Cefoxitin: Difference between revisions

{{Short description|Chemical compound}}

{{cs1 config|name-list-style=vanc}}

{{Drugbox

| Verifiedfields = changed

| Watchedfields = changed

| verifiedrevid = 401948921

| image = Cefoxitin.svg

<!--Clinical data-->

| tradename = Mefoxin, Renoxitin, others<ref>{{cite web | title=Cefoxitin International | website=Drugs.com | date=2 November 2020 | url=https://www.drugs.com/international/cefoxitin.html | access-date=8 November 2020}}</ref>

| Drugs.com = {{drugs.com|monograph|cefoxitin-sodium}}

| MedlinePlus = a682737

| DailyMedID = Cefoxitin

| pregnancy_AU = B1

| pregnancy_US = N

| pregnancy_category =

| routes_of_administration = [[Intravenous]]

| ATC_prefix = J01

| ATC_suffix = DC01

| legal_AU = S4

| legal_CA = <!-- / Schedule I, II, III, IV, V, VI, VII, VIII -->

| legal_UK = POM

| legal_US = Rx-only

| legal_US_comment = <ref name="Cefoxitin FDA label" />

| legal_status =

<!--Pharmacokinetic data-->

| bioavailability =

| protein_bound =

| metabolism = minimal

| elimination_half-life = 41-59 min

| excretion = 85% urine

<!--Identifiers-->

| index2_label = as salt

| CAS_number_Ref = {{cascite|correct|??}}

| CAS_number = 35607-66-0

| PubChem = 441199

| DrugBank_Ref = {{drugbankcite|changed|drugbank}}

| DrugBank = DB01331

| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}

| KEGG_Ref = {{keggcite|changed|kegg}}

| KEGG = D02345

| KEGG2_Ref = {{keggcite|changed|kegg}}

| KEGG2 = D00913

| ChEBI_Ref = {{ebicite|changed|EBI}}

| ChEBI = 209807

| ChEMBL_Ref = {{ebicite|changed|EBI}}

| ChEMBL = 996

<!--Chemical data-->

| IUPAC_name = (6''R'',7''S'')-3-(carbamoyloxymethyl)-7-methoxy-<br />8-oxo-7-[(2-thiophen-2-ylacetyl)amino]-5-thia-<br />1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid

| C=16 | H=17 | N=3 | O=7 | S=2

| StdInChI_Ref = {{stdinchicite|correct|chemspider}}

| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}

| melting_point = 149

| melting_high = 150

| melting_notes = (dec.)

'''Cefoxitin''' is a second-generation [[cephamycin]] [[antibiotic]] developed by [[Merck & Co.]], Inc. from Cephamycin C in the year following its discovery, 1972. It was synthesized in order to create an antibiotic with a broader spectrum.<ref>{{cite journal | vauthors = Gootz TD | title = Discovery and development of new antimicrobial agents | journal = Clinical Microbiology Reviews | volume = 3 | issue = 1 | pages = 13–31 | date = January 1990 | pmid = 2404566 | pmc = 358138 | doi = 10.1128/cmr.3.1.13 }}</ref> It is often grouped with the second-generation [[cephalosporin]]s.<ref>{{Cite book|url=https://books.google.com/books?id=5Fv0BwAAQBAJ&q=cefoxitin&pg=PA47|title=The Antibiotic Paradox: How Miracle Drugs Are Destroying the Miracle| vauthors = Levy SB |date=2013-11-11|publisher=Springer|isbn=978-1-4899-6042-9|language=en}}</ref> Cefoxitin requires a prescription and as of 2010 is sold under the brand name '''Mefoxin''' by Bioniche Pharma, LLC. The [[generic drug|generic version]] of cefoxitin is known as cefoxitin sodium.<ref>{{Cite web|url=https://www.accessdata.fda.gov/scripts/cder/ob/results_product.cfm?Appl_Type=A&Appl_No=065238|title=Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations|website=www.accessdata.fda.gov|access-date=2017-05-04}}</ref><ref>{{Cite web|url=https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2011/050517s050ltr.pdf|title=Supplement Approval|website=Food and Drug Administration|publisher=Department of Health and Human Services}}</ref>

== History and discovery ==

Groups of researchers at Merck and Lilly discovered Cephamycin C while looking at penicillin-producing bacteria. This followed their discovery of erythromycin, another antibiotic.<ref name="Dougherty_2011">{{Cite book|url=https://books.google.com/books?id=E6Dv5XsXU-IC&q=lilly&pg=PA47|title=Antibiotic Discovery and Development | vauthors = Dougherty TJ, Pucci MJ |date=2011-12-21|publisher=Springer Science & Business Media|isbn=978-1-4614-1399-8|language=en}}</ref> Cephamycin C was the first [[cephem]] discovered but while it was highly resistant to several beta-lactamases, as is its derivative cefoxitin, it was almost only effective against Gram negative bacteria.<ref name="Dougherty_2011"/> The scientists used chemically modified the compound to give cefoxitin, so titled due to its semi-synthetic nature. This new modification broadened its spectrum to include Gram positive bacteria. More than 300 modifications were made to it and tested on the cephalosporin base with methoxy groups at the 7-alpha position. Yet only cefoxitin retained its previous effectiveness against Gram negative bacteria, developed effectiveness against Gram positive bacteria, and resisted breakdown by beta-lactamase.<ref>{{Cite book|url=https://books.google.com/books?id=Cb6BOkj9fK4C&q=how+was+cefoxitin+discovered&pg=PA328|title=Drug Discovery: A History| vauthors = Sneader W |date=2005-06-23|publisher=John Wiley & Sons|isbn=978-0-471-89979-2|language=en}}</ref>

Cefoxitin, and the cephamycin family as a whole, served as a branching point and impulsed the discovery of more classes of beta-lactams. This is in part due to their primary and early discovery in the broths studied.<ref name="Dougherty_2011"/>

== Mechanism ==

Cefoxitin is a beta-lactam antibiotic which binds to penicillin binding proteins, or transpeptidases. By binding to PBPs, cefoxitin prevents the PBPs from forming the cross-linkages between the peptidoglycan layers that make up the bacterial cell wall, thereby interfering with cell wall synthesis. It is a strong [[beta-lactamase]] inducer, as are certain other antibiotics (such as [[imipenem]]). However, cefoxitin is a better substrate than imipenem for beta-lactamases.<ref>{{cite journal | vauthors = Phillips I, Shannon K | title = Importance of beta-lactamase induction | journal = European Journal of Clinical Microbiology & Infectious Diseases | volume = 12 | issue = Suppl 1 | pages = S19-26 | year = 1993 | pmid = 8477758 | doi = 10.1007/bf02389873 | s2cid = 22945967 }}</ref>

== Microbiological resistance ==

In the presence of cefoxitin, bacteria that make beta-lactamases will increase their production and secretion to cleave the beta lactam ring. As a cephamycin, cefoxitin is highly resistant to hydrolysis by some beta-lactamases, in part due to the presence of the 7-alpha-methoxy functional group (see skeletal formula above).<ref name="Moellering_1974">{{cite journal | vauthors = Moellering RC, Dray M, Kunz LJ | title = Susceptibility of clinical isolates of bacteria to cefoxitin and cephalothin | journal = Antimicrobial Agents and Chemotherapy | volume = 6 | issue = 3 | pages = 320–3 | date = September 1974 | pmid = 15830480 | pmc = 444644 | doi = 10.1128/aac.6.3.320 }}</ref><ref>{{cite journal | vauthors = Shaikh S, Fatima J, Shakil S, Rizvi SM, Kamal MA | title = Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment | journal = Saudi Journal of Biological Sciences | volume = 22 | issue = 1 | pages = 90–101 | date = January 2015 | pmid = 25561890 | pmc = 4281622 | doi = 10.1016/j.sjbs.2014.08.002 | series = Special issue: Biological Aspects of Global Health Issues }}</ref><ref>{{cite journal | vauthors = Onishi HR, Daoust DR, Zimmerman SB, Hendlin D, Stapley EO | title = Cefoxitin, a semisynthetic cephamycin antibiotic: resistance to beta-lactamase inactivation | journal = Antimicrobial Agents and Chemotherapy | volume = 5 | issue = 1 | pages = 38–48 | date = January 1974 | pmid = 4599124 | pmc = 428916 | doi = 10.1128/aac.5.1.38 }}</ref><ref>{{cite journal | vauthors = Fonzé E, Vanhove M, Dive G, Sauvage E, Frère JM, Charlier P | title = Crystal structures of the Bacillus licheniformis BS3 class A beta-lactamase and of the acyl-enzyme adduct formed with cefoxitin | journal = Biochemistry | volume = 41 | issue = 6 | pages = 1877–85 | date = February 2002 | pmid = 11827533 | doi = 10.1021/bi015789k | hdl = 2268/19928 | url = https://orbi.uliege.be/bitstream/2268/19928/1/biochemistry_2002_41_1877.pdf }}</ref>

Another more efficient form of resistance to cefoxitin is provided by the [[MecA (gene)|mecA]] gene in bacteria. This gene codes for an alternative penicillin binding protein, PBP2a. This PBP has a lower binding affinity for penicillin-based antibiotics such as cefoxitin and will continue to cross-link the peptidoglycan layers of the cell wall even in the presence of the beta-lactam antibiotics. [[Methicillin-resistant Staphylococcus aureus|MRSA]], or methicillin-resistant ''Staphylococcus aureus'' is a strain that has acquired resistance to cefoxitin via this gene.<ref>{{cite journal | vauthors = Paterson GK, Harrison EM, Holmes MA | title = The emergence of mecC methicillin-resistant Staphylococcus aureus | journal = Trends in Microbiology | volume = 22 | issue = 1 | pages = 42–7 | date = January 2014 | pmid = 24331435 | pmc = 3989053 | doi = 10.1016/j.tim.2013.11.003 }}</ref> For the purposes of detecting bacterial strains with the mecC gene, which like mecA codes for a different PBP, cefoxitin is more reliable than oxacillin because mecC does not correlate as strongly with oxacillin resistance.<ref>{{cite journal | vauthors = Skov R, Larsen AR, Kearns A, Holmes M, Teale C, Edwards G, Hill R | title = Phenotypic detection of mecC-MRSA: cefoxitin is more reliable than oxacillin | journal = The Journal of Antimicrobial Chemotherapy | volume = 69 | issue = 1 | pages = 133–5 | date = January 2014 | pmid = 24038776 | doi = 10.1093/jac/dkt341 | doi-access = free }}</ref>

== Spectrum of bacterial susceptibility ==

Cefoxitin's spectrum of ''in vitro'' antimicrobial activity includes a broad range of [[gram-negative]] and [[gram-positive]] [[bacteria]], including [[anaerobe]]s. It is inactive against most strains of ''[[Pseudomonas aeruginosa]]'' and many strains of ''[[Enterobacter cloacae]]''. [[Staphylococci]] that are resistant to [[methicillin]] and [[oxacillin]] should also be considered clinically resistant to cefoxitin even if they test susceptible by ''in vitro'' methods.<ref name="Cefoxitin FDA label">{{cite web | title=Cefoxitin- cefoxitin sodium powder, for solution | website=DailyMed | date=10 June 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=d02170ff-65aa-48b8-a922-94271c46ffa7 | access-date=8 November 2020}}</ref>

Major bacterial strains susceptible to cefoxitin include:<ref name="Moellering_1974"/>

* [[methicillin]]-susceptible ''[[Staphylococcus aureus]]''

* ''[[Streptococcus]]'' sp.

* ''[[Escherichia coli|E. coli]]''

* [[Salmonella|''Salmonella'' sp.]]

* ''[[Proteus vulgaris]]''

* ''[[Flavobacterium]]'' sp.

* ''[[Klebsiella]]'' sp.

Major bacteria resistant to cefoxitin include:<ref name="Moellering_1974" />

* methicillin-resistant ''Staphylococcus aureus''

* [[Enterococcus|Enterococci]]

* ''[[Listeria monocytogenes]]''

* ''[[Enterobacter]]'' sp.

* ''[[Bacteroides]]'' sp.

== Replacement and substitution ==

In a 2005 study, Fernandes et al. determined that cefoxitin serves as an appropriate replacement for methicillin in determining if some bacteria display methicillin resistance.<ref>{{cite journal | vauthors = Fernandes CJ, Fernandes LA, Collignon P | title = Cefoxitin resistance as a surrogate marker for the detection of methicillin-resistant Staphylococcus aureus | journal = The Journal of Antimicrobial Chemotherapy | volume = 55 | issue = 4 | pages = 506–10 | date = April 2005 | pmid = 15743899 | doi = 10.1093/jac/dki052 | doi-access = free }}</ref> Likewise, Funsun et al. found in a 2009 study that cefoxitin disk assays correctly identified all 60 mecA-positive ''Staphylococcus aureus'', or&nbsp;MRSA&nbsp;isolates, to be resistant to cefoxitin.<ref>{{cite journal | vauthors = Akcam FZ, Tinaz GB, Kaya O, Tigli A, Ture E, Hosoglu S | title = Evaluation of methicillin resistance by cefoxitin disk diffusion and PBP2a latex agglutination test in mecA-positive Staphylococcus aureus, and comparison of mecA with femA, femB, femX positivities | journal = Microbiological Research | volume = 164 | issue = 4 | pages = 400–3 | date = 2009-01-01 | pmid = 17481872 | doi = 10.1016/j.micres.2007.02.012 | doi-access = }}</ref>

Due, in part, to the unavailability of [[methicillin]] in the United States, cefoxitin has replaced methicillin for [[Agar diffusion test|disk diffusion]] tests, which determine the sensitivity of a bacterial specimen to a given antibiotic.<ref name="CDC MRSA Lab Tests">{{cite web|title=Laboratory Testing for MRSA|url=https://www.cdc.gov/mrsa/lab/|website=CDC.gov|publisher=CDC|access-date=9 May 2017}}</ref> Cefoxitin also yields more accurate results for disk diffusion tests.<ref name="CDC MRSA Lab Tests" /> Interpretive criteria for determining susceptibility to cefoxitin via&nbsp;disk diffusion are greater than or equal to 22mm resulting in a "susceptible" result for ''Staphylococcus aureus'' and greater than or equal to 25mm for coagulase-negative staphylococci to be considered susceptible.<ref name="CDC MRSA Lab Tests" />

The following are susceptibility data for several medically significant microorganisms, measured by minimum inhibitory concentration, which is an alternative, liquid medium test for susceptibility.

* ''Escherichia coli'': 0.2 μg/ml – 64 μg/ml{{cn|date=March 2023}}

* ''Haemophilus influenzae'': 0.5 μg/ml – 12.5 μg/ml{{cn|date=March 2023}}

* ''Streptococcus pneumoniae'': 0.2 μg/ml – 1 μg/ml<ref>{{cite web | title = Cefoxitin Susceptibility and Minimum Concentration (MIC) Data | url = http://www.toku-e.com/Assets/MIC/Cefoxitin.pdf | work = Toku-e }}</ref>

== Uses in medicine ==

Cefoxitin is sold in three major IV doses, 1g, 2g, and 10g.<ref>{{Cite web|url=http://www.catalog.md/drugs/mefoxin.html|title=Mefoxin Drug Information, Indications & Other Medicaments|website=www.catalog.md|access-date=2017-04-28}}</ref> It is usually given to adults every six to eight hours in 1g or 2g doses.<ref name="Cunha">{{Cite news|url=http://www.rxlist.com/mefoxin-side-effects-drug-center.htm|title=Common Side Effects of Mefoxin (Cefoxitin) Drug Center - RxList| vauthors = Cunha J |work=RxList|access-date=2017-05-02|language=en}}</ref> Cefoxitin may interfere with tests detecting urine glucose and result in a false positive.<ref name="edudrugs.com">{{Cite web|url=https://edudrugs.com/M/Mefoxin.html|title=Mefoxin tablet :: Generic, Side effects, Interchangeable drugs, etc..|website=edudrugs.com|language=en|access-date=2017-04-28}}</ref> As with any antibiotic, it should not be given to patients who are allergic to it.<ref name="edudrugs.com" />

Cefoxitin is used to treat:<ref>{{Cite web|url=https://edudrugs.com/M/Mefoxin/more.html#inter|title=Mefoxin Indication, Action of Mefoxin, Interactions..|website=edudrugs.com|language=en|access-date=2017-04-28}}</ref><ref>{{Cite web|url=http://www.marzanpharma.com/medicine_post/mefoxitin/|title=Cefoxitin Mefoxitin 1g|website=Marzan Pharma Corporation|access-date=2017-04-28}}{{Dead link|date=November 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref><ref>{{Cite web|url=http://www.ndrugs.com/?s=mefoxin|title=Méfoxin generic. Price of méfoxin. Uses, Indications and Description|website=ndrugs|access-date=2017-04-28}}</ref><ref name="PubMed Health_2017" />

* Skin infections, primarily due to ''Staphylococcus''

* Urinary tract infections

* Bronchitis

* Tonsillitis

* Ear infections

* Bacterial pneumonia

* Sepsis

* Bone and joint infections

* Abdominal infections and abscesses

* Perineum injuries

* Pelvic inflammatory disease

* Gonorrhea

* Infections caused by susceptible bacteria mentioned earlier

Cefoxitin has many other uses; it may be given prior to surgery to prevent the development of surgical wound infections,<ref>{{cite journal | vauthors = Bratzler DW, Houck PM | title = Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project | journal = American Journal of Surgery | volume = 189 | issue = 4 | pages = 395–404 | date = April 2005 | pmid = 15820449 | doi = 10.1016/j.amjsurg.2005.01.015 | s2cid = 6496587 }}</ref> and when used in third and fourth degree perineal injuries in women after giving vaginal birth, cefoxitin decreases infection rate at two and six weeks.<ref>{{cite journal | vauthors = Buppasiri P, Lumbiganon P, Thinkhamrop J, Thinkhamrop B | title = Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth | journal = The Cochrane Database of Systematic Reviews | issue = 10 | pages = CD005125 | date = October 2014 | volume = 2014 | pmid = 25289960 | doi = 10.1002/14651858.CD005125.pub4 | url = https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013267/ | pmc = 10542915 }}</ref> However, the earlier and more times a child is exposed to cefoxitin, as with early and multiple exposure to many antibiotics, the greater the likelihood of developing inflammatory bowel disease later in life. This may be due in part to a decreased variety of microorganisms in the digestive system.<ref>{{cite journal | vauthors = Kronman MP, Zaoutis TE, Haynes K, Feng R, Coffin SE | title = Antibiotic exposure and IBD development among children: a population-based cohort study | journal = Pediatrics | volume = 130 | issue = 4 | pages = e794-803 | date = October 2012 | pmid = 23008454 | pmc = 4074626 | doi = 10.1542/peds.2011-3886 }}</ref>

It is also used to treat pelvic inflammatory disease, because it is a broad spectrum antibiotic. For outpatient treatment, oral antibiotics or those with less frequent dosing may be prescribed.<ref>{{Cite book|title=Sexually transmitted diseases :treatment guidelines. |publisher=U.S. Department of Health and Human Services|location=Atlanta, GA|hdl = 2027/uiug.30112023431809}}</ref> As an effective alternative to [[penicillin]] and [[spectinomycin]], and replacement for methicillin, cefoxitin is used to treat gonorrhea in both men and women with few side effects.<ref name="Atlanta, Ga._1985" />

== Side effects ==

Side effects for cefoxitin are regarded as [[Adverse effect|mild]].<ref name="Atlanta, Ga._1985">{{Cite book|title=Survey of research on sexually transmitted diseases /|date=1985-01-01|publisher=Atlanta, Ga.|hdl = 2027/umn.31951000325661b}}</ref> Common side effects include:

* local tenderness or pain at the site of injection

* skin color change, mild diarrhea

* mild nausea

* headache

* loss of appetite

* vaginal discharge and itching

* swelling of feet or legs.<ref>{{Cite web|url=http://www.ndrugs.com/?s=mefoxin&t=side%20effects|title=Méfoxin Side effects, Contraindications|website=ndrugs|access-date=2017-05-02}}</ref><ref name="PubMed Health_2017">{{Cite web|url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009506/?report=details|title=Cefoxitin (By injection) - National Library of Medicine | work = PubMed Health|date= 1 April 2017 |publisher=U.S. National Library of Medicine|access-date=2017-04-28}}</ref><ref name="Cunha"/>

While cefoxitin has not been associated with alcohol incompatibility like other members of the second generation cephalosporins class, it has been with a higher risk of [[coagulopathy]], a bleeding disorder.<ref name="Dougherty_2011"/>

This is not a comprehensive list and not intended to provide medical advice. If any of the previous side effects are severe, or if an allergic reaction takes place immediately contact your doctor.

== Notable drug interactions ==

=== Contraindications ===

A contraindication means that the drug in question should not be used under particular circumstances. For cefoxitin, this includes patients who are hypersensitive to cephalosporin antibiotics.<ref>{{Cite news|url=http://www.rxlist.com/mefoxin-drug/overdosage-contraindications.htm|title=Mefoxin (Cefoxitin) Drug Information: Overdosage and Contraindications - Prescribing Information at RxList|work=RxList|access-date=2017-05-29|language=en}}</ref><ref>{{Cite web|url=http://www.druglib.com/druginfo/mefoxin/interactions_overdosage_contraindications/|title=Mefoxin (Cefoxitin) - Drug Interactions, Contraindications, Other Rx Info|website=www.druglib.com|language=en-US|access-date=2017-05-29}}</ref>

Patients with colitis, kidney disease, or liver disease are also advised not to take cefoxitin.<ref>{{Cite news|url=http://www.webmd.com/drugs/2/drug-18352-799/cefoxitin-vial/details/list-contraindications|title=Contraindications for Cefoxitin Vial|work=WebMD|access-date=2017-05-29|language=en-US}}</ref> However, some drug databases will considers the diseases means for caution rather than contraindications.<ref>{{Cite web|url=https://online.epocrates.com/u/1031574/cefoxitin/Contraindications+Cautions|title=cefoxitin Contraindications and Cautions - Epocrates Online|website=online.epocrates.com|access-date=2017-05-29}}</ref>

=== Major or Severe ===

Aside from the above-mentioned contraindications and diseases which require monitoring by a doctor, the live cholera and live typhoid vaccines are known to have a severe interaction with cefoxitin.<ref>{{Cite news|url=https://www.drugs.com/drug-interactions/cefoxitin-index.html?filter=3&generic_only=|title=Cefoxitin Drug Interactions |work=Drugs.com|access-date=2017-05-29|language=en-US}}</ref><ref name="WebMD">{{Cite news|url=http://www.webmd.com/drugs/2/drug-18352-799/cefoxitin-vial/details/list-interaction-medication|title=Cefoxitin Vial Interactions with Other Medication|work=WebMD|access-date=2017-05-29|language=en-US}}</ref>

Individuals on a low sodium diet, undergoing dialysis, or who have experienced seizures, particularly following antibiotic therapy, should also consult their physician prior to taking cefoxitin.<ref>{{Cite news|url=https://www.drugs.com/drug-interactions/cefoxitin.html|title=Cefoxitin Drug Interactions |work=Drugs.com|access-date=2017-05-29|language=en-US}}</ref>

=== Moderate ===

Only take additional antibiotics, anticoagulants and blood thinners under doctor supervision.<ref name="WebMD" /> Cefoxitin may decrease the effectiveness of hormonal birth control. This increases the risk for pregnancy and a medical consult will help determine whether backup birth control methods should be used.<ref>{{cite web |url=https://www.drugs.com/drug-interactions/camrese-with-cefoxitin-1042-15400-551-0.html |title=Camrese and cefoxitin Drug Interactions |work=Drugs.com |access-date=2017-05-29 }}</ref>

=== Minor ===

Minor drug interactions do not usually require a change in treatment. Your doctor may monitor specific events, such as bleeding, while taking cefoxitin. Two such minor interactions occur between cefoxitin and heparin<ref>{{Cite news|url=https://www.drugs.com/drug-interactions/cefoxitin-with-heparin-551-0-1235-0.html?consumer=1|title=Cefoxitin and heparin Drug Interactions |work=Drugs.com|access-date=2017-05-29|language=en-US}}</ref> as well as genistein.<ref>{{Cite news|url=https://www.drugs.com/drug-interactions/cefoxitin-with-cholecalciferol-genistein-zinc-chelazome-551-0-2854-0.html|title=Cefoxitin and cholecalciferol / genistein / zinc chelazome Drug Interactions |work=Drugs.com|access-date=2017-05-29|language=en-US}}</ref>

== Pharmacodynamic and pharmacokinetic data ==

[[Pharmacokinetics|Pharmocokinetic]] and [[Pharmacodynamics|pharmacodynamic]] data for cefoxitin are, as of 2013, considered limited and outdated. A few relatively recent studies have attempted to remedy that.

One such study was by the Hôpitaux de Paris in collaboration with the French Ministry of Health.<ref name="ICH GCP - Clinical Trials Registry">{{Cite web|url=http://ichgcp.net/clinical-trials-registry/NCT01820793|title=Efficacy and Pharmacokinetic/Pharmacodynamic Parameters of Cefoxitin in Women With Acute Pyelonephritis Without Severity Symptoms Due to Extended-spectrum β-lactamase Producing Escherichia Coli. | work = ICH GCP - Clinical Trials Registry |access-date=2017-05-29}}</ref> However, while the clinical trials were completed in 2015, no study data have been published.<ref>{{ClinicalTrialsGov|NCT01820793|Efficacy and Pharmacokinetic/Pharmacodynamic Parameters of Cefoxitin in Women With Acute Pyelonephritis Without Severity Symptoms Due to Extended-spectrum β-lactamase Producing Escherichia Coli}}</ref> The expected results from using cefoxitin over carbapenems, another type of antibiotic with a wider bacterial spectrum, included effective treatment of ''E. coli'' produce extended spectrum [[beta-lactamase]], less selective pressure on the GI tract which better maintains balanced flora, and a lower treatment cost.<ref name="ICH GCP - Clinical Trials Registry" />

This followed a 2012 French study on the same E. coli strain with CTX-M-15 extended release beta-lactamase.<ref name="Lepeule_2012">{{cite journal | vauthors = Lepeule R, Ruppé E, Le P, Massias L, Chau F, Nucci A, Lefort A, Fantin B | display-authors = 6 | title = Cefoxitin as an alternative to carbapenems in a murine model of urinary tract infection due to Escherichia coli harboring CTX-M-15-type extended-spectrum β-lactamase | journal = Antimicrobial Agents and Chemotherapy | volume = 56 | issue = 3 | pages = 1376–81 | date = March 2012 | pmid = 22214774 | pmc = 3294923 | doi = 10.1128/AAC.06233-11 }}</ref> Lepeule et al. determined that in mice, the ideal pharmacodynamic target of fT>MIC=33%, where MIC is the minimum inhibitory concentration, was obtained with 200&nbsp;mg/kg every four hours.<ref name="Lepeule_2012" /> The fT>MIC (%) was increased by 11% when the administration frequency was increased from every four hours to every three hours.<ref name="Lepeule_2012" /> This implied that increasing the frequency might yield similar results in humans. The study also found no significant difference between the effectiveness of carbapenems and cefoxitin and suggested that cefoxitin can be used as an alternative treatment for CTX-M producing E. coli to carbapenems such as imipenem and ertapenem.<ref name="Lepeule_2012" />

{{Reflist}}

== External links ==

* {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/rn/35607-66-0 | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Cefoxitin }}

* {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/cefoxitin%20sodium | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Cefoxitin sodium }}

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