ceftizoxime sodium
Cefizox

Available forms
Available by prescription only
Infusion: 1 g, 2 g in 100-ml vials
Injection: 500 mg, 1 g, 2 g

Indications and dosages
 Septicemia, meningitis, pelvic inflammatory disease, and serious respiratory tract, urinary tract, gynecologic, intra-abdominal, bone and joint, and skin infections from susceptible organisms. Adults: Usual dosage is 500 mg to 2 g I.V. or I.M. q 8 to 12 hours. In life-threatening infections, 3 to 4 g I.V. q 8 hours.
Children age 6 months and older: 50 mg/kg I.V. or I.M. q 6 to 8 hours.
 Total daily dose is same for I.M. or I.V. administration and depends on susceptibility of organism and severity of infection. Inject ceftizoxime deep into a large muscle mass, such as the gluteus or lateral aspect of the thigh.
 Uncomplicated gonorrhea. Adults: 1 g I.M. given as a single dose.
≡ Dosage adjustment. For patients with impaired renal function, modify doses or frequency of administration according to degree of renal impairment, severity of infection, and susceptibility of organism. To prevent toxic accumulation, reduced dosage may be required in patients with creatinine clearance of less than 80 ml/minute. See below for appropriate doses for adults.

Creatinine clearance (ml/min) Less severe infections Life-threatening infections 50-79 500 mg q 8 hr 750 mg-1.5 g q 8 hr 5-49 250 to 500 mg q 12 hr 500 mg-1 g q 12 hr 0-4 500 mg q 48 hr or 250 mg q 24 hr 500 mg-1 g q 48 hr or 500 mg q 24 hr

Pharmacodynamics
Antibacterial action: Ceftizoxime is primarily bactericidal; it also may be bacteriostatic. Activity depends on the organism, tissue penetration, dosage, and rate of organism multiplication. It acts by adhering to bacterial penicillin-binding proteins, thereby inhibiting cell wall synthesis. Third-generation cephalosporins appear to be more active against some beta-lactamase-producing gram-negative organisms.
  Drug is active against some gram-positive organisms and many enteric gram-negative bacilli, as well as streptococci (Streptococcus pneumoniae and S. pyogenes); Staphylococcus aureus (penicillinase- and non-penicillinase-producing); Staphylococcus epidermidis; Escherichia coli; Klebsiella species; Neisseriagonorrhoeae; Haemophilus influenzae; Enterobacter species; Proteus species; Serratia marcescens;Bacteroides species (including B. fragilis); Peptostreptococcus species; some strains of Pseudomonas and Acinetobacter. Cefotaxime and moxalactam are slightly more active than ceftizoxime against gram-positive organisms but are less active against gram-negative organisms.

Pharmacokinetics
Absorption: Not absorbed from the GI tract; must be given parenterally.
Distribution: Distributed widely into most body tissues and fluids, including the gallbladder, liver, kidneys, bone, sputum, bile, and pleural and synovial fluids. Unlike most other cephalosporins, ceftizoxime has good CSF penetration and achieves adequate levels in inflamed meninges; ceftizoxime crosses the placental barrier and is 30% protein-bound.
Metabolism: Not metabolized.
Excretion: Excreted primarily in urine by renal tubular secretion and glomerular filtration; small amounts of drug appear in breast milk. Elimination half-life is about 1 1/2 to 2 hours in patients with normal renal function; severe renal disease prolongs half-life up to 30 hours. Hemodialysis or peritoneal dialysis removes minimal amounts of ceftizoxime.

Contraindications and precautions
Contraindicated in patients hypersensitive to ceftizoxime or other cephalosporins. Use cautiously in breast-feeding women and in patients with impaired renal function or penicillin allergy.

Interactions
Drug-drug. Aminoglycosides: May slightly increase risk of nephrotoxicity. Avoid use.
Probenecid: Competitively inhibits renal tubular secretion of cephalosporins, causing higher, prolonged serum levels. May be used for this effect.

Adverse reactions
CV: elevated temperature.
Hematologic: eosinophilia, thrombocytosis.
Skin: maculopapular and erythematous rash, pruritus, injection site reaction.
Other: hypersensitivity reactions (serum sickness, anaphylaxis).

Effects on lab test results
• May increase BUN, creatinine, ALT, AST, alkaline phosphatase, bilirubin, GGT, and LDH levels. May decrease albumin and protein levels.
• May increase eosinophil and platelet counts.

Overdose and treatment
Overdose may cause neuromuscular hypersensitivity. Seizures may follow high CNS levels.
 Ceftizoxime may be removed by hemodialysis.

Special considerations
 ALERT Names of some cephalosporins are similar. Use caution when prescribing.
• For patients on sodium restriction, note that ceftizoxime contains 2.6 mEq of sodium per gram of drug.
• Drug may be supplied as frozen, sterile solution in plastic containers. Thaw at room temperature. Thawed solution is stable for 24 hours at room temperature or for 21 days if refrigerated. Don’t refreeze.
• For I.M. use, reconstitute with sterile water for injection. Shake vial well to ensure complete dissolution of drug. To administer a dose that exceeds 1 g, divide the dose and inject it into separate sites to prevent tissue injury.
• For I.V. use, reconstitute I.V. dose with sterile water for injection. Solution should clear after shaking well and range in color from yellow to amber. If particles are visible, discard solution. Reconstituted solution is stable for 24 hours at room temperature or for 96 hours if refrigerated.
• Administer ceftizoxime I.V. as a direct injection slowly over 3 to 5 minutes directly or through tubing of compatible infusion fluid. If given as intermittent infusion, the reconstituted drug is diluted in 50 to 100 ml of compatible fluid. Check package insert.
• Ceftizoxime causes false-positive results in urine glucose tests using cupric sulfate (Benedict’s reagent or Clinitest); use glucose oxidase (Chemstrip uG, Diastix, or glucose enzymatic test strip) instead. Ceftizoxime also causes false elevations in urine creatinine levels using Jaffe reaction. Ceftizoxime may cause positive Coombs’ test results.
• Monitor patient for hypersensitivity. If a severe hypersensitivity reaction occurs during therapy, stop drug and start appropriate therapy (such as epinephrine, I.V. fluids, oxygen).
• Monitor renal function when maximum dose is given to severely ill patients.
Breast-feeding patients
• Drug appears in breast milk; use cautiously in breast-feeding women. Safety hasn’t been established.
Pediatric patients
• Safety and efficacy haven’t been established in infants younger than age 6 months.
Geriatric patients
• Reduced dosage may be needed in elderly patients with diminished renal function.

Patient education
• Inform patient of potential adverse reactions.
• Tell patient to report discomfort at I.V. site.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use