CEFTIZOXIME
DESCRIPTION:
CEFIZOX (sterile ceftizoxime sodium) is a sterile, semisynthetic, broad-
spectrum, beta- lactamase resistant cephalosporin antibiotic for parenteral
(I.V., I.M.) administration. It is the sodium salt of (6R-(6a, 7beta(Z)))-7-
(((2,3-dihydro-2-imino-4-thiazolyl) (methoxyimino) acetyl) amino)-8-oxo-5-thia-
1-azabicyclo (4.2.0) oct-2-ene-2-carboxylic acid. Its sodium content is
approximately 60 mg (2.6 mEq) per gram of ceftizoxime activity.
ACTIONS/CLINICAL PHARMACOLOGY:
The table below demonstrates the serum levels and duration of Cefizox (sterile
ceftizoxime sodium) following intramuscular administration of 500 mg and 1 gram
doses, respectively, to normal volunteers.
SERUM CONCENTRATIONS AFTER INTRAMUSCULAR ADMINISTRATION
Serum Concentration (mcg/mL)
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Dose 1/2 hr 1 hr 2 hr 4 hr 6 hr 8 hr
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500 mg 13.3 13.7 9.2 4.8 1.9 0.7
1 gm 36.0 39.0 31.0 15.0 6.0 3.0
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Following intravenous administration of 1, 2, and 3 gram doses of Cefizox to
normal volunteers, the following serum levels were obtained.
SERUM CONCENTRATIONS AFTER INTRAVENOUS ADMINISTRATION
Serum Concentration (mcg/mL)
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Dose 5 min 10 min 30 min 1 hr 2 hr 4 hr 8 hr
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1 gram ND ND 60.5 38.9 21.5 8.4 1.4
2 grams 131.8 110.9 77.5 53.6 33.1 12.1 2.0
3 grams 221.1 174.0 112.7 83.9 47.4 26.2 4.8
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ND=Not Done
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A serum half-life of approximately 1.7 hours was observed after intravenous or
intramuscular 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 mcg/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.
In clinical experience to date, no disulfiram- like reactions have been reported
with Cefizox.
MICROBIOLOGY
The bactericidal action of Cefizox (sterile ceftizoxime sodium) results from
inhibition of cell-wall synthesis. Cefizox is highly resistant to a broad
spectrum of beta-lactamases (penicillinase and cephalosporinase), including
Richmond types I, II, III, TEM, and IV, produced by both aerobic and anaerobic
gram-positive and gram-negative organisms. Cefizox is active against a wide
range of gram-positive and gram- negative organisms, and is usually active
against the following organisms In Vitro and in clinical situations (see
Indications and Usage.)
GRAM-POSITIVE AEROBES
Staphylococcus Aureus (including penicillinase- and nonpenicillinase-producing
strains)
NOTE: Methicillin-resistant staphylococci are resistant to cephalosporins,
including ceftizoxime.
Staphylococcus Epidermidis (including penicillinase- and nonpenicillinase-
producing strains)
Streptococcus Agalactiae
Streptococcus Pneumoniae
Streptococcus Pyogenes
NOTE: Ceftizoxime is usually inactive against most strains of Enterococcus
Faecalis (formerly S. Faecalis).
GRAM-NEGATIVE AEROBES
Acinetobacter spp.
Enterobacter spp.
Escherichia Coli
Haemophilus Influenzae (including ampicillin- resistant strains)
Klebsiella Pneumoniae
Morganella Morganii (formerly Proteus Morganii)
Neisseria Gonorrhoeae
Proteus Mirabilis
Proteus Vulgaris
Providencia Rettgeri (formerly Proteus Rettgeri)
Pseudomonas Aeruginosa
Serratia Marcescens
ANAEROBES
Bacteroides spp.
Peptococcus spp.
Peptostreptococcus spp.
Ceftizoxime is usually active against the following organisms In Vitro, BUT THE
CLINICAL SIGNIFICANCE OF THESE DATA IS UNKNOWN.
GRAM-POSITIVE AEROBES
Corynebacterium Diphtheriae
GRAM-NEGATIVE AEROBES
Aeromonas Hydrophila
Citrobacter spp.
Moraxella spp.
Neisseria Meningitidis
Pasteurella Multocida
Providencia Stuartii
Salmonella spp.
Shigella spp.
Yersinia Enterocolitica
ANAEROBES
Actinomyces spp.
Bifidobacterium spp.
Clostridium spp.
NOTE: Most strains of Clostridium Difficile are resistant.
Eubacterium spp.
Fusobacterium spp.
Propionibacterium spp.
Veillonella spp.
SUSCEPTIBILITY TESTING: DIFFUSION TECHNIQUES
Quantitative methods that require measurement of zone diameters give the most
precise estimate of the susceptibility of bacteria to antimicrobial agents. One
such standard procedure (REF. 1) has been recommended for use with disks to test
susceptibility of organisms to ceftizoxime. Interpretation involves the
correlation of the diameters obtained in the disk test with the minimum
inhibitory concentration (MIC) for ceftizoxime.
Organisms should be tested with the ceftizoxime disk, since ceftizoxime has been
shown by In Vitro tests to be active against certain strains found resistant
when other beta-lactam disks are used.
Reports from the laboratory giving results of the standard single-disk
susceptibility test with a 30 mcg ceftizoxime disk should be interpreted
according to the following criteria (with the exception of Pseudomonas
Aeruginosa).
ZONE DIAMETER (MM) INTERPRETATION
>/=20 (S) Susceptible
15-19 (MS) Moderately Susceptible
=14 (R) Resistant
A report of "Susceptible" indicates that the pathogen is likely to be inhibited
by generally achievable blood levels. A report of "Moderately Susceptible"
suggests that the organism would be susceptible if high dosage is used or if the
infection is confined to tissue and fluids (e.g., urine) in which high
antibiotic levels are attained. A report of "Resistant" indicates that
achievable concentrations of the antibiotic are unlikely to be inhibitory and
other therapy should be selected.
Standardized procedures require the use of laboratory control organisms. The 30
mcg ceftizoxime disk should give the following zone diameters.
ORGANISM ATCC ZONE DIAMETER (MM)
Escherichia Coli 25922 30-36
Pseudomonas Aeruginosa 27853 12-17
Staphylococcus Aureus 25923 27-35
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
mcg/mL at 2 hours with 1 gram I.V.) 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.
SUSCEPTIBILITY TESTING: DILUTION TECHNIQUES
When using the NCCLS agar dilution or broth dilution (including microdilution)
method (REF. 2) or equivalent, the following MIC data should be used for
interpretation.
MIC (MCG/ML) INTERPRETATION
=8 (S) Susceptible
16-32 (MS) Moderately Susceptible
>/=64 (R) Resistant
As with standard disk diffusion methods, dilution procedures require the use of
laboratory control organisms. Standard ceftizoxime powder should give MIC values
in the following ranges.
ORGANISM ATCC MIC (MCG/ML)
Escherichia Coli 25922 0.03-0.12
Pseudomonas Aeruginosa 27853 16-64
Staphylococcus Aureus 29213 2-8
INDICATIONS AND USAGE:
Cefizox (sterile ceftizoxime sodium) is indicated in the treatment of infections
due to susceptible strains of the microorganisms listed below.
Lower Respiratory Tract Infections caused by Klebsiella spp.; Proteus Mirabilis;
Escherichia Coli; Haemophilus Influenzae including ampicillin-resistant strains;
Staphylococcus Aureus (penicillinase- and nonpenicillinase- producing); Serratia
spp.; Enterobacter spp.; Bacteroides spp.; and Streptococcus spp. including S.
Pneumoniae, but excluding enterococci.
Urinary Tract Infections caused by Staphylococcus Aureus (penicillinase- and
nonpenicillinase- producing); Escherichia Coli; Pseudomonas spp. including P.
Aeruginosa; Proteus Mirabilis; P. Vulgaris; Providencia Rettgeri (formerly
Proteus Rettgeri) and Morganella Morganii (formerly Proteus Morganii);
Klebsiella spp.; Serratia spp. including S. Marcescens; and Enterobacter spp.
Gonorrhea including uncomplicated cervical and urethral gonorrhea caused by
Neisseria Gonorrhoeae.
Pelvic Inflammatory Disease caused by Neisseria Gonorrhoeae, Escherichia Coli or
Streptococcus Agalactiae.
NOTE: Ceftizoxime, like other cephalosporins, has no activity against Chlamydia
Trachomatis. Therefore, when cephalosporins are used in the treatment of
patients with pelvic inflammatory disease and C. Trachomatis is one of the
suspected pathogens, appropriate antichlamydial coverage should be added.
Intra-Abdominal Infections caused by Escherichia Coli; Staphylococcus
Epidermidis; 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 nonpenicillinase-
producing); Escherichia Coli; Bacteroides spp. including B. Fragilis; Klebsiella
spp.; and Serratia spp.
Skin and Skin Structure Infections caused by Staphylococcus Aureus
(penicillinase- and nonpenicillinase-producing); 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
nonpenicillinase-producing); Streptococcus spp. (excluding enterococci); Proteus
Mirabilis; Bacteroides spp.; and anaerobic cocci, including Peptococcus spp. and
Peptostreptococcus spp.
Meningitis caused by Haemophilus Influenzae. 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.
Infections caused by aerobic gram-negative 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.
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 other antibiotics, the prescribing information for those
agents should be reviewed for contraindications, warnings, precautions, and
adverse reactions. Renal function should be carefully monitored.
CONTRAINDICATIONS:
Cefizox (sterile ceftizoxime sodium) 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 PENICILLIN- SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED
BECAUSE CROSS HYPERSENSITIVITY AMONG BETA-LACTAM 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, INTRAVENOUS FLUIDS, INTRAVENOUS
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 "antibiotic-associated" 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 broad-spectrum antibiotics, Cefizox (sterile ceftizoxime sodium)
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.
DRUG INTERACTIONS
Although the occurrence has not been reported with Cefizox, nephrotoxicity has
been reported following concomitant administration of other cephalosporins and
aminoglycosides.
CARCINOGENESIS, MUTAGENESIS, IMPAIRMENT OF FERTILITY
Long term 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 0.001-0.5 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/M(squared) 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/M(squared) 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/M(squared) basis.
PREGNANCY: TERATOGENIC EFFECTS: PREGNANCY CATEGORY 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 well- controlled 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.
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 infants from birth to six months of age have not been
established. In children 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
I.M. administration.
The potential for the toxic effect in children from chemicals that may leach
from the single- dose I.V. preparation in plastic has not been determined.
DRUG INTERACTIONS:
Although the occurrence has not been reported with Cefizox, nephrotoxicity has
been reported following concomitant administration of other cephalosporins and
aminoglycosides.
(See Also PRECAUTIONS)
ADVERSE REACTIONS:
CEFIZOX (sterile ceftizoxime sodium) is generally well tolerated. The Most
frequent adverse reactions (greater than 1% but Less than 5%) are:
Hypersensitivity--Rash, pruritus, fever.
Hepatic--Transient elevation in AST (SGOT), ALT (SGPT), and alkaline
phosphatase.
Hematologic--Transient eosinophilia, thrombocytosis. Some individuals have
developed a positive Coombs test.
Local--Injection site--Burning, cellulitis, phlebitis with I.V. administration,
pain, induration, tenderness, paresthesia.
The Less frequent adverse reactions (less than 1%) are:
Hypersensitivity--Numbness and anaphylaxis have been reported rarely.
Hepatic--Elevation of bilirubin has been reported rarely.
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.
Urogenital--Vaginitis has occurred rarely.
Gastrointestinal--Diarrhea; nausea and vomiting have been reported occasionally.
Symptoms of pseudomembranous colitis can appear during or after antibiotic
treatment (see Warnings).
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:
Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis,
serum-sickness 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.
DOSAGE AND ADMINISTRATION:
The usual adult dosage is 1 or 2 grams of Cefizox (sterile ceftizoxime sodium)
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.
GENERAL GUIDELINES FOR DOSAGE OF CEFIZOX
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Type of Daily Dose Frequency
Infection (Grams) and Route
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Uncomplicated
Urinary Tract 1 500 mg q12h I.M. or I.V.
Other Sites 2-3 1 gram q8-12h I.M. or I.V.
Severe or Refractory 3-6 1 gram q8h I.M. or I.V.
2 grams q8-12h I.M.(a) or I.V.
PID(b) 6 2 grams q8h I.V.
Life-Threatening(c) 9-12 3-4 grams q8h I.V.
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a) When administering 2 gram I.M. doses, the dose should be divided and
given in different large muscle masses.
b) If C. Trachomatis is a suspected pathogen, appropriate anti-chlamydial
coverage should be added, because ceftizoxime has no activity against
this organism.
c) In life-threatening infections, dosages up to 2 grams every 4 hours have
been given.
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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 I.M. dose is the usual dose for treatment of uncomplicated
gonorrhea.
The intravenous route may be preferable for patients with bacterial septicemia,
localized parenchymal abscesses (such as intra-abdominal abscess), peritonitis,
or other severe or life- threatening infections.
In those with normal renal function, the intravenous dosage for such infections
is 2 to 12 grams of Cefizox (sterile ceftizoxime sodium) daily. In conditions
such as bacterial septicemia, 6 to 12 grams/day may be given initially by the
intravenous route for several days, and the dosage may then be gradually reduced
according to clinical response and laboratory findings.
PEDIATRIC DOSAGE SCHEDULE
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Unit Dose Frequency
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Children 6 months 50 mg/kg q6-8h
and older
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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 I.M. or I.V., 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
Weight (kg) X (140 - age)
Clcr = ---------------------------------------
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.
DOSAGE IN ADULTS WITH REDUCED RENAL FUNCTION
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Creatinine
Clearance Renal Less Severe Life-Threatening
mL/min Function Infections Infections
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79-50 Mild 500 mg q8h 0.75-1.5 grams
impairment q8h
49-5 Moderate 250-500 mg 0.5-1 gram
to severe q12h q12h
impairment
4-0 Dialysis 500 mg q48h 0.5-1 gram
patients or q48h
250 mg q24h or
0.5 gram q24h
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PREPARATION OF PARENTERAL SOLUTION
RECONSTITUTION
I.M. Administration: Reconstitute with Sterile Water for Injection. SHAKE WELL.
Vial Size Diluent to Approx. Approx. Avg.
Be Added Avail. Vol. Concentration
500 mg 1.5 mL 1.8 mL 280 mg/mL
1 gram 3.0 mL 3.7 mL 270 mg/mL
2 grams* 6.0 mL 7.4 mL 270 mg/mL
*When administering 2 gram I.M. doses, the dose should be divided and given in
different large muscle masses.
I.V. Administration: Reconstitute with Sterile Water for Injection. SHAKE WELL.
Vial Size Diluent to Approx. Approx. Avg.
Be Added Avail. Vol. Concentration
500 mg 5 mL 5.3 mL 95 mg/mL
1 gram 10 mL 10.7 mL 95 mg/mL
2 grams 20 mL 21.4 mL 95 mg/mL
These solutions of Cefizox are stable 24 hours at room temperature or 96 hours
if refrigerated (5 deg C).
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 I.V. solution listed below.
SHAKE WELL
Administer with primary I.V. fluids, as a single dose. These solutions of
Cefizox are stable 24 hours at room temperature or 96 hours if refrigerated (5
deg C).
A solution of 1 gram Cefizox in 13 mL Sterile Water for Injection is isotonic.
I.M. 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 I.M. doses, the dose should be divided and given in different large
muscle masses.
I.V. 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 (5 deg C).
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