Drug products: Cefotaxim AB Unimedic Vial Mate, Cefotaxim Copyfarm, Cefotaxim Eberth, Cefotaxim MIP, Cefotaxim Navamedic, Cefotaxim Sandoz, Cefotaxim Stragen, Cefotaxim Teva, Cefotaxima SALA, Cefotaxime Sodium for Injection, BP, Claforan®
ATC code: J01DD01
Substances: cefotaxime, cefotaxime sodium
In gonorrhea, the antibacterial effect of cefotaxime has been shown to be similar in men and women.
Pharmacokinetics and dosing
A study in elderly patients (15 men, 15 women) found no sex differences in cefotaxime pharmacokinetics but rather an age-effect with slower elimination of cefotaxime in patients over 80 years of age . Another study compared cefotaxime in obese individuals compared to normal-weight individuals (6 men and 6 women in each group). Concentrations of the active metabolite desacetylcefotaxime were ~70% higher in women than in men, in both normal and obese individuals. However, clearance was higher in men than in women only in obese individuals . Contrary to this, no sex differences in disposition of cefotaxime or desacetylcefotaxime were observed in patients (13 men, 11 women) with end-stage renal disease (<15 ml/min) after receiving a single i.v. 1 g cefotaxime dose .Since pharmacokinetic studies show varying results and effect seems to be similar in men and women treated with the same dose we do not at present find dose adjustment to be motivated. No studies with a clinically relevant sex analysis regarding the dosing of cefotaxim have been found.
A randomized study evaluated the antibacterial effect of a single IM injection of 1 g cefotaxime against N. gonorrhoeae(86 men, 56 women). The gonococcal culture became negative after treatment to a similar degree in both women and men . Another study in patients with uncomplicated gonorrhea treated with cefotaxime 1 g IM, observed no differences in cure rate between heterosexual men, homosexual men and women . Also a lower single IM dose of cefotaxime, 500 mg, has been shown to be similarly effective in men and women with uncomplicated gonorrhea .In some settings urine cultures to identify pathogens and resistance pattern cannot always be obtained and therapy of urinary tract infections then has to be empirical. A Brazilian study analyzed urine isolates to identify suitable empirical therapy options for cystitis and urinary tract infections in relation to patient’s sex and age (1098 men, 8700 women). Drug classes analyzed was ampicillin, nitrofurantoin, fluoroquinolones (ciprofloxacin and levofloxacin), trimethoprim-sulfamethoxazole, gentamicin, and ceftriazone/cefotaxime. Women exhibited higher susceptibility values for all drug classes studied than men. For women in any age group, only nitrofurantoin and gentamicin provided adequate activity for empirical therapy (> 80% susceptibility). For men in any age group, only gentamicin was suitable for empirical therapy. In women aged over 60 years, few suitable empirical treatment options were identified .
No studies with a clinically relevant sex analysis regarding adverse effects of cefotaxime have been found.
Reproductive health issues
Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).
Date of litterature search: 2016-02-24
- Rocha JL, Tuon FF, Johnson JR. Sex, drugs, bugs, and age: rational selection of empirical therapy for outpatient urinary tract infection in an era of extensive antimicrobial resistance. Braz J Infect Dis. 2012;16:115-21. PubMed
- Ludwig E, Székely E, Csiba A, Graber H. Pharmacokinetics of cefotaxime and desacetylcefotaxime in elderly patients. Drugs. 1988;35 Suppl 2:51-6. PubMed
- Yost RL, Derendorf H. Disposition of cefotaxime and its desacetyl metabolite in morbidly obese male and female subjects. Ther Drug Monit. 1986;8:189-94. PubMed
- Guay DR, Matzke GR, Heim KL, Halstenson CE, Abraham PA, Keane WF. Influence of gender on the disposition of cefotaxime and desacetylcefotaxime. Ther Drug Monit. 1987;9:259-62. PubMed
- van der Willigen AH, Wagenvoort JH, Schalla WO, Knapp JS, Boot JM, Heeres-Weststrate PL et al. Randomized comparative study of 05 and 1 g of cefodizime (HR 221) versus 1 g of cefotaxime for acute uncomplicated urogenital gonorrhea. Antimicrob Agents Chemother. 1988;32:426-9. PubMed
- Handsfield HH, Holmes KK. Treatment of uncomplicated gonorrhea with cefotaxime. Sex Transm Dis. 1981;8:187-91. PubMed
- Judson FN, Eron LJ, Lutz FB, Rand KH, Tennican PO, Mogabgab WJ. Multicenter study of a single 500-mg dose of cefotaxime for treatment of uncomplicated gonorrhea. Sex Transm Dis. 1991;18:41-3. PubMed
- Concise. Stockholm: eHälsomyndigheten. 2015 [cited 2016-03-21.] länk
Reviewed by: Mia von Euler
Approved by: Karin Schenck-Gustafsson