From the Guidelines
Yes, cefotaxime can be combined with amikacin, as this combination is supported by the most recent and highest quality study available, which prioritizes the treatment of severe infections where gram-negative bacteria are suspected 1.
Key Points to Consider
- Cefotaxime is a third-generation cephalosporin that targets the cell wall synthesis of many gram-positive and gram-negative bacteria.
- Amikacin is an aminoglycoside that inhibits bacterial protein synthesis, creating a synergistic effect against many pathogens and helping to prevent the emergence of resistance.
- This combination is particularly useful for empiric therapy in settings such as febrile neutropenia, severe pneumonia, complicated urinary tract infections, and sepsis.
- Standard dosing for adults typically includes cefotaxime 1-2g every 8 hours and amikacin 15-20 mg/kg once daily, with adjustments needed for patients with renal impairment, as indicated in studies such as 1.
Important Considerations for Administration
- Monitoring renal function regularly is crucial, as aminoglycosides can cause nephrotoxicity.
- Checking drug levels for amikacin is necessary to ensure therapeutic concentrations while avoiding toxicity.
- The combination of cefotaxime and amikacin is supported by guidelines for the treatment of various infections, including those outlined in 1 and 1, which provide recommendations for empiric antibiotic treatment in different patient groups.
From the FDA Drug Label
Solutions of cefotaxime must not be admixed with aminoglycoside solutions. If cefotaxime and aminoglycosides are to be administered to the same patient, they must be administered separately and not as mixed injection
- Cefotaxime and amikacin (an aminoglycoside) should not be combined in the same solution.
- They can be administered to the same patient, but must be given separately and not as a mixed injection 2
From the Research
Combination of Cefotaxime and Amikacin
- Cefotaxime can be combined with amikacin, as shown in several studies 3, 4, 5.
- The combination of cefotaxime and amikacin has been used as empiric therapy in the treatment of febrile episodes in neutropenic patients with hematologic malignancies, with an overall clinical response of 86.2% 3.
- In vitro studies have demonstrated synergy between cefotaxime and amikacin against gram-negative bacilli, including Pseudomonas aeruginosa and Serratia marcescens 4, 5.
- The combination of cefotaxime and amikacin has been shown to be effective against multiresistant Pseudomonas and Serratia infections, with a clinical response rate of 100% and a bacteriological cure rate of 80% 5.
- However, it is worth noting that the study in 6 compared the efficacy and toxicity of single daily doses of amikacin and ceftriaxone (not cefotaxime) with multiple daily doses of amikacin and ceftazidime, and found that single daily dosing of amikacin and ceftriaxone was as effective and no more toxic than multiple daily dosing of amikacin and ceftazidime.
- Another study in 7 discussed the use of cefotaxime alone or in combination with an aminoglycoside, but did not provide specific information on the combination of cefotaxime and amikacin.