1. 50-100mg/kg/dose (to a maximum of 200 mg/kg/day ⁹ I.V. over 3 to 5 minutes ^{9, 10} , or IM.
2. The higher doses are used in severe sepsis and meningitis.

Postmenstrual Age* (weeks)	Postnatal Age (days)	Dosing Interval (hr)
≤29	0 to 28	12
	>28	8
30 to 36	0 to 14	12
	>14	8
37 to 44	0 to 7	12
	>7	8
≥45	All	6

* PMA at the time of prescribing.

Indications

1. Neonatal meningitis.
2. Empirical therapy in infants with suspected sepsis who have previously received multiple courses of antibiotics.

Contraindications

1. Hypersensitivity to penicillins/cephalosporins.

Precautions

1. Infants with liver, renal or gastrointestinal disease.
2. Use of high doses in those infants receiving aminoglycosides or furosemide ⁴ .

Drug Interactions

• Phenobarbitone = Increase in skin rashes

Clinical Pharmacology

Broad spectrum third generation cephalosporin antibiotic. At therapeutic doses it is active, in vitro, against gram positive organisms such as staphylococci (including penicillinase resistant strains), Streptococcus pyogenes, Streptococcus pneumoniae (Streptococcus faecalis is resistant); and Gram negative organisms such as Enterobacter, Klebsiella, Haemophilus influenza, and E.coli ⁴ . There is only moderate activity against Pseudomonas ⁷ .

Poor oral absorption. Widely distributed at varying concentrations in human body tissues and fluids. Usually penetrates the CSF in levels above the MIC of common sensitive organisms when meninges are inflamed: CSF concentrations are considerably lower than plasma. Cefotaxime is about 40% bound to plasma protein (in adults) ⁷. Metabolised in the liver to an active compound, desacetylcefotaxime. Renal excretion with 20-36% of the drug unchanged in urine. Cefotaxime and metabolites are excreted by haemodialysis ⁷. Elimination half life is prolonged in neonates.

Possible Adverse Effects

1. Venous irritation, soft tissue injury at IV injection site.
2. Pain, soft tissue injury at IM injection site.
3. Rash, pruritus, urticaria.
4. Gastrointestinal disturbance (nausea, diarrhoea); pseudomembranous colitis.
5. Neutropenia, thrombocytopenia, eosinophilia, leucopenia.
6. Positive Coombs test.
7. Transient elevation of hepatic enzymes.
8. Superinfection with non-susceptible organisms including fungi ⁴.

Special Considerations

1. Monitor renal and hepatic function.
2. Reduce dose in suspected renal dysfunction ⁷.
3. Reduce dose in suspected liver dysfunction (only if there is concurrent renal impairment) ⁸.
4. Sodium content  2.1mmol/g of cefotaxime.