Cefotetan

Table of contents

  • Brand Names
  • Chemistry
  • Pharmacologic Category
  • Mechanism of Action
  • Therapeutic Use
  • Pregnancy and Lactation Implications
  • Contraindications
  • Warnings and Precautions
  • Adverse Reactions
  • Genes that may be involved
  • Drug Interactions
  • Nutrition/Nutraceutical Interactions
  • Dosage
  • Pharmacokinetics and Pharmacodynamics
  • Special Considerations

Brand Names

North America

USA: Cefotetan.

Asia

Japan: Yamatetan.

Drug combinations

Chemistry

Cefotetan Disodium: C~17~H~15~N~7~Na~2~O~8~S~4~. Mw: 619.58. (1) 5-Thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid, 7-[[[4-(2-amino-1-carboxy-2-oxoethylidene)-1,3-dithietan-2-yl]carbonyl]amino]-7-methoxy-3-[[(1-methyl-1H-tetrazol-5-yl)thio]methyl]-8-oxo-, disodium salt, [6R-(6α,7α)]-; (2)(6R,7S)-7-[4-(Carbamoylcarboxymethylene)-1,3-dithietane-2-carboxamido]-7-methoxy-3-[[(1-methyl-1H-tetrazol-5-yl)thio]methyl]-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid, disodium salt. CAS-74356-00-6 (1983).

Pharmacologic Category

Antibacterials; Second Generation Cephalosporins. Miscellaneous β-Lactams; Cephamycins. (ATC-Code: J01DC05).

Mechanism of action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins, thus inhibiting the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, and so cell wall biosynthesis. Active in vitro and in clinical infections against Gram-positive aerobic bacteria, such as S. aureus (including penicillinase-producing strains), S. epidermidis, S. pneumoniae, S. pyogenes (group A β-hemolytic streptococci), and S. agalactiae (group B streptococci). Oxacillin-resistant staphylococci (methicillin-resistant staphylococci) and most enterococci (e.g. Enterococcus faecalis) are resistant. Active in vitro and in clinical infections against Gram-negative aerobic bacteria such as E. coli, H. influenzae (including ampicillin-resistant strains), Klebsiella (including K. pneumoniae), M. morganii, N. gonorrhoeae, P. mirabilis, P. vulgaris, P. rettgeri, and S. marcescens. Also active in vitro against Citrobacter, K. oxytoca, Moraxella catarrhalis, Salmonella, Shigella, and Yersinia enterocolitica. Many strains of Enterobacter (e.g. E. aerogenes, E. cloacae) and most Ps. aeruginosa and Acinetobacter are resistant. Active in vitro and in clinical infections against anaerobes such as Bacteroides fragilis, B. vulgatus, Provotella bivia, P. disiens, P. melaninogenica, Fusobacterium, Clostridium (except C. difficile), Peptococcus, and Peptostreptococus. Also active in vitro against B. splanchnicus, Prevotella oralis, Propionibacterium, and Veillonella. It is inactive against Chlamydia, fungi, and viruses.

Therapeutic use

Surgical prophylaxis. Intra-abdominal infections and other mixed infections. Respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic infections as well as septicemia.

Pregnancy and lactiation implications

Adverse events have not been observed in animal reproduction studies. Cefotetan crosses the placenta and produces therapeutic concentrations in the amniotic fluid and cord serum. Enters breast milk (small amounts). Non-dose-related effects could include modification of bowel flora.

Unlabeled use

Contraindications

Hypersensitivity to cefotetan, any component of the formulation, or other cephalosporins. Previous cephalosporin-associated hemolytic anemia.

Warnings and precautions

Although it contains the methyltetrazolethiol side chain, bleeding has not been a significant problem. May be associated with increased INR, especially in nutritionally-deficient patients, prolonged treatment, hepatic or renal disease. Has been associated with a higher risk of hemolytic anemia relative to other cephalosporins (approximately threefold). Use with caution in history of penicillin allergy, especially IgE-mediated reactions (e.g. anaphylaxis, angioedema, urticaria). Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea and pseudomembranous colitis. Use with caution in renal impairment. May cause positive direct Coombs’, false-positive urinary glucose test using cupric sulfate, false-positive serum or urine creatinine with Jaffé reaction.

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