Ceftizoxime: Difference between revisions

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* [[Intra­Abdominal Infections]] caused by Escherichia coli; [[Staphylococcusepidermidis]]; [[Streptococcus]] spp. (excluding enterococci); [[Enterobacter]] spp.; [[Klebsiella]] spp.; [[Bacteroides]] spp. including B. fragilis; and anaerobic cocci, including [[Peptococcus]] spp. and [[Peptostreptococcus]] spp.
* [[Intra­Abdominal Infections]] caused by Escherichia coli; [[Staphylococcusepidermidis]]; [[Streptococcus]] spp. (excluding enterococci); [[Enterobacter]] spp.; [[Klebsiella]] spp.; [[Bacteroides]] spp. including B. fragilis; and anaerobic cocci, including [[Peptococcus]] spp. and [[Peptostreptococcus]] spp.


* [[Septicemia]] caused by Streptococcus spp. including [[S. pneumoniae]] (but excluding enterococci); [[Staphylococcus aureus]] (penicillinase­ and nonpenicillinase­producing); Escherichia coli; Bacteroides spp. including B. fragilis; Klebsiella spp.; and Serratia spp.
* [[Septicemia]] caused by Streptococcus spp. including [[S. pneumoniae]] (but excluding [[enterococci]]); [[Staphylococcus aureus]] ([[penicillinase]]­ and nonpenicillinase­producing); [[Escherichia coli]]; [[Bacteroides spp.]] including [[B. fragilis]]; [[Klebsiella spp.]]; and [[Serratia spp.]]


* Skin and Skin Structure Infections caused by Staphylococcus aureus (penicillinase­ and nonpenicillinase­producing); Staphylococcus epidermidis; Escherichia coli; Klebsiella spp.; Streptococcus spp. including Streptococcus pyogenes (but excluding enterococci); Proteus mirabilis; Serratia spp.; Enterobacter spp.; Bacteroides spp. including B. fragilis; and anaerobic cocci, including Peptococcus spp. and Peptostreptococcus spp.
* Skin and Skin Structure Infections caused by [[Staphylococcus aureus]] ([[penicillinase]]­ and nonpenicillinase­producing); [[Staphylococcus epidermidis]]; [[Escherichia coli]]; [[Klebsiella spp.]]; [[Streptococcus spp.]] including [[Streptococcus pyogenes]] (but excluding [[enterococci]]); [[Proteus mirabilis]]; [[Serratia spp.]]; [[Enterobacter spp.]]; [[Bacteroides spp.]] including [[B. fragilis]]; and anaerobic cocci, including [[Peptococcus spp.]] and [[Peptostreptococcus spp.]]


* Bone and Joint Infections caused by [[Staphylococcus aureus]] (penicillinase­ and nonpenicillinase­producing); Streptococcus spp. (excluding enterococci); Proteusmirabilis; Bacteroides spp.; and anaerobic cocci, including Peptococcus spp. and Peptostreptococcus spp.
* Bone and Joint Infections caused by [[Staphylococcus aureus]] ([[penicillinase]]­ and nonpenicillinase­producing); [[Streptococcus spp.]] (excluding enterococci); [[Proteusmirabilis]]; [[Bacteroides spp.]]; and anaerobic cocci, including [[Peptococcus spp.]] and [[Peptostreptococcus spp.]]


* [[Meningitis]] caused by [[Haemophilus influenza]]e. Cefizox has also been used successfully in the treatment of a limited number of pediatric and adult cases of meningitis caused by Streptococcus pneumoniae.
* [[Meningitis]] caused by [[Haemophilus influenza]]e. Cefizox has also been used successfully in the treatment of a limited number of pediatric and adult cases of [[meningitis]] caused by [[Streptococcus pneumoniae]].


* Cefizox has been effective in the treatment of seriously ill, compromised patients, including those who were debilitated, immunosuppressed, or neutropenic.
* Cefizox has been effective in the treatment of seriously ill, compromised patients, including those who were debilitated, immunosuppressed, or neutropenic.


* Infections caused by aerobic gram­negative and by mixtures of organisms resistant to other cephalosporins, aminoglycosides, or penicillins have responded to treatment with Cefizox.
* Infections caused by aerobic gram­negative and by mixtures of organisms resistant to other [[cephalosporins]], [[aminoglycosides]], or [[penicillins]] have responded to treatment with Cefizox.


* Because of the serious nature of some urinary tract infections due to P. aeruginosa and because many strains of Pseudomonas species are only moderately susceptible to Cefizox, higher dosage is recommended. Other therapy should be instituted if the response is not prompt.
* Because of the serious nature of some urinary tract infections due to [[P. aeruginosa]] and because many strains of Pseudomonas species are only moderately susceptible to Cefizox, higher dosage is recommended. Other therapy should be instituted if the response is not prompt.


* Susceptibility studies on specimens obtained prior to therapy should be used to determine the response of causative organisms to Cefizox. Therapy with Cefizox may be initiated pending results of the studies; however, treatment should be adjusted according to study findings. In serious infections, Cefizox has been used
* Susceptibility studies on specimens obtained prior to therapy should be used to determine the response of causative organisms to Cefizox. Therapy with Cefizox may be initiated pending results of the studies; however, treatment should be adjusted according to study findings. In serious infections, Cefizox has been used


:* concomitantly with aminoglycosides (see PRECAUTIONS). Before using Cefizox
:* concomitantly with [[aminoglycosides]]. Before using Cefizox


:* concomitantly with other antibiotics, the prescribing information for those agents
:* concomitantly with other antibiotics, the prescribing information for those agents
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: [[File:Ceftizoxime Dos Tab 1.png|none|500px]]
: [[File:Ceftizoxime Dos Tab 1.png|none|500px]]


* Because of the serious nature of urinary tract infections due to P. aeruginosa and because many strains of Pseudomonas species are only moderately susceptible to Cefizox, higher dosage is recommended. Other therapy should be instituted if the response is not prompt.
* Because of the serious nature of urinary tract infections due to [[P. aeruginosa]] and because many strains of Pseudomonas species are only moderately susceptible to Cefizox, higher dosage is recommended. Other therapy should be instituted if the response is not prompt.


* A single, 1 gram IM dose is the usual dose for treatment of uncomplicated gonorrhea.
* A single, 1 gram IM dose is the usual dose for treatment of [[uncomplicated gonorrhea]].


* The IV route may be preferable for patients with bacterial septicemia, localized parenchymal abscesses (such as intra­abdominal abscess), peritonitis, or other severe or life­threatening infections.
* The IV route may be preferable for patients with [[bacterial septicemia]], localized [[parenchymal abscesses]] (such as intra­abdominal abscess), [[peritonitis]], or other severe or life­threatening infections.


* In those with normal renal function, the IV dosage for such infections is 2 to 12 grams of Cefizox (ceftizoxime for injection, USP) daily. In conditions such as bacterial septicemia, 6 to 12 grams/day may be given initially by the IV route for several days, and the dosage may then be gradually reduced according to clinical response and laboratory findings.
* In those with normal renal function, the IV dosage for such infections is 2 to 12 grams of Cefizox (ceftizoxime for injection, USP) daily. In conditions such as bacterial septicemia, 6 to 12 grams/day may be given initially by the IV route for several days, and the dosage may then be gradually reduced according to clinical response and laboratory findings.
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* Modification of Cefizox dosage is necessary in patients with impaired renal function. Following an initial loading dose of 500 mg-1 gram IM or IV, the maintenance dosing schedule shown below should be followed. Further dosing should be determined by therapeutic monitoring, severity of the infection, and susceptibility of the causative organisms.
* Modification of Cefizox dosage is necessary in patients with impaired renal function. Following an initial loading dose of 500 mg-1 gram IM or IV, the maintenance dosing schedule shown below should be followed. Further dosing should be determined by therapeutic monitoring, severity of the infection, and susceptibility of the causative organisms.


* When only the serum creatinine level is available, creatinine clearance may be calculated from the following formula. The serum creatinine level should represent current renal function at the steady state.
* When only the serum [[creatinine]] level is available, [[creatinine clearance]] may be calculated from the following formula. The serum [[creatinine]] level should represent current renal function at the steady state.


=====Males=====
=====Males=====
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* Females are 0.85 of the calculated clearance values for males.
* Females are 0.85 of the calculated clearance values for males.


* In patients undergoing hemodialysis, no additional supplemental dosing is required following hemodialysis; however, dosing should be timed so that the patient receives the dose (according to the table below) at the end of the dialysis.
* In patients undergoing [[hemodialysis]], no additional supplemental dosing is required following [[hemodialysis]]; however, dosing should be timed so that the patient receives the dose (according to the table below) at the end of the dialysis.
: [[File:Ceftizoxime Dos Tab 3.png|none|500px]]
: [[File:Ceftizoxime Dos Tab 3.png|none|500px]]


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<!--Warnings-->
<!--Warnings-->
|warnings=* BEFORE THERAPY WITH CEFIZOX IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFIZOX, OTHER CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN­SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS HYPERSENSITIVITY AMONG BETA­LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY. IF AN ALLERGIC REACTION TO CEFIZOX OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE TREATMENT WITH EPINEPHRINE AND OTHER EMERGENCY MEASURES, INCLUDING OXYGEN, IV FLUIDS, IV ANTIHISTAMINES, CORTICOSTEROIDS, PRESSOR AMINES, AND AIRWAY MANAGEMENT, AS CLINICALLY INDICATED.
|warnings=* BEFORE THERAPY WITH CEFIZOX IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFIZOX, OTHER [[CEPHALOSPORINS]], [[PENICILLINS]], OR OTHER DRUGS. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN­SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS [[HYPERSENSITIVITY]] AMONG [[BETA­LACTAM ANTIBIOTICS]] HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY. IF AN ALLERGIC REACTION TO CEFIZOX OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE TREATMENT WITH EPINEPHRINE AND OTHER EMERGENCY MEASURES, INCLUDING OXYGEN, IV FLUIDS, IV [[ANTIHISTAMINES]], [[CORTICOSTEROIDS]], PRESSOR AMINES, AND AIRWAY MANAGEMENT, AS CLINICALLY INDICATED.


* Pseudomembranous colitis has been reported with nearly all antibacterial agents, including ceftizoxime, and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.
* [[Pseudomembranous colitis]] has been reported with nearly all antibacterial agents, including ceftizoxime, and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.


* Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is a primary cause of “antibiotic­associated” colitis.
* Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of [[clostridia]]. Studies indicate that a toxin produced by [[Clostridium difficile]] is a primary cause of “antibiotic­associated” colitis.


* After the diagnosis of [[pseudomembranous colitis]] has been established, appropriate therapeutic measures should be initiated. Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation, and treatment with an antibacterial drug clinically effective against Clostridium difficile colitis.
* After the diagnosis of [[pseudomembranous colitis]] has been established, appropriate therapeutic measures should be initiated. Mild cases of [[pseudomembranous colitis]] usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation, and treatment with an antibacterial drug clinically effective against [[Clostridium difficile colitis]].


====Precautions====
====Precautions====


General
=====General=====
As with all broad­spectrum antibiotics, Cefizox (ceftizoxime for injection, USP) should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis.
* As with all broad­spectrum antibiotics, Cefizox (ceftizoxime for injection, USP) should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly [[colitis]].


Although Cefizox has not been shown to produce an alteration in renal function, renal status should be evaluated, especially in seriously ill patients receiving maximum dose therapy. As with any antibiotic, prolonged use may result in overgrowth of nonsusceptible organisms. Careful observation is essential; appropriate measures should be taken if superinfection occurs.
* Although Cefizox has not been shown to produce an alteration in renal function, renal status should be evaluated, especially in seriously ill patients receiving maximum dose therapy. As with any antibiotic, prolonged use may result in overgrowth of nonsusceptible organisms. Careful observation is essential; appropriate measures should be taken if superinfection occurs.


Cephalosporins may be associated with a fall in prothrombin activity. Those at risk include patients with renal or hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy. Prothrombin time should be monitored in patients at risk and exogenous vitamin K administered as indicated.
* [[Cephalosporins]] may be associated with a fall in [[prothrombin]] activity. Those at risk include patients with renal or hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy. Prothrombin time should be monitored in patients at risk and exogenous [[vitamin K]] administered as indicated.


Prescribing Cefizox in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
* Prescribing Cefizox in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.


<!--Adverse Reactions-->
<!--Adverse Reactions-->


<!--Clinical Trials Experience-->
<!--Clinical Trials Experience-->
|clinicalTrials=Cefizox® (ceftizoxime for injection, USP) is generally well tolerated. The most frequent adverse reactions (greater than 1% but less than 5%) are:
|clinicalTrials=* Cefizox® (ceftizoxime for injection, USP) is generally well tolerated. The most frequent adverse reactions (greater than 1% but less than 5%) are:


Hypersensitivity--Rash, pruritus, fever.
=====Hypersensitivity=====
* [[Rash]], [[pruritus]], [[fever]]


Hepatic--Transient elevation in AST (SGOT), ALT (SGPT), and alkaline phosphatase.
=====Hepatic=====
* Transient elevation in [[AST]] ([[SGOT]]), [[ALT]] ([[SGPT]]), and [[alkaline phosphatase]].


Hematologic--Transient eosinophilia, thrombocytosis. Some individuals have developed a positive Coombs test.
=====Hematologic=====
* Transient [[eosinophilia]], [[thrombocytosis]]. Some individuals have developed a positive [[Coombs test]].


Local--Injection site--Burning, cellulitis, phlebitis with IV administration, pain, induration, tenderness, paresthesia.
=====Local=====
* Injection site--[[Burning]], [[cellulitis]], [[phlebitis]] with IV administration, [[pain]], [[induration]], [[tenderness]], [[paresthesia]].


The less frequent adverse reactions (less than 1%) are:
* The less frequent adverse reactions (less than 1%) are:


Hypersensitivity--Numbness and anaphylaxis have been reported rarely.
=====Hypersensitivity=====
* [[Numbness]] and [[anaphylaxis]] have been reported rarely.


Hepatic--Elevation of bilirubin has been reported rarely.
=====Hepatic=====
* Elevation of [[bilirubin]] has been reported rarely.


Renal--Transient elevations of BUN and creatinine have been occasionally observed with Cefizox.
=====Renal=====
* Transient elevations of [[BUN]] and [[creatinine]] have been occasionally observed with Cefizox.


Hematologic--Anemia, including hemolytic anemia with occasional fatal outcome, leukopenia, neutropenia, and thrombocytopenia have been reported rarely.
=====Hematologic=====
* [[Anemia]], including [[hemolytic anemia]] with occasional fatal outcome, [[leukopenia]], [[neutropenia]], and [[thrombocytopenia]] have been reported rarely.


Urogenital--Vaginitis has occurred rarely.
=====Urogenital=====
* [[Vaginitis]] has occurred rarely.


Gastrointestinal--Diarrhea; nausea and vomiting have been reported occasionally.
=====Gastrointestinal=====
* [[Diarrhea]]; [[nausea]] and [[vomiting]] have been reported occasionally.


Symptoms of pseudomembranous colitis can appear during or after antibiotic treatment (see WARNINGS).
* Symptoms of [[pseudomembranous colitis]] can appear during or after antibiotic treatment.


In addition to the adverse reactions listed above which have been observed in patients treated with ceftizoxime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin­class antibiotics:
* In addition to the adverse reactions listed above which have been observed in patients treated with ceftizoxime, the following adverse reactions and altered laboratory tests have been reported for [[cephalosporin]]­class antibiotics:


Stevens­Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, serum­sickness like reaction, toxic nephropathy, aplastic anemia, hemorrhage, prolonged prothrombin time, elevated LDH, pancytopenia, and agranulocytosis.
* [[Stevens­Johnson syndrome]], [[erythema multiforme]], [[toxic epidermal necrolysis]], [[serum­sickness like reaction]], [[toxic nephropathy]], [[aplastic anemia]], [[hemorrhage]], prolonged [[prothrombin time]], elevated [[LDH]], [[pancytopenia]], and [[agranulocytosis]].


Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment, when the dosage was not reduced. (See DOSAGE AND ADMINISTRATION.) If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated.
* Several [[cephalosporins]] have been implicated in triggering seizures, particularly in patients with renal impairment, when the dosage was not reduced. If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated.
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
=====Body as a Whole=====
=====Cardiovascular=====
=====Digestive=====
=====Endocrine=====
=====Hematologic and Lymphatic=====
=====Metabolic and Nutritional=====
=====Musculoskeletal=====
=====Neurologic=====
=====Respiratory=====
=====Skin and Hypersensitivy Reactions=====
=====Special Senses=====
=====Urogenital=====
=====Miscellaneous=====






<!--Drug Interactions-->
<!--Drug Interactions-->
|drugInteractions=* Although the occurrence has not been reported with Cefizox, nephrotoxicity has been reported following concomitant administration of other cephalosporins and aminoglycosides.
|drugInteractions=* Although the occurrence has not been reported with Cefizox, [[nephrotoxicity]] has been reported following concomitant administration of other [[cephalosporins]] and [[aminoglycosides]].


<!--Use in Specific Populations-->
<!--Use in Specific Populations-->
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<!--Administration and Monitoring-->
<!--Administration and Monitoring-->
|administration=* Intravenous
|administration=* Intravenous
|monitoring=* Prothrombin time should be monitored in patients at risk and exogenous vitamin K administered as indicated.
|monitoring=* [[Prothrombin time]] should be monitored in patients at risk and exogenous [[vitamin K]] administered as indicated.


<!--IV Compatibility-->
<!--IV Compatibility-->
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<!--Mechanism of Action-->
<!--Mechanism of Action-->
|mechAction=* The bactericidal action of ceftizoxime results from inhibition of cell­wall synthesis. Ceftizoxime is highly resistant to a broad spectrum of beta­lactamases (penicillinase and cephalosporinase), including Richmond types I, II, III, TEM, and IV, produced by both aerobic and anaerobic gram­positive and gram­negative organisms.
|mechAction=* The bactericidal action of ceftizoxime results from inhibition of cell­wall synthesis. Ceftizoxime is highly resistant to a broad spectrum of [[beta­lactamases]] ([[penicillinase]] and [[cephalosporinase]]), including Richmond types I, II, III, TEM, and IV, produced by both aerobic and anaerobic gram­positive and gram­negative organisms.


<!--Structure-->
<!--Structure-->
|structure=* Cefizox® (ceftizoxime for injection, USP) is a sterile, semisynthetic, broad­spectrum, beta­lactamase resistant cephalosporin antibiotic for parenteral (IV, IM) administration. It is the sodium salt of [6R­6a,7β(Z)]­7­(2,3­dihydro­2­imino­4­ thiazolyl) (methoxyimino) acetyl amino­8­oxo­5­thia­1­azabicyclo [4.2.0] oct­2­ene­2­carboxylic acid. Its sodium content is approximately 60 mg (2.6 mEq) per gram of ceftizoxime activity.
|structure=* Cefizox® (ceftizoxime for injection, USP) is a sterile, semisynthetic, broad­spectrum, beta­lactamase resistant cephalosporin antibiotic for parenteral (IV, IM) administration. It is the sodium salt of [6R­6a,7β(Z)]­7­(2,3­dihydro­2­imino­4­ thiazolyl) (methoxyimino) acetyl amino­8­oxo­5­thia­1­azabicyclo [4.2.0] oct­2­ene­2­carboxylic acid. Its sodium content is approximately 60 mg (2.6 mEq) per gram of ceftizoxime activity.


It has the following structural formula:
* It has the following structural formula:


: [[File:Ceftizoxime Str.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime Str.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


Ceftizoxime for injection, USP is a white to pale yellow crystalline powder.
* Ceftizoxime for injection, USP is a white to pale yellow crystalline powder.


Cefizox is supplied in vials equivalent to 500 mg, 1 gram or 2 grams of ceftizoxime, and in Piggyback Vials for IV admixture equivalent to 1 gram or 2 grams of ceftizoxime.
* Cefizox is supplied in vials equivalent to 500 mg, 1 gram or 2 grams of ceftizoxime, and in Piggyback Vials for IV admixture equivalent to 1 gram or 2 grams of ceftizoxime.


<!--Pharmacodynamics-->
<!--Pharmacodynamics-->
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<!--Pharmacokinetics-->
<!--Pharmacokinetics-->
|PK=The table below demonstrates the serum levels and duration of Cefizox (ceftizoxime for injection, USP) following IM administration of 500 mg and 1 gram doses, respectively, to normal volunteers.
|PK=* The table below demonstrates the serum levels and duration of Cefizox (ceftizoxime for injection, USP) following IM administration of 500 mg and 1 gram doses, respectively, to normal volunteers.


: [[File:Ceftizoxime PK 1.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime PK 1.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


A serum half­life of approximately 1.7 hours was observed after IV or IM administration.
* A serum half­life of approximately 1.7 hours was observed after IV or IM administration.


Cefizox is 30% protein bound.
* Cefizox is 30% protein bound.


Cefizox is not metabolized, and is excreted virtually unchanged by the kidneys in 24 hours. This provides a high urinary concentration. Concentrations greater than 6000 μg/mL have been achieved in the urine by 2 hours after a 1 gram dose of Cefizox intravenously. Probenecid slows tubular secretion and produces even higher serum levels, increasing the duration of measurable serum concentrations.
* Cefizox is not metabolized, and is excreted virtually unchanged by the kidneys in 24 hours. This provides a high urinary concentration. Concentrations greater than 6000 μg/mL have been achieved in the urine by 2 hours after a 1 gram dose of Cefizox intravenously. [[Probenecid]] slows tubular secretion and produces even higher serum levels, increasing the duration of measurable serum concentrations.


Cefizox achieves therapeutic levels in various body fluids, e.g., cerebrospinal fluid (in patients with inflamed meninges), bile, surgical wound fluid, pleural fluid, aqueous humor, ascitic fluid, peritoneal fluid, prostatic fluid and saliva, and in the following body tissues: heart, gallbladder, bone, biliary, peritoneal, prostatic, and uterine.
* Cefizox achieves therapeutic levels in various body fluids, e.g., cerebrospinal fluid (in patients with inflamed meninges), bile, surgical wound fluid, [[pleural fluid]], [[aqueous humor]], [[ascitic fluid]], [[peritoneal fluid]], [[prostatic fluid]] and saliva, and in the following body tissues: [[heart]], [[gallbladder]], [[bone]], [[biliary]], [[peritoneal]], [[prostatic]], and uterine.


In clinical experience to date, no disulfiram­like reactions have been reported with Cefizox.
* In clinical experience to date, no disulfiram­like reactions have been reported with Cefizox.


Microbiology
=====Microbiology=====
The bactericidal action of ceftizoxime results from inhibition of cell­wall synthesis. Ceftizoxime is highly resistant to a broad spectrum of beta­lactamases (penicillinase and cephalosporinase), including Richmond types I, II, III, TEM, and IV, produced by both aerobic and anaerobic gram­positive and gram­negative organisms. Ceftizoxime has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections described in the INDICATIONS AND USAGE section:
* The bactericidal action of ceftizoxime results from inhibition of cell­wall synthesis. Ceftizoxime is highly resistant to a broad spectrum of [[beta­lactamases]] ([[penicillinase]] and [[cephalosporinase]]), including Richmond types I, II, III, TEM, and IV, produced by both aerobic and anaerobic gram­positive and gram­negative organisms. Ceftizoxime has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections described in the INDICATIONS AND USAGE section:


Aerobic Gram-Positive Microorganisms
=====Aerobic Gram-Positive Microorganisms=====
Staphylococcus aureus (including penicillinase producing strains)
* [[Staphylococcus aureus]] (including penicillinase producing strains)


NOTE: Methicillin­resistant staphylococci are resistant to cephalosporins, including ceftizoxime.
* NOTE: Methicillin­resistant [[staphylococci]] are resistant to [[cephalosporins]], including ceftizoxime.


Staphylococcus epidermidis (including penicillinase producing strains)
* [[Staphylococcus epidermidis]] (including [[penicillinase]] producing strains)


Streptococcus agalactiae
* [[Streptococcus agalactiae]]


Streptococcus pneumoniae
* [[Streptococcus pneumoniae]]


Streptococcus pyogenes
* [[Streptococcus pyogenes]]


NOTE: A streptococcal isolate that is susceptible to penicillin can be considered susceptible to ceftizoxime4.
* NOTE: A streptococcal isolate that is susceptible to [[penicillin]] can be considered susceptible to ceftizoxime.


NOTE: Ceftizoxime is usually inactive against most strains of Enterococcus faecalis.
* NOTE: Ceftizoxime is usually inactive against most strains of [[Enterococcus faecalis]].


Aerobic Gram-Negative Microorganisms
=====Aerobic Gram-Negative Microorganisms=====
Enterobacter spp.
* [[Enterobacter spp.]]


Escherichia coli
* [[Escherichia coli]]


Haemophilus influenzae (including ampicillin­resistant strains)
* [[Haemophilus influenzae]] (including ampicillin­resistant strains)


Klebsiella pneumoniae
* [[Klebsiella pneumoniae]]


Morganella morganii
* [[Morganella morganii]]


Neisseria gonorrhoeae
* [[Neisseria gonorrhoeae]]


Proteus mirabilis
* [[Proteus mirabilis]]


Proteus vulgaris
* [[Proteus vulgaris]]


Providencia rettgeri
* [[Providencia rettgeri]]


Pseudomonas aeruginosa
* [[Pseudomonas aeruginosa]]


Serratia marcescens
* [[Serratia marcescens]]


Anaerobic Microorganisms
=====Anaerobic Microorganisms=====
Bacteroides spp.
* [[Bacteroides spp.]]


Peptococcus spp.
* [[Peptococcus spp.]]


Peptostreptococcus spp.
* [[Peptostreptococcus spp.]]


The following in vitro data are available, but their clinical significance is unknown. At least 90% of the following microorganisms exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for ceftizoxime. However, the safety and effectiveness of ceftizoxime in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled clinical trials.
* The following in vitro data are available, but their clinical significance is unknown. At least 90% of the following microorganisms exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for ceftizoxime. However, the safety and effectiveness of ceftizoxime in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled clinical trials.


Aerobic Gram-Negative Microorganisms
=====Aerobic Gram-Negative Microorganisms=====
Aeromonas hydrophila
* [[Aeromonas hydrophila]]


Citrobacter spp.
* [[Citrobacter spp.]]


Moraxellacatarrhalis
* [[Moraxellacatarrhalis]]


Neisseria meningitidis
* [[Neisseria meningitidis]]


Providencia stuartii
* [[Providencia stuartii]]


Susceptibility Testing Methods:
=====Susceptibility Testing Methods:=====
Dilution techniques:
=====Dilution techniques:=====


Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations (MICs). These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized procedure. Standardized procedures are based on a dilution method1 (broth or agar) or equivalent with standardized inoculum concentrations and standardized concentrations of ceftizoxime powder. The MIC values should be interpreted according to the following criteria:
* Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations (MICs). These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized procedure. Standardized procedures are based on a dilution method1 (broth or agar) or equivalent with standardized inoculum concentrations and standardized concentrations of ceftizoxime powder. The MIC values should be interpreted according to the following criteria:


: [[File:Ceftizoxime PK 2.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime PK 2.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


A report of “Susceptible” indicates that the pathogen is likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable. A report of “Intermediate” indicates that the result should be considered equivocal, and, if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where high dosage of drug can be used. This category also provides a buffer zone, which prevents small-uncontrolled technical factors from causing major discrepancies in interpretation. A report of “Resistant” indicates that the pathogen is not likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable, other therapy should be selected.
* A report of “Susceptible” indicates that the pathogen is likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable. A report of “Intermediate” indicates that the result should be considered equivocal, and, if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where high dosage of drug can be used. This category also provides a buffer zone, which prevents small-uncontrolled technical factors from causing major discrepancies in interpretation. A report of “Resistant” indicates that the pathogen is not likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable, other therapy should be selected.


Standardized susceptibility test procedures require the use of laboratory control microorganisms to control the technical aspects of the laboratory procedures. Standard ceftizoxime powder should provide the following MIC values:
* Standardized susceptibility test procedures require the use of laboratory control microorganisms to control the technical aspects of the laboratory procedures. Standard ceftizoxime powder should provide the following MIC values:


: [[File:Ceftizoxime PK 3.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime PK 3.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


Diffusion Techniques:
=====Diffusion Techniques:=====
Quantitative methods that require measurement of zone diameters also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. One such standardized procedure2 requires the use of standardized inoculum concentrations. This procedure uses paper disks impregnated with 30-μg ceftizoxime to test the susceptibility of microorganisms to ceftizoxime.
* Quantitative methods that require measurement of zone diameters also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. One such standardized procedure2 requires the use of standardized inoculum concentrations. This procedure uses paper disks impregnated with 30-μg ceftizoxime to test the susceptibility of microorganisms to ceftizoxime.


Reports from the laboratory providing results of the standard single-disk susceptibility test with a 30-μg ceftizoxime disk should be interpreted according to the following criteria:
* Reports from the laboratory providing results of the standard single-disk susceptibility test with a 30-μg ceftizoxime disk should be interpreted according to the following criteria:


: [[File:Ceftizoxime PK 4.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime PK 4.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


Interpretation should be as stated above for results using dilution techniques. Interpretation involves correlation of the diameter obtained in the disk test with the MIC for ceftizoxime.
* Interpretation should be as stated above for results using dilution techniques. Interpretation involves correlation of the diameter obtained in the disk test with the MIC for ceftizoxime.


As with standardized dilution techniques, diffusion methods require the use of laboratory control microorganisms that are used to control the technical aspects of the laboratory procedures. For the diffusion technique, the 30-μg ceftizoxime disk should provide the following zone diameters in these laboratory test quality control strains:
* As with standardized dilution techniques, diffusion methods require the use of laboratory control microorganisms that are used to control the technical aspects of the laboratory procedures. For the diffusion technique, the 30-μg ceftizoxime disk should provide the following zone diameters in these laboratory test quality control strains:


: [[File:Ceftizoxime PK 5.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime PK 5.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


Anaerobic Techniques:
=====Anaerobic Techniques:=====
For anaerobic bacteria, the susceptibility to ceftizoxime as MICs can be determined by standardized test methods. Agar dilution results can vary widely when using ceftizoxime. It is recommended that broth microdilution method be used when possible.3 The MIC values obtained should be interpreted according to following criteria:
* For anaerobic bacteria, the susceptibility to ceftizoxime as MICs can be determined by standardized test methods. Agar dilution results can vary widely when using ceftizoxime. It is recommended that broth microdilution method be used when possible.3 The MIC values obtained should be interpreted according to following criteria:


: [[File:Ceftizoxime PK 6.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime PK 6.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


Interpretation is identical to that described in Susceptibility Testing: Dilution Techniques.
* Interpretation is identical to that described in Susceptibility Testing: Dilution Techniques.


As with other susceptibility techniques, the use of laboratory control microorganisms is required to control the technical aspects of the laboratory standardized procedures. Standardized ceftizoxime powder should provide the following MIC values:
* As with other susceptibility techniques, the use of laboratory control microorganisms is required to control the technical aspects of the laboratory standardized procedures. Standardized ceftizoxime powder should provide the following MIC values:


: [[File:Ceftizoxime PK 7.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
: [[File:Ceftizoxime PK 7.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]


Susceptibility Testing for Pseudomonas in Urinary Tract Infections
=====Susceptibility Testing for Pseudomonas in Urinary Tract Infections=====
Most strains of Pseudomonas aeruginosa are moderately susceptible to ceftizoxime.
* Most strains of Pseudomonas aeruginosa are moderately susceptible to ceftizoxime.


Ceftizoxime achieves high levels in the urine (greater than 6000 μg/mL at 2 hours with
* Ceftizoxime achieves high levels in the urine (greater than 6000 μg/mL at 2 hours with


1 gram IV) and, therefore, the following zone sizes should be used when testing
1 gram IV) and, therefore, the following zone sizes should be used when testing
Line 472: Line 432:
aeruginosa.
aeruginosa.


Susceptible organisms produce zones of 20 mm or greater, indicating that the
* Susceptible organisms produce zones of 20 mm or greater, indicating that the


test organism is likely to respond to therapy.
test organism is likely to respond to therapy.


Organisms that produce zones of 11 to 19 mm are expected to be susceptible
* Organisms that produce zones of 11 to 19 mm are expected to be susceptible


when the infection is confined to the urinary tract (in which high antibiotic levels
when the infection is confined to the urinary tract (in which high antibiotic levels
Line 482: Line 442:
are attained).
are attained).


Resistant organisms produce zones of 10 mm or less, indicating that other
* Resistant organisms produce zones of 10 mm or less, indicating that other


therapy should be selected.
therapy should be selected.


<!--Nonclinical Toxicology-->
<!--Nonclinical Toxicology-->
|nonClinToxic=Carcinogenesis, Mutagenesis, Impairment of Fertility
|nonClinToxic======Carcinogenesis, Mutagenesis, Impairment of Fertility=====
Long­term studies in animals to evaluate the carcinogenic potential of ceftizoxime have not been conducted.
* Long­term studies in animals to evaluate the carcinogenic potential of ceftizoxime have not been conducted.


In an in vitro bacterial cell assay (i.e., Ames test), there was no evidence of mutagenicity at ceftizoxime concentrations of 0.001­0.5 mcg/plate. Ceftizoxime did not produce increases in micronuclei in the in vivo mouse micronucleus test when given to animals at doses up to 7500 mg/kg, approximately six times greater than the maximum human daily dose on a mg/M2 basis.
* In an in vitro bacterial cell assay (i.e., [[Ames test]]), there was no evidence of mutagenicity at ceftizoxime concentrations of 0.001­0.5 mcg/plate. Ceftizoxime did not produce increases in micronuclei in the in vivo mouse micronucleus test when given to animals at doses up to 7500 mg/kg, approximately six times greater than the maximum human daily dose on a mg/M2 basis.


Ceftizoxime had no effect on fertility when administered subcutaneously to rats at daily doses of up to 1000 mg/kg/day, approximately two times the maximum human daily dose on a mg/M2 basis. Ceftizoxime produced no histological changes in the sexual organs of male and female dogs when given intravenously for thirteen weeks at a dose of 1000 mg/kg/day, approximately five times greater than the maximum human daily dose on a mg/M2 basis.
* Ceftizoxime had no effect on fertility when administered subcutaneously to rats at daily doses of up to 1000 mg/kg/day, approximately two times the maximum human daily dose on a mg/M2 basis. Ceftizoxime produced no histological changes in the sexual organs of male and female dogs when given intravenously for thirteen weeks at a dose of 1000 mg/kg/day, approximately five times greater than the maximum human daily dose on a mg/M2 basis.


<!--Clinical Studies-->
<!--Clinical Studies-->
Line 500: Line 460:
|howSupplied=* Cefizox® (ceftizoxime for injection, USP)
|howSupplied=* Cefizox® (ceftizoxime for injection, USP)


NDC 0469­7250­01    Product No. 725001
: NDC 0469­7250­01    Product No. 725001


          Equivalent to 500 mg ceftizoxime in 10 mL, single­dose, flip­top vials, individually
:*        Equivalent to 500 mg ceftizoxime in 10 mL, single­dose, flip­top vials, individually


packaged
packaged


NDC 0469­7251­01    Product No. 725101  
: NDC 0469­7251­01    Product No. 725101  


          Equivalent to 1 gram ceftizoxime in 20 mL, single­dose, flip­top vials, individually
:*        Equivalent to 1 gram ceftizoxime in 20 mL, single­dose, flip­top vials, individually


packaged
packaged


NDC 0469­7252­01    Product No. 725201
: NDC 0469­7252­01    Product No. 725201


          Equivalent to 1 gram ceftizoxime in 100 mL, single­dose, Piggyback, flip­top vials, packaged in tens
:*        Equivalent to 1 gram ceftizoxime in 100 mL, single­dose, Piggyback, flip­top vials, packaged in tens


NDC 0469­7253­02    Product No. 725302
: NDC 0469­7253­02    Product No. 725302


        Equivalent to 2 grams ceftizoxime in 20 mL, single­dose, flip­top vials, individually packaged
:*      Equivalent to 2 grams ceftizoxime in 20 mL, single­dose, flip­top vials, individually packaged


NDC 0469­7254­02    Product No. 725402
: NDC 0469­7254­02    Product No. 725402


          Equivalent to 2 grams ceftizoxime in 100 mL, single­dose, Piggyback, flip­top vials, packaged in tens
:*      Equivalent to 2 grams ceftizoxime in 100 mL, single­dose, Piggyback, flip­top vials, packaged in tens
|storage=Unreconstituted Cefizox should be protected from excessive light, and stored at controlled room temperature (59º­86ºF) in the original package until used.
|storage=* Unreconstituted Cefizox should be protected from excessive light, and stored at controlled room temperature (59º­86ºF) in the original package until used.
|packLabel=====Ingredients and Appearance====
|packLabel=====Ingredients and Appearance====


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<!--Look-Alike Drug Names-->
<!--Look-Alike Drug Names-->
|drugShortage=
|drugShortage=
}}
{{PillImage
|fileName=No image.jpg
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
{{LabelImage
|fileName={{PAGENAME}}11.png
}}
}}
<!--Pill Image-->
<!--Pill Image-->

Latest revision as of 18:51, 18 August 2015

Ceftizoxime
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rabin Bista, M.B.B.S. [2]

Disclaimer

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Overview

Ceftizoxime is a 3rd Generation Cephalosporin that is FDA approved for the treatment of Lower Respiratory Tract Infections, Urinary Tract Infections, Gonorrhea, Pelvic Inflammatory Disease, Intra­Abdominal Infections, Septicemia, Skin and Skin Structure Infections, Bone and Joint Infections, Meningitis,. Common adverse reactions include Injection site pain, Pruritus, Rash, Increased liver enzymes, Fever.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Indications

  • Cefizox (ceftizoxime for injection, USP) is indicated in the treatment of infections due to susceptible strains of the microorganisms listed below.
  • Cefizox has been effective in the treatment of seriously ill, compromised patients, including those who were debilitated, immunosuppressed, or neutropenic.
  • Because of the serious nature of some urinary tract infections due to P. aeruginosa and because many strains of Pseudomonas species are only moderately susceptible to Cefizox, higher dosage is recommended. Other therapy should be instituted if the response is not prompt.
  • Susceptibility studies on specimens obtained prior to therapy should be used to determine the response of causative organisms to Cefizox. Therapy with Cefizox may be initiated pending results of the studies; however, treatment should be adjusted according to study findings. In serious infections, Cefizox has been used
  • concomitantly with other antibiotics, the prescribing information for those agents
  • should be reviewed for contraindications, warnings, precautions, and adverse reactions. Renal function should be carefully monitored.
  • To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cefizox and other antibacterial drugs, Cefizox should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Dosage

  • The usual adult dosage is 1 or 2 grams of Cefizox (ceftizoxime for injection, USP) every 8 to 12 hours. Proper dosage and route of administration should be determined by the condition of the patient, severity of the infection, and susceptibility of the causative organisms.
  • Because of the serious nature of urinary tract infections due to P. aeruginosa and because many strains of Pseudomonas species are only moderately susceptible to Cefizox, higher dosage is recommended. Other therapy should be instituted if the response is not prompt.
  • In those with normal renal function, the IV dosage for such infections is 2 to 12 grams of Cefizox (ceftizoxime for injection, USP) daily. In conditions such as bacterial septicemia, 6 to 12 grams/day may be given initially by the IV route for several days, and the dosage may then be gradually reduced according to clinical response and laboratory findings.
  • Dosage may be increased to a total daily dose of 200 mg/kg (not to exceed the maximum adult dose for serious infection).
Impaired Renal Function
  • Modification of Cefizox dosage is necessary in patients with impaired renal function. Following an initial loading dose of 500 mg-1 gram IM or IV, the maintenance dosing schedule shown below should be followed. Further dosing should be determined by therapeutic monitoring, severity of the infection, and susceptibility of the causative organisms.
  • When only the serum creatinine level is available, creatinine clearance may be calculated from the following formula. The serum creatinine level should represent current renal function at the steady state.
Males
Clcr =Weight (kg) x (140 ­ age)
72 x serum creatinine
(mg/100 mL)
  • Females are 0.85 of the calculated clearance values for males.
  • In patients undergoing hemodialysis, no additional supplemental dosing is required following hemodialysis; however, dosing should be timed so that the patient receives the dose (according to the table below) at the end of the dialysis.
Preparation of Parenteral Solution
  • RECONSTITUTION
  • IM Administration: Reconstitute with Sterile Water for Injection. SHAKE WELL.
  • These solutions of Cefizox are stable 24 hours at room temperature or 96 hours if refrigerated (5ºC).
  • Parenteral drug products should be inspected visually for particulate matter prior to administration. If particulate matter is evident in reconstituted fluids, then the drug solution should be discarded. Reconstituted solutions may range from yellow to amber without changes in potency.
  • Piggyback Vials: Reconstitute with 50 to 100 mL of Sodium Chloride Injection or any other IV solution listed below.
  • SHAKE WELL.
  • Administer with primary IV fluids, as a single dose. These Piggyback vial solutions of Cefizox are stable 24 hours at room temperature or 96 hours if refrigerated (5ºC).
  • A solution of 1 gram Cefizox in 13 mL Sterile Water for Injection is isotonic.
  • IM Injection
  • Inject well within the body of a relatively large muscle. Aspiration is necessary to avoid inadvertent injection into a blood vessel. When administering 2 gram IM doses, the dose should be divided and given in different large muscle masses.
  • IV Administration
  • Direct (bolus) injection, slowly over 3 to 5 minutes, directly or through tubing for patients receiving parenteral fluids (see list below). Intermittent or continuous infusion, dilute reconstituted Cefizox in 50 to 100 mL of one of the following solutions:
  • Sodium Chloride Injection
  • 5% or 10% Dextrose Injection
  • 5% Dextrose and 0.9%, 0.45%, or 0.2% Sodium Chloride Injection
  • Ringer’s Injection
  • Lactated Ringer’s Injection
  • Invert Sugar 10% in Sterile Water for Injection
  • 5% Sodium Bicarbonate in Sterile Water for Injection
  • 5% Dextrose in Lactated Ringer’s Injection (only when reconstituted with 4% Sodium Bicarbonate Injection)
  • In these fluids, Cefizox is stable 24 hours at room temperature or 96 hours if refrigerated (5ºC).

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Ceftizoxime in adult patients.

Non–Guideline-Supported Use

  • Bacterial infectious disease - Cancer[1][2]
  • Gonorrhea, Disseminated
  • Postoperative infection; Prophylaxis[3]

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Dosage

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Ceftizoxime in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Ceftizoxime in pediatric patients.

Contraindications

  • Cefizox (ceftizoxime for injection, USP) is contraindicated in patients who have known allergy to the drug.

Warnings

  • BEFORE THERAPY WITH CEFIZOX IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFIZOX, OTHER CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN­SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS HYPERSENSITIVITY AMONG BETA­LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY. IF AN ALLERGIC REACTION TO CEFIZOX OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE TREATMENT WITH EPINEPHRINE AND OTHER EMERGENCY MEASURES, INCLUDING OXYGEN, IV FLUIDS, IV ANTIHISTAMINES, CORTICOSTEROIDS, PRESSOR AMINES, AND AIRWAY MANAGEMENT, AS CLINICALLY INDICATED.
  • Pseudomembranous colitis has been reported with nearly all antibacterial agents, including ceftizoxime, and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.
  • Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is a primary cause of “antibiotic­associated” colitis.
  • After the diagnosis of pseudomembranous colitis has been established, appropriate therapeutic measures should be initiated. Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation, and treatment with an antibacterial drug clinically effective against Clostridium difficile colitis.

Precautions

General
  • As with all broad­spectrum antibiotics, Cefizox (ceftizoxime for injection, USP) should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis.
  • Although Cefizox has not been shown to produce an alteration in renal function, renal status should be evaluated, especially in seriously ill patients receiving maximum dose therapy. As with any antibiotic, prolonged use may result in overgrowth of nonsusceptible organisms. Careful observation is essential; appropriate measures should be taken if superinfection occurs.
  • Cephalosporins may be associated with a fall in prothrombin activity. Those at risk include patients with renal or hepatic impairment, or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy. Prothrombin time should be monitored in patients at risk and exogenous vitamin K administered as indicated.
  • Prescribing Cefizox in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Adverse Reactions

Clinical Trials Experience

  • Cefizox® (ceftizoxime for injection, USP) is generally well tolerated. The most frequent adverse reactions (greater than 1% but less than 5%) are:
Hypersensitivity
Hepatic
Hematologic
Local
  • The less frequent adverse reactions (less than 1%) are:
Hypersensitivity
Hepatic
  • Elevation of bilirubin has been reported rarely.
Renal
  • Transient elevations of BUN and creatinine have been occasionally observed with Cefizox.
Hematologic
Urogenital
Gastrointestinal
  • In addition to the adverse reactions listed above which have been observed in patients treated with ceftizoxime, the following adverse reactions and altered laboratory tests have been reported for cephalosporin­class antibiotics:
  • Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment, when the dosage was not reduced. If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated.

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Ceftizoxime in the drug label.

Drug Interactions

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): B

  • Reproduction studies performed in rats and rabbits have revealed no evidence of impaired fertility or harm to the fetus due to Cefizox. There are, however, no adequate and well­controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human effects, this drug should be used during pregnancy only if clearly needed.


Pregnancy Category (AUS):

  • Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Ceftizoxime in women who are pregnant.

Labor and Delivery

  • Safety of Cefizox use during labor and delivery has not been established.

Nursing Mothers

  • Cefizox is excreted in human milk in low concentrations. Caution should be exercised when Cefizox is administered to a nursing woman.

Pediatric Use

  • Safety and efficacy in pediatric patients from birth to six months of age have not been established. In pediatric patients six months of age and older, treatment with Cefizox has been associated with transient elevated levels of eosinophils, AST (SGOT), ALT (SGPT), and CPK (creatine phosphokinase). The CPK elevation may be related to IM administration.

The potential for the toxic effect in pediatric patients from chemicals that may leach from the single­dose IV preparation in plastic has not been determined.

Geriatic Use

  • Clinical studies of ceftizoxime did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Gender

There is no FDA guidance on the use of Ceftizoxime with respect to specific gender populations.

Race

There is no FDA guidance on the use of Ceftizoxime with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Ceftizoxime in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Ceftizoxime in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Ceftizoxime in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Ceftizoxime in patients who are immunocompromised.

Administration and Monitoring

Administration

  • Intravenous

Monitoring

IV Compatibility

There is limited information regarding IV Compatibility of Ceftizoxime in the drug label.

Overdosage

There is limited information regarding Overdose of Ceftizoxime in the drug label.

Pharmacology

Template:Px
Ceftizoxime
Systematic (IUPAC) name
(6R,7R)-7-{[(2Z)-2-(2-amino-1,3-thiazol-4-yl)-2-methoxyiminoacetyl]amino}-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid
Identifiers
CAS number 68401-81-0
68401-82-1
ATC code J01DD07
PubChem 6533629
Chemical data
Formula Template:OrganicBox atomTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox 
Mol. mass 383.405 g/mol
Pharmacokinetic data
Bioavailability ?
Metabolism ?
Half life ?
Excretion ?
Therapeutic considerations
Pregnancy cat.

?

Legal status
Routes ?

Mechanism of Action

  • The bactericidal action of ceftizoxime results from inhibition of cell­wall synthesis. Ceftizoxime is highly resistant to a broad spectrum of beta­lactamases (penicillinase and cephalosporinase), including Richmond types I, II, III, TEM, and IV, produced by both aerobic and anaerobic gram­positive and gram­negative organisms.

Structure

  • Cefizox® (ceftizoxime for injection, USP) is a sterile, semisynthetic, broad­spectrum, beta­lactamase resistant cephalosporin antibiotic for parenteral (IV, IM) administration. It is the sodium salt of [6R­6a,7β(Z)]­7­(2,3­dihydro­2­imino­4­ thiazolyl) (methoxyimino) acetyl amino­8­oxo­5­thia­1­azabicyclo [4.2.0] oct­2­ene­2­carboxylic acid. Its sodium content is approximately 60 mg (2.6 mEq) per gram of ceftizoxime activity.
  • It has the following structural formula:
This image is provided by the National Library of Medicine.
  • Ceftizoxime for injection, USP is a white to pale yellow crystalline powder.
  • Cefizox is supplied in vials equivalent to 500 mg, 1 gram or 2 grams of ceftizoxime, and in Piggyback Vials for IV admixture equivalent to 1 gram or 2 grams of ceftizoxime.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Ceftizoxime in the drug label.

Pharmacokinetics

  • The table below demonstrates the serum levels and duration of Cefizox (ceftizoxime for injection, USP) following IM administration of 500 mg and 1 gram doses, respectively, to normal volunteers.
This image is provided by the National Library of Medicine.
  • A serum half­life of approximately 1.7 hours was observed after IV or IM administration.
  • Cefizox is 30% protein bound.
  • Cefizox is not metabolized, and is excreted virtually unchanged by the kidneys in 24 hours. This provides a high urinary concentration. Concentrations greater than 6000 μg/mL have been achieved in the urine by 2 hours after a 1 gram dose of Cefizox intravenously. Probenecid slows tubular secretion and produces even higher serum levels, increasing the duration of measurable serum concentrations.
  • In clinical experience to date, no disulfiram­like reactions have been reported with Cefizox.
Microbiology
  • The bactericidal action of ceftizoxime results from inhibition of cell­wall synthesis. Ceftizoxime is highly resistant to a broad spectrum of beta­lactamases (penicillinase and cephalosporinase), including Richmond types I, II, III, TEM, and IV, produced by both aerobic and anaerobic gram­positive and gram­negative organisms. Ceftizoxime has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections described in the INDICATIONS AND USAGE section:
Aerobic Gram-Positive Microorganisms
  • NOTE: A streptococcal isolate that is susceptible to penicillin can be considered susceptible to ceftizoxime.
Aerobic Gram-Negative Microorganisms
Anaerobic Microorganisms
  • The following in vitro data are available, but their clinical significance is unknown. At least 90% of the following microorganisms exhibit an in vitro minimum inhibitory concentration (MIC) less than or equal to the susceptible breakpoint for ceftizoxime. However, the safety and effectiveness of ceftizoxime in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled clinical trials.
Aerobic Gram-Negative Microorganisms
Susceptibility Testing Methods:
Dilution techniques:
  • Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations (MICs). These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized procedure. Standardized procedures are based on a dilution method1 (broth or agar) or equivalent with standardized inoculum concentrations and standardized concentrations of ceftizoxime powder. The MIC values should be interpreted according to the following criteria:
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  • A report of “Susceptible” indicates that the pathogen is likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable. A report of “Intermediate” indicates that the result should be considered equivocal, and, if the microorganism is not fully susceptible to alternative, clinically feasible drugs, the test should be repeated. This category implies possible clinical applicability in body sites where the drug is physiologically concentrated or in situations where high dosage of drug can be used. This category also provides a buffer zone, which prevents small-uncontrolled technical factors from causing major discrepancies in interpretation. A report of “Resistant” indicates that the pathogen is not likely to be inhibited if the antimicrobial compound in the blood reaches the concentrations usually achievable, other therapy should be selected.
  • Standardized susceptibility test procedures require the use of laboratory control microorganisms to control the technical aspects of the laboratory procedures. Standard ceftizoxime powder should provide the following MIC values:
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Diffusion Techniques:
  • Quantitative methods that require measurement of zone diameters also provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. One such standardized procedure2 requires the use of standardized inoculum concentrations. This procedure uses paper disks impregnated with 30-μg ceftizoxime to test the susceptibility of microorganisms to ceftizoxime.
  • Reports from the laboratory providing results of the standard single-disk susceptibility test with a 30-μg ceftizoxime disk should be interpreted according to the following criteria:
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  • Interpretation should be as stated above for results using dilution techniques. Interpretation involves correlation of the diameter obtained in the disk test with the MIC for ceftizoxime.
  • As with standardized dilution techniques, diffusion methods require the use of laboratory control microorganisms that are used to control the technical aspects of the laboratory procedures. For the diffusion technique, the 30-μg ceftizoxime disk should provide the following zone diameters in these laboratory test quality control strains:
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Anaerobic Techniques:
  • For anaerobic bacteria, the susceptibility to ceftizoxime as MICs can be determined by standardized test methods. Agar dilution results can vary widely when using ceftizoxime. It is recommended that broth microdilution method be used when possible.3 The MIC values obtained should be interpreted according to following criteria:
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  • Interpretation is identical to that described in Susceptibility Testing: Dilution Techniques.
  • As with other susceptibility techniques, the use of laboratory control microorganisms is required to control the technical aspects of the laboratory standardized procedures. Standardized ceftizoxime powder should provide the following MIC values:
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Susceptibility Testing for Pseudomonas in Urinary Tract Infections
  • Most strains of Pseudomonas aeruginosa are moderately susceptible to ceftizoxime.
  • Ceftizoxime achieves high levels in the urine (greater than 6000 μg/mL at 2 hours with

1 gram IV) and, therefore, the following zone sizes should be used when testing

ceftizoxime for treatment of urinary tract infections caused by Pseudomonas

aeruginosa.

  • Susceptible organisms produce zones of 20 mm or greater, indicating that the

test organism is likely to respond to therapy.

  • Organisms that produce zones of 11 to 19 mm are expected to be susceptible

when the infection is confined to the urinary tract (in which high antibiotic levels

are attained).

  • Resistant organisms produce zones of 10 mm or less, indicating that other

therapy should be selected.

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility
  • Long­term studies in animals to evaluate the carcinogenic potential of ceftizoxime have not been conducted.
  • In an in vitro bacterial cell assay (i.e., Ames test), there was no evidence of mutagenicity at ceftizoxime concentrations of 0.001­0.5 mcg/plate. Ceftizoxime did not produce increases in micronuclei in the in vivo mouse micronucleus test when given to animals at doses up to 7500 mg/kg, approximately six times greater than the maximum human daily dose on a mg/M2 basis.
  • Ceftizoxime had no effect on fertility when administered subcutaneously to rats at daily doses of up to 1000 mg/kg/day, approximately two times the maximum human daily dose on a mg/M2 basis. Ceftizoxime produced no histological changes in the sexual organs of male and female dogs when given intravenously for thirteen weeks at a dose of 1000 mg/kg/day, approximately five times greater than the maximum human daily dose on a mg/M2 basis.

Clinical Studies

There is limited information regarding Clinical Studies of Ceftizoxime in the drug label.

How Supplied

  • Cefizox® (ceftizoxime for injection, USP)
NDC 0469­7250­01 Product No. 725001
  • Equivalent to 500 mg ceftizoxime in 10 mL, single­dose, flip­top vials, individually

packaged

NDC 0469­7251­01 Product No. 725101
  • Equivalent to 1 gram ceftizoxime in 20 mL, single­dose, flip­top vials, individually

packaged

NDC 0469­7252­01 Product No. 725201
  • Equivalent to 1 gram ceftizoxime in 100 mL, single­dose, Piggyback, flip­top vials, packaged in tens
NDC 0469­7253­02 Product No. 725302
  • Equivalent to 2 grams ceftizoxime in 20 mL, single­dose, flip­top vials, individually packaged
NDC 0469­7254­02 Product No. 725402
  • Equivalent to 2 grams ceftizoxime in 100 mL, single­dose, Piggyback, flip­top vials, packaged in tens

Storage

  • Unreconstituted Cefizox should be protected from excessive light, and stored at controlled room temperature (59º­86ºF) in the original package until used.

Images

Drug Images

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Package and Label Display Panel

Ingredients and Appearance

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Patient Counseling Information

  • Patients should be counseled that antibacterial drugs including Cefizox should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When Cefizox is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Cefizox or other antibacterial drugs in the future.

Precautions with Alcohol

  • Alcohol-Ceftizoxime interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

Look-Alike Drug Names

There is limited information regarding Ceftizoxime Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

  1. ↑ Rolston KV, Jones PG, Fainstein V, Elting L, Bodey GP (1987). "Ceftizoxime plus ticarcillin: double beta-lactam therapy for infections in cancer patients". J Antimicrob Chemother. 19 (3): 367–71. PMID 3471752.
  2. ↑ Lawson RD, Baskin RC (1982). "Ceftizoxime treatment of infection in neutropenic patients with malignancies". J Antimicrob Chemother. 10 Suppl C: 159–65. PMID 6296001.
  3. ↑ Ridley PD, Sagar S (1988). "Cephalosporin prophylaxis in abdominal surgery". Br J Clin Pract. 42 (8): 337–42. PMID 3061436.
  4. ↑ "Ceftizoxime sodium".
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