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Cefotaxime is given as the sodium salt by deep intramuscular (IM) injection or intravenously (IV) by slow injection over 3 to 5 minutes or by infusion over 20 to 60 minutes. Doses are expressed in terms of the equivalent amount of cefotaxime. 1.05 g of cefotaxime sodium is approximately equivalent to 1 g of cefotaxime. It is usually given in doses of 2 to 6 g daily in 2 to 4 divided doses to adults. In severe infections up to 12 g may be given daily by the intravenous route in up to 6 divided doses; pseudomonal infections usually require more than 6 g daily, but a cephalosporin with greater antipseudomonal activity, such as ceftazidime, is preferable. Children may be given 100 to 150 mg/kg (50 mg/kg for neonates) daily in 2 to 4 divided doses, increased in severe infections to 200 mg/kg (150 to 200 mg/kg for neonates) daily if necessary.
Neonates, Infants and Children: Neonates (birth to 1 month): 0-1 week of age - 50 mg/kg per dose every 12 hours IV.
1-4 weeks of age - 50 mg/kg per dose every 8 hours IV.
It is not necessary to differentiate between premature and normal-gestational age infants.
Infants and Children (1 month to 12 years): Body weight (BW) <50 kg, recommended daily dose is 50 to 180 mg/kg IM or IV, BW divided into four to six equal doses. The higher dosages should be used for more severe or serious infections; including meningitis.
BW ≥ 50 kg - usual adult dosage; not exceeding 12 g.
In the treatment of gonorrhoea, a single dose of 500 mg or 1 g of cefotaxime is given.
For Gonococcal urethritis/Cervicitis in males and females and Rectal gonorrhea in females: 500 mg IM once daily.
Rectal gonorrhea in Males: 1 g IM once daily.
Uncomplicated infections: 1 g IM or IV twice daily.
Moderate to severe infections: 1-2 g every 8 hours IM or IV.
Infections commonly needing antibiotics in higher dosage (e.g. septicemia): 2 g every 6-8 hours IV.
Life-threatening infections: 2 g every 4 hours IV.
If C. trachomatis is a suspected pathogen appropriate anti-chlamydial coverage should be added, because cefotaxime sodium has no activity against this organism.
For surgical infection prophylaxis: 1 g is given 30 to 90 minutes before surgery. At caesarean section, 1 g is given intravenously to the mother as soon as the umbilical cord is clamped and two further doses intramuscularly or intravenously 6 and 12 hours later.
Cefotaxime may be used with an aminoglycoside as synergy may occur against some Gram-negative organisms, but the drugs should be administered separately. It has sometimes been used with another beta lactam to broaden the spectrum of activity. Cefotaxime has also been used with metronidazole in the treatment of mixed aerobic-anaerobic infections.
Dosage in renal impairment: Doses of cefotaxime should be reduced in severe renal impairment; after an initial loading dose of 1 g for adults, halving the dose while maintaining the usual frequency of dosing has been suggested.
