Cefotetan

Bone and joint infections, Gynaecological infections, Intra-abdominal infections, Lower respiratory tract infections, Skin and skin structure infections, Urinary tract infections, Prophylaxis of surgical infections, Pelvic inflammatory disease

Intramuscular, Intravenous Bone and joint infections, Gynaecological infections, Intra-abdominal infections, Lower respiratory tract infections Adult: Usual dose: 1-2 g 12 hourly for 5-10 days depending on the severity of the infection. Severe: 2 g 12 hourly. Life threatening infections: 3 g 12 hourly up to max 6 g daily. All doses to be given by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes. Skin and skin structure infections Adult: Mild to moderate: 1 g 12 hourly. Severe: 2 g 12 hourly. K. pneumoniae infections: 1-2 g 12 hourly. All doses to be given for 5-10 days by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes. Urinary tract infections Adult: 1-4 g daily for 5-10 days depending on the severity of the infection by deep IM inj, slow IV inj over 3-5 minutes, or intermittent IV infusion over 30 minutes. Intravenous Prophylaxis of surgical infections Adult: 1-2 g 30-60 minutes before the procedure or when the umbilical cord is clamped in caesarean section. Pelvic inflammatory disease Adult: In combination with doxycycline: 2 g 12 hourly for 5-10 days.

Renal Impairment CrCl 10-30 mL/min: Give qDay CrCl <10 mL/min: Give q48hr

IV Preparation (for powder) Solution: add 10 mL diluent to 1 g vial; withdraw 10.5 mL (95 mg/mL) IV Administration Intermittent infusion over 20-60 min Do not administer with other drugs Canadian (but not US) formulations allow for IV inj or deep IM

Hypersensitivity to cefotetan and other cephalosporins. History of cephalosporin associated haemolytic anaemia.

Hypersensitivity reactions including anaphylaxis and serious skin reactions: if an allergic reaction occurs discontinue the drug. Severe cases of hemolytic anemia, including fatalities, have been reported. If the patient develops anemia, discontinue drug. Fall in prothrombin activity and risk of bleeding may occur. Monitor prothrombin time and administer exogenous vitamin K as indicated Clostridium difficile-associated diarrhea. May range from mild diarrhea to fatal colitis. Evaluate if diarrhea occurs.

Not Classi Pregnancy Available data from published observational studies and case reports over several decades with drug use in pregnant women have not established a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes Animal data In animal reproduction studies, no adverse developmental effects were observed when pregnant rats and monkeys were treated, during period of organogenesis, at doses up to approximately 3 and 2 times maximum recommended human dose (MRHD), respectively Maternal gonorrhea may be associated with preterm birth, low neonatal birth weight, chorioamnionitis, intrauterine growth restriction, small for gestational age and premature rupture of membranes; perinatal transmission of gonorrhea to offspring can result in infant blindness, joint infections and bloodstream infections Lactation Published literature reports that drug is present in human milk at low levels following intravenous administration; there is no information regarding effects of cefotetan on milk production or the breastfed infant; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from drug or from underlying maternal condition

Enhanced nephrotoxic effect with aminoglycosides. Increased serum concentration with probenecid. May enhance the anticoagulant effect of vitamin K antagonists (e.g. warfarin). May diminish the therapeutic effect of Na picosulfate, BCG, typhoid and cholera vaccines. Contraindicated (1) dronabinol Serious (3) BCG vaccine live cholera vaccine microbiota oral

1-10% Diarrhea (1%) Hepatic enzyme elevation (1%) Hypersensitivity reaction (1%) <1% Prolongation of bleeding time Neutropenia Thrombocytopenia Immune-mediated hemolytic anemia

Cefotetan is a 2nd generation cephalosporin which inhibits bacterial cell wall biosynthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn prevents the final transpeptidation step of peptidoglycan synthesis, thus arresting cell wall assembly resulting in bacterial cell death.