Monowel Dosage/Direction for Use

Cefoxitin sodium (Monowel) may be administered intravenously or intramuscularly. (See INTRAVENOUS ADMINISTRATION and INTRAMUSCULAR ADMINISTRATION in the following text). Dosage and route of administration should be determined by severity of infections, susceptibility of the causative organism and condition of the patient. Therapy may be started while awaiting the results of susceptibility testing.
TREATMENT DOSAGE: ADULTS: Usual adult dose: 1 g or 2 g of Cefoxitin sodium (Monowel) every 8 hours (see Table 1).

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Adults with renal insufficiency: An initial loading dose of 1 g to 2 g may be given. After a loading dose, the recommendations on Maintenance Dose in Adults with Reduced Renal Function, may be used as a guide.
Patients undergoing hemodialysis: The loading dose of 1-2 g should be given after each hemodialysis, and the maintenance dose should be given as indicated in the table on Maintenance Dose in Adults with Reduced Renal Function. (See Table 2.)

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Uncomplicated urinary tract infection: In uncomplicated urinary tract infection due to susceptible organisms, 1 g intramuscularly twice a day has been shown effective.
Uncomplicated gonorrhea: For single dose therapy of uncomplicated gonorrhea, including those caused by penicillinase-producing strains, the recommended dose is 2 g of Cefoxitin sodium (Monowel) intramuscularly given 1 g of probenecid by mouth at the same time or up to 1 hour before.
Neonates (Including Premature Infants), Infants and Children: (See Table 3.)

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In severe infections, the total daily dosage may be increased to 200 mg/Kg, but not to exceed 12 g per day. Cefoxitin sodium (Monowel) is not recommended for the therapy of meningitis. If meningitis is suspected, an appropriate antibiotic should be used. In children with renal insufficiency the dose frequency should be reduced as indicated for adults. (See Warnings.)
PROPHYLACTIC DOSE: For prophylactic use in surgery the following doses are recommended: General Surgery: Adults: 2 g administered intramuscularly or intravenously 1/2 to 1 hours before initial incision; then 2 g every 6 hours. Ordinarily, prophylactic therapy does not extend beyond 24 hours.
Neonates, infants and children: In case of infants and children, 30-40 mg/Kg doses may be given at times designated previously. However, in neonates 30-40 mg/Kg doses may be given one half to 1 hour prior to surgery has been effective. For prolonged or heavily contaminated procedures, additional 2 g doses may be given at 6 hours intervals. Ordinarily, prophylactic therapy does not extend beyond 24 hours (see Warnings).
Obstetric-Gynecologic: For patients undergoing caesarean section a single 2 g dose should be administered intravenously as soon as the umbilical cord is clamped. For prophylactic use in gynecologic surgical procedure a single 2 g dose administered intravenously or intramuscularly one-half to one hour prior to surgery has been effective. For prolonged or heavily contaminated procedures, additional 2 g doses may be given at 6 hours intervals. Ordinarily, prophylactic therapy does not extend beyond 24 hours.
Administration: INTRAVENOUS ADMINISTRATION: The intravenous route is preferable for patients with bacteremia, bacterial septicemia, or other severe or life-threatening infections, or for patients who may be poor risks because of lowered resistance resulting from such debilitating conditions as malnutrition, trauma, surgery, diabetes, heart failure, or malignancy, particularly if shock is present or impending.
For intermittent intravenous administration, a solution containing 1 g or 2 g in 10 ml of Sterile Water for Injection can be injected over a period of 3 to 5 minutes. Using an infusion system, it may also be given over a longer period of time through the tubing system by which the patient may be receiving other intravenous solutions. However, during infusion of the solution containing cefoxitin sodium, it is advisable to temporarily discontinue administration of any other solutions at the same site.
For the administration of higher doses by continuous intravenous infusion, a solution of cefoxitin sodium be added to an intravenous bottle containing 5% Dextrose Injection, 0.9% Sodium Chloride Injection, 5% Dextrose and 0.9% Sodium Chloride Injection or 5% Dextrose Injection with 0.02% sodium bicarbonate solution. Butterfly or scalp vein type needles are preferred for this type of infusion.
INTRAMUSCULAR ADMINISTRATION ONLY: Reconstitute Cefoxitin sodium (Monowel) 1 g with 2 mL Sterile Water for Injection, or 0.5% or 1% lidocaine HCl (without epinephrine) solution. Cefoxitin sodium (Monowel) is given by deep injection into a large muscle mass.
Avoid injection into a blood vessel. Note: Some patients may be hypersensitive to lidocaine.