THERAPEUTIC OPTIONS FOR CEFOTAXIME IN THE MANAGEMENT OF BACTERIAL-INFECTIONS

Clinical studies of cefotaxime administered every 8 and 12 h have demo nstrated comparable clinical and microbiologic success when compared t o traditional 6-h regimens. This phenomena may be explained, in part, by the pharmacokinetic and pharmacodynamic properties of cefotaxime an d the antimicrobially active metabolite desacetyl-cefotaxime. Although cefotaxime levels cannot be maintained above the bacterial minimum in hibitory concentration (MIG) for all infecting pathogens with extended dosing intervals, concentrations of desacetyl-cefotaxime remain above the effective concentration for a variety of organisms throughout the extended interval. Cefotaxime dosage adjustment may be accomplished i n nonimmunocompromised patients with infections outside the central ne rvous system including uncomplicated urinary tract and lower respirato ry infections. Infections caused by bacteria with MIC(90) values less than or equal to 1 mu g/ml usually respond to 8- or 12-h dosage interv als. Less susceptible organisms with MIC(90) values between 2 and 8 mu g/ml, such as Serratia marcescens, may initially require cefotaxime a dministered every 6 or 8 h. Extended intervals should be avoided or us ed cautiously in patients that are neutropenic, immunocompromised, or hypermetabolic. Upon evidence of clinical and microbiologic response, therapy may be continued with alternative step-down therapy.