Usual Adult Dose for Cesarean Section

1 to 2 g IV one time, as soon as the umbilical cord is clamped

Prophylaxis for cesarean sections is considered controversial in low-risk patients and is not routinely recommended by the American College of Obstetricians and Gynecologists.

Usual Adult Dose for Cholecystitis

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: 7 to 14 days

Usual Adult Dose for Intraabdominal Infection

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: 7 to 14 days

Usual Adult Dose for Joint Infection

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: Therapy should be continued for approximately 3 to 4 weeks, depending on the nature and severity of the infection. Longer therapy, 6 weeks or more, may be required for prosthetic joint infections. In addition, removal of the involved prosthesis is usually required.

Usual Adult Dose for Osteomyelitis

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: Therapy should be continued for approximately 4 to 6 weeks, depending on the nature and severity of the infection. Chronic osteomyelitis may require additional oral antibiotic therapy, possibly for up to 6 months. Surgical debridement of devitalized bone is critical to the management of osteomyelitis.

Usual Adult Dose for Pelvic Inflammatory Disease

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: Parental therapy should be continued for at least 24 hours after clinical improvement is demonstrated. Oral therapy with either doxycycline and clindamycin or metronidazole may then be substituted to complete a 14 day treatment course.

Usual Adult Dose for Peritonitis

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: 10 to 14 days

Usual Adult Dose for Pneumonia

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: Therapy should be continued for approximately 7 days for pneumococcal pneumonia and 21 days for other infecting organisms. The duration of therapy depends on the nature and severity of the infection.

Usual Adult Dose for Pyelonephritis

Moderate: 1 to 2 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Life-threatening: 3 g IV every 12 hours
Duration: 14 days

Usual Adult Dose for Skin or Soft Tissue Infection

Moderate: 2 g IV or IM every 24 hours or 1 g IV or IM every 12 hours
Severe: 2 g IV every 12 hours
Duration: Therapy should be continued for approximately seven days or until three days after acute inflammation disappears. For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.

Usual Adult Dose for Surgical Prophylaxis

1 to 2 g IV one time, 30 to 60 minutes prior to surgery

Agents with both aerobic and anaerobic activity are indicated in potentially contaminated procedures. Cefotetan is recommended for appendectomies, for colorectal surgeries in patients who are unable to take oral neomycin/erythromycin, and for hysterectomies.

Cefazolin is considered the drug of choice in clean operations because it is active against Staphylococcus aureus and S epidermidis, has a long duration of action, and is relatively inexpensive. Alternatively, vancomycin may be indicated in patients with severe beta-lactam hypersensitivity or for major surgeries at institutions with high rates of MRSA or MRSE infections.

Usual Adult Dose for Urinary Tract Infection

Mild: 500 mg IV or IM every 12 hours
Moderate: 1 to 2 g IV or IM every 24 hours
Severe: 1 to 2 g IV or IM every 12 hours
Duration: 3 to 7 days

Usual Pediatric Dose for Bacterial Infection

1 year or older: 20 to 40 mg/kg IV or IM every 12 hours

Usual Pediatric Dose for Surgical Prophylaxis

1 year or older: 40 mg/kg IV one time, 30 to 60 minutes prior to surgery
For cases of ruptured viscus, gentamicin 2 mg/kg may be added.

Renal Dose Adjustments

CrCl 31 mL/min or more: The usual recommended dose administered every 12 hours.
CrCl 10 to 30 mL/min: The usual dose administered every 24 hours or half the usual dose administered every 12 hours.
CrCl 9 mL/min or less: The usual dose administered every 48 hours or one-fourth of the usual dose administered every 12 hours.

Liver Dose Adjustments

No adjustment recommended

Precautions

Cefotetan is contraindicated in patients who have a history of hemolytic anemia associated with cephalosporin use.

Cefotetan should be discontinued until etiology is determined if anemia develops within 2 or 3 weeks of initiation of therapy.

Patients should be advised to avoid alcohol for at least 3 days after cefotetan use in order to avoid possible disulfiram-like reaction.

Cefotetan solutions should not be physically mixed with aminoglycosides.

Safety and effectiveness have not been established in pediatric patients.

Dialysis

Hemodialysis: One-fourth of the usual dose every 24 hours on days between dialysis and one-half the usual dose on the day of dialysis.

Other Comments

Maximum dosage should not exceed 6 g per 24 hours.

If Chlamydia trachomatis is a suspected pathogen, appropriate antichlamydial coverage should be added, because cefotetan has no activity against this organism.

Cefotetan may be administered intramuscularly; however, IM administration may be painful. The IV route is preferred for severe or life-threatening infections such as sepsis/septicemia, bacteremia, meningitis, peritonitis, and for patients with reduced resistance (i.e., malnutrition, trauma, surgery, heart failure, malignancy, or shock).