some other operations
• Infections inside the abdomen, such as peritonitis and abscesses
• Pelvic infections in women, including pelvic inflammatory disease
• Skin and soft tissue infections, including diabetic foot infections
• Some lung, urinary tract, bone, joint and blood infections

It does not work against viral infections such as colds or flu.

How It Works

Cefoxitin stops bacteria from building their cell walls. Without a strong wall, the bacteria burst and die. It is stable against many of the enzymes (beta-lactamases) that some bacteria use to destroy antibiotics, which gives it good activity against gut anaerobes such as Bacteroides.

Dosage and Administration

Cefoxitin is given by a doctor or nurse as an injection or infusion into a vein, or sometimes into a muscle. The dose, how often it is given and for how long are decided by the doctor according to the type and severity of the infection, the patient's weight and kidney function. For prevention during surgery, it is usually given shortly before the operation and sometimes for a short time afterwards. Doses for children are calculated by body weight and are given as prescribed.

Interactions

• Probenecid: raises cefoxitin levels in the blood.
• Aminoglycoside antibiotics (such as Gentamicin) and strong diuretics (such as Furosemide): may increase the risk of kidney problems.
• Warfarin: the effect on blood clotting may increase; INR should be checked.
• Live oral typhoid vaccine and live oral cholera vaccine may be less effective.
• Cefoxitin can affect some laboratory tests, such as certain creatinine tests, urine sugar tests and the Coombs test; tell the laboratory staff you are receiving it.

Contraindications

• Allergy to cefoxitin or any other cephalosporin
• History of a severe allergic reaction (anaphylaxis) to penicillin or other beta-lactam antibiotics

Side Effects

Common or possible side effects include:

• Pain, swelling or inflammation of the vein at the injection site
• Diarrhoea, nausea or vomiting
• Skin rash or itching
• Changes in blood tests (liver enzymes, white cells, platelets)
• Fungal infections such as oral or vaginal thrush

Tell the doctor or nurse at once, or get urgent medical help, if you have swelling of the face, lips or throat, difficulty breathing, a widespread rash or blistering of the skin, severe or bloody diarrhoea (even weeks after treatment), unusual bleeding or bruising, or fits.

Pregnancy and Lactation

Cefoxitin is generally considered acceptable during pregnancy when the doctor feels it is clearly needed. Small amounts pass into breast milk; breastfeeding can usually continue, but watch the baby for diarrhoea, thrush or rash and tell the doctor.

Precautions and Warnings

• Tell the doctor about any previous allergy to antibiotics, especially penicillins or cephalosporins.
• Kidney problems: the dose needs to be reduced.
• People with a history of bowel disease, especially colitis, need extra care because of the risk of antibiotic-related diarrhoea.
• Long courses may need blood tests to check blood counts and kidney and liver function.
• Complete the full course as prescribed by the doctor.

Overdose

Overdose is unlikely because the medicine is given by health professionals. Very high levels, especially in people with kidney failure, may cause fits. Treatment is supportive, and the medicine can be removed from the blood by haemodialysis.

Therapeutic Class

Cephalosporin antibiotic (second-generation cephamycin)

Storage

Hospital medicine: store as directed on the pack, usually the dry powder below 30°C, protected from light and moisture. Once mixed, the solution should be used within the time stated on the pack. Keep out of the reach of children.