Cefoxitin inhibits bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis and arresting cell wall assembly resulting in bacterial cell death.

Cefoxitin is indicated for the treatment of serious infections caused by susceptible strains of the designated microorganisms in the diseases listed below.

Lower respiratory tract infections, including pneumonia and lung abscess, caused by Streptococcus pneumoniae, other streptococci (excluding enterococci, e.g., Enterococcus faecalis), Staphylococcus aureus(including penicillinaseproducing strains), Escherichia coli, Klebsiella species, Haemophilus influenzae, and Bacteroides species.

Urinary tract infections caused by Escherichia coli, Klebsiella species, Proteus mirabilis, Morganella morganii, Proteus vulgarisand Providencia species (including P. rettgeri).

Intra-abdominal infections, including peritonitis and intra-abdominal abscess, caused by Escherichia coli, Klebsiella species, Bacteroides species including Bacteroides fragilis, and Clostridium species.

Gynecological infections, including endometritis, pelvic cellulitis, and pelvic inflammatory disease caused by Escherichia coli, Neisseria gonorrhoeae (including penicillinase-producing strains), Bacteroides species including B. fragilis, Clostridium species, Peptococcus niger, Peptostreptococcus species, and Streptococcus agalactiae. Cefoxitin, like cephalosporins, has no activity against Chlamydia trachomatis. Therefore, when Cefoxitin is used in the treatment of patients with pelvic inflammatory disease and C. trachomatis is one of the suspected pathogens, appropriate anti-chlamydial coverage should be added.

Septicemia caused by Streptococcus pneumoniae, Staphylococcus aureus (including penicillinase-producing strains), Escherichia coli, Klebsiella species, and Bacteroides species including B. fragilis.

Bone and joint infections caused by Staphylococcus aureus (including Penicillinaseproducing strains).

Skin and skin structure infections caused by Staphylococcus aureus (including penicillinase-producing strains), Staphylococcus epidermidis, Streptococcus pyogenes and other streptococci (excluding enterococci e.g., Enterococcus faecalis), Escherichia coli, Proteus mirabilis, Klebsiella species, Bacteroides species includingB. fragilis, Clostridium species, Peptococcus niger, and Peptostreptococcus species.

Intravenous:

Abdominal infections, Bone and joint infections, Gynaecological infections, Respiratory tract infections, Skin and skin structure infections, Urinary tract infections:

• Adult: 1-2 g 6-8 hrly, up to 12 g daily given in 4-6 divided doses in severe infections. Doses are given by slow inj over 3-5 min or, by intermittent or continuous infusion.
• Child: ≥3 mth 80-160 mg/kg daily in 4-6 equally divided doses. Max: 12 g daily.

Prophylaxis of surgical infections:

• Adult: 2 g 30-60 min prior to surgery, then 6 hrly for not more than 24 hr. For caesarean section: 2 g as a single dose as soon as the umbilical cord is clamped; a further 2 g dose 4 hr and 8 hr after the initial dose may be given if necessary.
• Child: ≥3 mth 30-40 mg/kg 30-60 min prior to surgery, then 6 hrly for not more than 24 hr.

Hypersensitivity to cefoxitin and other cephalosporins.

Hypersensitivity reactions (e.g. maculopapular or erythematous rash, exfoliative dermatitis, pruritus, urticaria, eosinophilia, fever, angioedema); elevated serum creatinine and/or BUN concentrations, anaemia; transient increase in serum AST (SGOT), ALT (SGPT), LDH and alkaline phosphatase levels; jaundice; thrombophlebitis. Rarely, oliguria, renal toxicity, neutropenia, transient leucopenia, granulocytopenia, thrombocytopenia, bone marrow depression; GI effects (e.g. nausea, vomiting, diarrhoea).

Patient with history of penicillin allergy, GI disease (particularly colitis) and seizure disorder. Renal impairment. Pregnancy and lactation.

Use in Special Populations

Haemodialysis patient: Repeat loading dose after each dialysis session.

• CrCl <5 ml/min: 0.5-1 g 24-48 hrly. 
• CrCl 5-9 ml/min: 0.5-1 g 12-24 hrly.
• CrCl 10-29 ml/min: 1-2 g 12-24 hrly.
• CrCl 30-50 ml/min: 1-2 g 8-12 hrly.

Pregnancy & Lactation

Pregnancy Category B. Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters).