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Disclaimer: <p><b>Due to the current critical shortage of Cefotaxime for Injection products in the United States (U.S.) market, SteriMax Inc. (SteriMax), in conjunction with Provepharm, Inc. (Provepharm) and Direct Success, Inc. (Direct Success) is coordinating with the U.S. Food and Drug Administration (FDA) to increase the availability of the drug. Provepharm now has available non-FDA approved Cefotaxime for Injection (1 g/vial, and 2 g/vial) in the U.S. market. <a class="external-link" href="https://www.fda.gov/media/152896/download" rel="nofollow noopener" target="_blank" title="Follow link">For more information click here</a>.</b></p>
<h3>Cefotaxime For Injection, powder for solution</h3>
<p><strong>INDICATIONS AND IMPORTANT SAFETY INFORMATION</strong></p>
<p><br />
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cefotaxime for Injection (cefotaxime sodium) and other antibacterial drugs, Cefotaxime for Injection should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.</p>
<p><br />
<strong>INDICATION</strong><br />
Cefotaxime for Injection is indicated for the treatment of patients with serious infections caused by susceptible strains of the designated microorganisms in the diseases listed below.</p>
<p><br />
<strong>(1) Lower respiratory tract infections</strong>, including pneumonia, caused by <em>Streptococcus pneumoniae</em> (formerly <em>Diplococcus pneumoniae</em>), <em>Streptococcus pyogenes*</em> (Group A streptococci) and other streptococci (excluding <em>enterococci</em>, <em>e.g., Enterococcus faecalis</em>), <em>Staphylococcus aureus</em> (penicillinase and non-penicillinase producing), <em>Escherichia coli</em>, <em>Klebsiella species</em>, <em>Haemophilus influenzae</em> (including ampicillin resistant strains), <em>Haemophilus parainfluenzae</em>, <em>Proteus mirabilis, Serratia marcescens*, Enterobacter species</em>, indole positive <em>Proteus and Pseudomonas </em>species (including <em>P. aeruginosa</em>).</p>
<p><br />
<strong>(2) Genitourinary infections. </strong>Urinary tract infections caused by <em>Enterococcus </em>species,<em> Staphylococcus epidermidis, Staphylococcus aureus*,</em> (<em>penicillinase </em>and <em>nonpenicillinase </em>producing), <em>Citrobacter species, Enterobacter species, Escherichia coli, Klebsiella species, Proteus mirabilis, Proteus vulgaris*, Providencia stuartii, Morganella morganii*, Providencia rettgeri*, Serratia marcescens </em>and<em> Pseudomonas species</em> (including <em>P. aeruginosa</em>). Also, uncomplicated gonorrhea (cervical/urethral and rectal) caused by <em>Neisseria gonorrhoeae</em>, including penicillinase producing strains.</p>
<p><br />
<strong>(3) Gynecologic infections</strong>, including pelvic inflammatory disease, endometritis and pelvic cellulitis caused by <em>Staphylococcus epidermidis, Streptococcus</em> species, <em>Enterococcus</em> species, <em>Enterobacter </em>species*, <em>Klebsiella </em>species*, <em>Escherichia coli, Proteus mirabilis, Bacteroides</em> species (including <em>Bacteroides fragilis*</em>), <em>Clostridium </em>species, and anaerobic cocci (including <em>Peptostreptococcus </em>species and <em>Peptococcus </em>species) and <em>Fusobacterium </em>species (including <em>F. nucleatum*</em>). Cefotaxime for Injection, like other cephalosporins, has no activity against <em>Chlamydia trachomatis.</em> Therefore, when cephalosporins are 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.</p>
<p><br />
<strong>(4) Bacteremia/Septicemia </strong>caused by <em>Escherichia coli, Klebsiella </em>species, and <em>Serratia marcescens</em>, <em>Staphylococcus aureus</em> and <em>Streptococcus </em>species (including<em> S. pneumoniae</em>).</p>
<p><br />
<strong>(5) Skin and skin structure infections </strong>caused by<em> Staphylococcus aureus </em>(penicillinase and non-penicillinase producing), <em>Staphylococcus epidermidis</em>, <em>Streptococcus pyogenes </em>(Group A streptococci) and other streptococci, <em>Enterococcus </em>species, <em>Acinetobacter </em>species*, <em>Escherichia coli, Citrobacter</em> species (including <em>C. freundii*</em>), <em>Enterobacter </em>species, <em>Klebsiella </em>species, <em>Proteus mirabilis, Proteus vulgaris*, Morganella morganii, Providencia rettgeri*, Pseudomonas </em>species, <em>Serratia marcescens, Bacteroides </em>species, and anaerobic cocci (including <em>Peptostreptococcus*</em> species and <em>Peptococcus </em>species).<br />
<br />
<strong>(6) Intra-abdominal infections</strong> including peritonitis caused by <em>Streptococcus</em> species*,<em> Escherichia coli, Klebsiella</em> species, <em>Bacteroides </em>species, and anaerobic cocci (including <em>Peptostreptococcus</em>* species and Peptococcus* species) <em>Proteus mirabilis*</em>, and <em>Clostridium </em>species*.</p>
<p><br />
<strong>(7) Bone and/or joint infections</strong> caused by <em>Staphylococcus aureus</em> (penicillinase and non-penicillinase producing strains), <em>Streptococcus </em>species (including <em>S. pyogenes*</em>), <em>Pseudomonas </em>species (including <em>P. aeruginosa*</em>), and <em>Proteus mirabilis*.</em></p>
<p><br />
<strong>(8) Central nervous system infections</strong>, e.g., meningitis and ventriculitis, caused by <em>Neisseria meningitidis</em>, <em>Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae* </em>and <em>Escherichia coli*.</em></p>
<p><br />
<strong>(*)</strong> Efficacy for this organism, in this organ system, has been studied in fewer than 10 infections.</p>
<p><br />
<strong>CONTRAINDICATIONS </strong></p>
<p>Cefotaxime is contraindicated in patients who have shown hypersensitivity to cefotaxime sodium, or the cephalosporin group of antibiotics.</p>
<p><br />
<strong>WARNINGS AND PRECAUTIONS.<br />
Hypersensitivity Reactions: </strong>BEFORE THERAPY WITH CEFOTAXIME IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFOTAXIME SODIUM, CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. THIS PRODUCT SHOULD BE GIVEN WITH CAUTION TO PATIENTS WITH TYPE I HYPERSENSITIVITY REACTIONS TO PENICILLIN. ANTIBIOTICS SHOULD BE ADMINISTERED WITH CAUTION TO ANY PATIENT WHO HAS DEMONSTRATED SOME FORM OF ALLERGY, PARTICULARLY TO DRUGS. IF AN ALLERGIC REACTION TO CEFOTAXIME OCCURS, DISCONTINUE TREATMENT WITH THE DRUG. SERIOUS HYPERSENSITIVITY REACTIONS MAY REQUIRE EPINEPHRINE AND OTHER EMERGENCY MEASURES.</p>
<p><br />
<strong>Arrhythmia:</strong> During post-marketing surveillance, a potentially life-threatening arrhythmia was reported in each of six patients who received a rapid (less than 60 seconds) bolus injection of cefotaxime through a central venous catheter. Therefore, cefotaxime should only be administered as instructed in the DOSAGE AND ADMINISTRATION section of the Prescribing Information.</p>
<p><br />
<strong><em>Clostridium difficile </em>associated diarrhea (CDAD): </strong>CDAD has been reported with use of nearly all antibacterial agents, including cefotaxime, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of <em>C. difficile.</em></p>
<p><br />
<em>C. difficile </em>produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of <em>C. difficile</em> cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.</p>
<p><br />
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against <em>C. difficile</em> may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of <em>C. difficile</em>, and surgical evaluation should be instituted as clinically indicated.</p>
<p><br />
<strong>ADVERSE REACTIONS </strong></p>
<p>The most common adverse reactions have been local reactions following IM or IV injection. Other adverse reactions have been encountered infrequently. The most frequent adverse reactions (greater than 1%) are: Local (4.3%) - Injection site inflammation with IV administration. Pain, induration, and tenderness after IM injection. Hypersensitivity (2.4%) - Rash, pruritus, fever, eosinophilia. Gastrointestinal (1.4%) - Colitis, diarrhea, nausea, and vomiting. Symptoms of pseudomembranous colitis can appear during or after antibiotic treatment. Nausea and vomiting have been reported rarely.</p>
<p><br />
<strong>Cephalosporin Class Labeling: </strong>In addition to the adverse reactions listed above which have been observed in patients treated with cefotaxime sodium, the following adverse reactions and altered laboratory tests have been reported for cephalosporin class antibiotics: allergic reactions, hepatic dysfunction including cholestasis, aplastic anemia, hemorrhage, and false-positive test for urinary glucose.</p>
<p><br />
Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced. If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated.</p>
<p><br />
<strong>DRUG INTERACTIONS </strong></p>
<p><strong>Nephrotoxic drugs: </strong>As with other cephalosporins, cefotaxime may potentiate the nephrotoxic effects of nephrotoxic drugs such as aminoglycosides, NSAIDs and furosemide.</p>
<p><br />
<strong>Probenecid: </strong>Probenecid interferes with the renal tubular transfer of cefotaxime, decreasing the total clearance of cefotaxime by approximately 50% and increasing the plasma concentrations of cefotaxime. Administration of cefotaxime in excess of 6 grams/day should be avoided in patients receiving probenecid.</p>
<p><br />
<strong>Laboratory Test Interactions: </strong>Cephalosporins, including cefotaxime sodium, are known to occasionally induce a positive direct Coombs' test.</p>
<p><br />
<strong>DOSAGE AND ADMINISTRATION</strong><br />
Dosage and route of administration should be determined by susceptibility of the causative organisms, severity of the infection, and the condition of the patient (see table in full prescribing information for dosage guideline). Cefotaxime may be administered IM or IV after reconstitution. The maximum daily dosage should not exceed 12 grams.</p>
<p><br />
<strong>USE IN SPECIFIC POPULATIONS </strong></p>
<p><strong>Pregnancy:</strong> There are no well-controlled studies in pregnant women. Because animal reproductive studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.</p>
<p><br />
<strong>Lactation:</strong> Cefotaxime is excreted in human milk in low concentrations. Caution should be exercised when cefotaxime is administered to a nursing woman.</p>
<p><br />
<strong>Females of Reproductive Potential:</strong> Use of the drug in women of child-bearing potential requires that the anticipated benefit be weighed against the possible risks. In perinatal and postnatal studies with rats, the pups in the group given 1200 mg/kg/day of cefotaxime were significantly lighter in weight at birth and remained smaller than pups in the control group during the 21 days of nursing.</p>
<p><br />
<strong>Geriatric Use:</strong> This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.</p>
<p><br />
<strong>For additional Safety Information, please see Full Prescribing Information.</strong></p>
<p><br />
<strong>You are encouraged to report adverse drug events to Provepharm at 1-833-727-6556 or to the FDA by visiting <a href="www.fda.gov/medwatch">www.fda.gov/medwatch</a> or by calling 1-800-FDA-1088.</strong></p>
<p>ase for which the patient is being treated.</p>
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