Neonatal Intensive Care UnitChildren's Hospital


Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.



  • cefoxitin is a cephamycin antibiotic which may be useful in the treatment of mixed aerobic-anaerobic infections


  • cefoxitin is a Beta-lactam antibiotic and is related to the cephalosporins and penicillins
  • its spectrum of activity resembles the second generation cephalosporins, ie. less active than first generation cephalosporins (eg. cefazolin) against gram positive organisms, but wider spectrum of activity against strains of Gram-negative bacilli (especially E. coli, Klebsiella and Proteus); cefoxitin is also active against many strains of Bacteroides fragilis
  • cefoxitin is NOT active against Pseudomonas species or methicillin-resistant staphylococci
  • up to 85% of a dose is excreted unchanged in the urine
  • penetrates poorly into the CNS, even in the presence of meningitis

Side Effects

  • local reactions (thrombophlebitis after IV use) are the most frequent type
  • infrequent side effects include hypersensitivity reactions (rash, eosinophilia) nephrotoxicity, GI effects (vomiting, diarrhea) and hematologic effects (transient decrease in WBC count, thrombocytopenia)


  • cefoxitin may cause a false positive direct Coombs' test, a falsely positive result for urine glucose (using cupric sulfate solution) and a falsely elevated serum or urine creatinine (Jaffe method)


  • may be given IM or slow IV infusion

    < 7 days of life:
    > 7 days to 1 month:
    20 to 40 mg/kg q12h
    20 to 40 mg/kg q8h
    1 month to 2 years:20 to 40 mg/kg q6h or q8h


  • 20mg/mL syringe prepared by Pharmacy
  • 1g vial, when reconstituted with 9.5mL sterile water for injection produces a concentration of 100mg/mL, draw up 10mL of 100mg/mL solution and further dilute to a total volume of 50mL with D5W to produce a 20mg/mL solution


  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  3. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  4. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.

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