Recommended Cefotaxime IV Dosage
The standard recommended dosage of cefotaxime for adults is 2 grams administered intravenously every 6-8 hours, with a maximum daily dose of 12 grams. 1
Adult Dosing Guidelines
General Infections
- Uncomplicated infections: 2 g daily (1 g every 12 hours) IV 1
- Moderate to severe infections: 3-6 g daily (1-2 g every 8 hours) IV 1
- Septicemia: 6-8 g daily (2 g every 6-8 hours) IV 1
- Life-threatening infections: Up to 12 g daily (2 g every 4 hours) IV 1
Specific Conditions
- Bacterial meningitis: 2 g every 6 hours IV 2
- Spontaneous bacterial peritonitis: 2 g every 8 hours IV 2
- 5-day treatment has shown similar efficacy to 10-day treatment for SBP 2
- Gram-negative enteric bacilli infections: 200 mg/kg/day IV divided every 6 hours (up to 12 g daily) 2
Pediatric Dosing
- Neonates (0-1 week): 50 mg/kg every 12 hours IV 1
- Neonates (1-4 weeks): 50 mg/kg every 8 hours IV 1
- Infants and children (1 month to 12 years):
Special Populations
Elderly Patients
- Dose adjustment may be necessary due to decreased renal function 1
- Monitor renal function closely in elderly patients 1
Renal Impairment
- Dosage adjustment required based on creatinine clearance 1
- For patients with severe renal impairment, consider extending dosing interval rather than reducing individual doses 5
Duration of Therapy
- General infections: Minimum 48-72 hours after patient defervesces or evidence of bacterial eradication 1
- Meningococcal meningitis: 5 days if clinical recovery has occurred 2, 6
- Pneumococcal meningitis: 10 days if stable, up to 14 days if slower to respond 2, 6
- Spontaneous bacterial peritonitis: 5-10 days, with 5 days showing similar efficacy to 10 days 2
- Group A beta-hemolytic streptococcal infections: Minimum 10 days to prevent rheumatic fever or glomerulonephritis 1
Clinical Pearls and Caveats
- Twice-daily dosing (2 g every 12 hours) has shown similar efficacy to once-daily ceftriaxone for serious infections outside the ICU setting 7, 8
- For hospital-acquired spontaneous bacterial peritonitis, consider the risk of extended-spectrum beta-lactamase (ESBL)-producing bacteria, which may be resistant to third-generation cephalosporins 2
- Cefotaxime penetrates well into ascitic fluid, with 20-fold killing power after one dose 2
- Adjust therapy based on culture and sensitivity results when available
- In patients with normal renal function, cefotaxime 1-2 g every 12 hours should be effective against organisms with MICs <0.5 μg/ml 5
Remember that cefotaxime should be administered for a minimum of 48-72 hours after the patient defervesces or after evidence of bacterial eradication has been obtained 1. Always consider local resistance patterns when selecting empiric antibiotic therapy.