Cefoxitin Route of Administration
Cefoxitin is only available for intravenous (IV) or intramuscular (IM) administration—there is no oral formulation of this antibiotic. 1, 2
Available Routes and Formulations
Intravenous Administration (Preferred Route)
IV is the preferred route for serious infections, including bacteremia, septicemia, severe infections, or patients at high risk due to debilitating conditions such as malnutrition, trauma, surgery, diabetes, heart failure, or malignancy, particularly when shock is present or impending 2
Standard IV dosing for adults: 1-2 grams every 6-8 hours for moderate infections; up to 12 grams daily (2 grams every 4 hours or 3 grams every 6 hours) for severe infections like gas gangrene 1, 2
Preparation requirements: Doses over 2 grams must be diluted in sodium chloride 0.9% or glucose 5% for IV infusion 1, 3
Administration technique: Can be given as intermittent IV injection over 3-5 minutes (1-2 grams in 10 mL) or as continuous infusion through existing IV lines 2
Intramuscular Administration (Alternative for Mild-Moderate Infections)
IM route is appropriate for mild to moderate infections when IV access is not necessary or as continuation therapy after initial IV treatment 4
IM dosing: 1 gram diluted in 1 mL of 0.5% or 1.0% lidocaine four times daily 4
Tolerability: 96% of patients found IM administration not painful when properly diluted with lidocaine 4
Clinical efficacy: IM cefoxitin achieved cure or improvement in 45 of 47 patients (96%) with skin/soft tissue infections, all 16 patients with lower respiratory tract infections, and 10 of 12 patients (83%) with urinary tract infections 4
Oral Alternatives When Cefoxitin Coverage Is Needed
Since cefoxitin has no oral formulation, consider these oral alternatives based on infection type:
First-Choice Oral Alternative
- Amoxicillin-clavulanic acid provides similar gram-negative and anaerobic coverage to cefoxitin 5
Second-Choice Oral Alternatives
- Ciprofloxacin plus metronidazole when beta-lactams cannot be used 5
- Cefuroxime (oral second-generation cephalosporin) for less severe infections 1
Specific Clinical Scenarios
- For pelvic inflammatory disease: After initial IM cefoxitin 2 grams plus probenecid 1 gram orally, continue with doxycycline 100 mg orally twice daily for 10-14 days 1, 5
- For intra-abdominal infections: Amoxicillin-clavulanic acid or ciprofloxacin plus metronidazole for outpatient continuation 1, 5
Critical Monitoring for IV/IM Cefoxitin
- Renal function monitoring is essential, especially when combining with aminoglycosides or furosemide due to increased nephrotoxicity risk 1, 3
- Dose adjustment required in renal impairment: reduce to 1-2 grams every 8-12 hours for creatinine clearance 30-50 mL/min, and further reductions for more severe impairment 2
- Monitor complete blood count, renal function tests, and liver function tests intermittently throughout treatment 1, 3
- Watch for thrombophlebitis at IV injection sites, the most common adverse effect 1
Important Caveats
- Do not mix cefoxitin with aminoglycoside solutions in the same IV line due to potential interaction, though they may be administered separately 2
- Benzyl alcohol-containing diluents should not be used in pediatric patients, particularly neonates and infants up to 3 months of age 2
- Resistance concerns: Bacteroides fragilis group organisms have shown increasing resistance to cefoxitin, limiting its use for anaerobic infections 1