What solvent should be used to reconstitute cefotaxime?

Cefotaxime Reconstitution Guidelines

For cefotaxime reconstitution, sterile water for injection should be used as the primary solvent, with specific volumes depending on the administration route and desired concentration.

Reconstitution for Intramuscular (IM) Use

• Reconstitute cefotaxime vials with Sterile Water for Injection or Bacteriostatic Water for Injection using the following volumes 1:
  • 500 mg vial: Add 2 mL to achieve approximately 230 mg/mL
  • 1 g vial: Add 3 mL to achieve approximately 300 mg/mL
  • 2 g vial: Add 5 mL to achieve approximately 330 mg/mL 1

Reconstitution for Intravenous (IV) Use

• Reconstitute cefotaxime vials with at least 10 mL of Sterile Water for Injection 1:
  • 500 mg vial: Add 10 mL to achieve approximately 50 mg/mL
  • 1 g vial: Add 10 mL to achieve approximately 95 mg/mL
  • 2 g vial: Add 10 mL to achieve approximately 180 mg/mL 1
• For infusion bottles, reconstitute with 50 or 100 mL of 0.9% Sodium Chloride Injection or 5% Dextrose Injection 1

Compatible Diluents for Further Dilution

• Reconstituted solutions may be further diluted up to 1000 mL with the following solutions 1:
  • 0.9% Sodium Chloride Injection
  • 5% or 10% Dextrose Injection
  • 5% Dextrose and 0.9% Sodium Chloride Injection
  • 5% Dextrose and 0.45% Sodium Chloride Injection
  • 5% Dextrose and 0.2% Sodium Chloride Injection
  • Lactated Ringer's Solution
  • Sodium Lactate Injection (M/6)
  • 10% Invert Sugar Injection
  • 8.5% TRAVASOL® (Amino Acid) Injection without Electrolytes 1

Important Stability Considerations

• Cefotaxime solutions exhibit maximum stability in the pH 5-7 range 1
• Do not use diluents with pH above 7.5, such as Sodium Bicarbonate Injection 1
• Reconstituted solutions in original containers remain stable for the following periods 1:
  • IM preparations: 12 hours at room temperature (≤22°C) or 7 days refrigerated (≤5°C)
  • IV preparations: 12-24 hours at room temperature or 7 days refrigerated 1

Administration Warnings

• Solutions of cefotaxime must not be admixed with aminoglycoside solutions 1
• If cefotaxime and aminoglycosides are to be administered to the same patient, they must be administered separately 1
• A solution of 1 g cefotaxime in 14 mL of Sterile Water for Injection is isotonic 1
• For IV administration, inject over a period of three to five minutes; never administer over less than three minutes 1

Clinical Applications

• For spontaneous bacterial peritonitis, cefotaxime is typically administered at 2 g every 6-8 hours IV 2
• For bacterial meningitis, higher doses of cefotaxime (2 g every 6 hours) are recommended 3, 4
• For bacterial keratitis, cefotaxime can be prepared as a fortified topical solution (50 mg/mL) by adding 9.2 mL of artificial tears to 1 g of cefotaxime powder, dissolving, then taking 5 mL of this solution and adding it to 5 mL of artificial tears 2

Always inspect solutions for particulate matter and discoloration prior to administration. Solutions of cefotaxime range from very pale yellow to light amber, depending on concentration, diluent used, and storage conditions 1.