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Ceftizoxime; Indications/Uses, Dosage, Side Effects, Interactions ,Pregnancy

Ceftizoxime is a semisynthetic, broad-spectrum, beta-lactamase-resistant, third-generation cephalosporin with antibacterial activity & safe and effective in aged patients and in patients with hematologic disorders . Ceftizoxime binds to and inactivates penicillin-binding proteins (PBPs) located on the inner membrane of the bacterial cell wall. PBPs are enzymes involved in the terminal stages of assembling the bacterial cell wall and in reshaping the cell wall during growth and division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis.

Mechanism of action of Ceftizoxime

The bactericidal activity of Ceftizoxime results from the inhibition of cell wall synthesis via affinity for penicillin-binding proteins (PBPs). Ceftizoxime is highly resistant to a broad spectrum of beta-lactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative organisms. It has few side effects and is reported to be safe and effective in aged patients and in patients with hematologic disorders. Ceftizoxime is an aminothiazolyl cephalosporin with an extended spectrum of activity against many gram-negative, nosocomially acquired pathogens. It has excellent beta-lactamase stability, with good in vitro activity against Haemophilus influenza, Neisseria gonorrhoeae, and Klebsiella pneumonia. Ceftizoxime, like the penicillins, is a beta-lactam antibiotic. By binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, it inhibits the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that ceftizoxime interferes with an autolysin inhibitor.

Indications of Ceftizoxime

For the treatment of infections due to susceptible strains of microorganisms.

Intra-Abdominal
For the treatment of serious infections caused by susceptible strains microorganisms.
Lower respiratory tract infections, including pneumonia and lung abscess,s
Urinary tract infections caused by Escherichia coli, Klebsiella species,
Intra-abdominal infections, including peritonitis and intra-abdominal abscess,
Gynecological infections, including endometritis, pelvic cellulitis, and pelvic inflammatory disease caused
Bacterial Infections
Bloodstream Infections
Bone and Joint Infections
Aspiration Pneumonia Cesarean Section
Bronchitis
Tonsillitis

Contra-Indications of Ceftizoxime

Hemolytic anemia
Liver problems
Interstitial nephritis
Subacute cutaneous lupus erythematosus
Systemic lupus erythematosus
Allergies cephalosporins & beta-lactams

Dosage of Ceftizoxime

Usual Adult Dose for Bacteremia

1 to 4 g IV or IM every 8 to 12 hours for 14 days, depending on the nature and severity of the infection
Doses up to 12 g/day may be used for severe, life-threatening infections.

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Usual Adult Dose for Cystitis

500 mg IV or IM every 12 hours for 3 to 7 days

Usual Adult Dose for Epiglottitis

1 to 4 g IV every 8 to 12 hours for 7 to 10 days, depending on the nature and severity of the infection
Doses up to 12 g/day may be used for severe, life-threatening infections.

Usual Adult Dose for Gonococcal Infection

1 g IV or IM every 8 hours
Parenteral therapy should continue for 24 hours after clinical improvement has been observed. Oral therapy with cefixime or cefpodoxime should then be continued to complete a total course of at least 1 week.
Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat the possible concurrent chlamydial infection.

Usual Adult Dose for Gonococcal Infection

Uncomplicated infections of the cervix, urethra, or rectum: 500 mg IM once
Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin is also recommended to treat the possible concurrent chlamydial infection.

This regimen is recommended as an alternative regimen by the Centers for Disease Control and Prevention.

Usual Adult Dose for Intraabdominal Infection

1 to 4 g IV or IM every 8 to 12 hours for 7 to 14 days, depending on the nature and severity of the infection
Doses up to 12 g/day may be used for severe, life-threatening infections.

Usual Adult Dose for Joint Infection

1 to 4 g IV or IM every 8 to 12 hours for 3 to 4 weeks, depending on the nature and severity of the infection
Longer therapy, up to 6 weeks, may be required in cases involving infected prosthetic joints. Doses up to 12 g/day may be used for severe, life-threatening infections.

Usual Adult Dose for MeningitisInterstitial nephritis

1 to 3 g IV every 6 to 12 hours for 10 to 14 days, depending on the nature and severity of the infection
Doses up to 12 g/day may be used for severe, life-threatening infections.

Usual Adult Dose for Osteomyelitis

1 to 2 g IV or IM every 8 to 12 hours for 4 to 6 weeks, depending on the nature and severity of the infection
Doses up to 12 g/day may be used for severe, life-threatening infections.

Usual Adult Dose for Pelvic Inflammatory Disease

2 g IV every 8 hours to continue until 24 hours after clinical improvement is observed
At that point, appropriate oral antimicrobial therapy may be initiated and continued for a total of 14 days of therapy.
Alternatively, 1 g ceftizoxime IM administered on an outpatient basis, followed by oral doxycycline therapy with or without metronidazole, may be substituted.
Doxycycline therapy for 14 days (if not pregnant) is also recommended to treat the possible concurrent chlamydial infection. Azithromycin is active against chlamydia and may be considered for pregnant patients.

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Usual Adult Dose for Peritonitis

1 to 4 g IV or IM every 8 to 12 hours for 10 to 14 days, depending on the nature and severity of the infection
Doses up to 12 g/day may be used for severe, life-threatening infections.

Usual Adult Dose for Pneumonia

1 to 4 g IV or IM every 8 to 12 hours for 7 to 21 days, depending on the nature and severity of the infection
Doses up to 12 g/day may be used for severe, life-threatening infections.

Usual Adult Dose for Pyelonephritis

1 to 2 g IV or IM every 8 to 12 hours for 14 days

Usual Adult Dose for Skin or Soft Tissue Infection

1 to 2 g IV or IM every 8 to 12 hours for 7 to 10 days, or until 3 days after acute inflammation subsides, depending on the nature and severity of the infection
For more serious infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.

Usual Adult Dose for Urinary Tract Infection

1 to 2 g IV or IM every 8 to 12 hours

Side Effects of Ceftizoxime

The most common

local tenderness or pain at the site of injection
skin color change, mild diarrhea
mild nausea
loss of appetite
vaginal discharge and itching
swelling of feet or legs
chest pain
constipation
a cough
diarrhea or loose stools
difficulty with breathing
dizziness
heartburn

More common

Abdominal or stomach pain, discomfort, or tenderness
chills or fever
difficulty with moving
a headache, severe and throbbing
joint or back pain
muscle aching or cramping
muscle pains or stiffness
chest pressure or squeezing pain in the chest
excessive sweating
feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
sudden tingling or coldness in an arm or leg
sudden slow or difficult speech
sudden drowsiness or need to sleep
fast breathing
sharp pain when taking a deep breath
fast or slow heartbeat
coughing up blood
rust colored urine
decreased amount of urine

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Rare

Anxiety
change in vision
seizures
abnormal or fast heart rate
tremors
weight loss
chest pain or tightness
confusion
a cough
Agitation
arm, back, or jaw pain
blurred vision
chest pain or discomfort
convulsions
extra heartbeats
fainting
hallucinations
a headache
irritability
lightheadedness
mood or mental changes
muscle pain or cramps

Drug Interactions of Ceftizoxime

Ceftizoxime may interact with the following drugs, supplements, & may change the efficacy of drugs

aminoglycoside antibiotics (e.g., gentamicin, tobramycin)
probenecid
typhoid vaccine
cholera vaccine,
amoxicillin
BCG vaccine
Aspirin Low Strength (aspirin)
Diphenhydramine
Rosuvastatin
Duloxetine
Albuterol
Topiramate
Carbamazepine
Vitamin D3 (cholecalciferol)
Alprazolam
Cetirizine
Phenprocoumon
Picosulfuric acid
Warfarin

Pregnancy Catagory of Ceftizoxime

FDA Pregnancy Category B

Pregnancy

It is not known if ceftizoxime is safe for use by pregnant women. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Lactation

This medication may pass into breast milk. If you are a breastfeeding mother and are taking ceftizoxime it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. It is not known if ceftizoxime is safe for children under 6 months of age.