Cefotetan
Cefotan
2nd-generation cephalosporin (cephamycin) with anaerobic coverage
β-lactam; adds anaerobic (B. fragilis) coverage → colorectal/gynecologic prophylaxis.
Indications
- •Colorectal + gynecologic surgical prophylaxis
- •Intra-abdominal infection
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Surgical prophylaxis | 2 g IV within 60 min of incision; long half-life → often no intraop redose | — |
Pharmacokinetics
Longer half-life ~3–4.5 h (less frequent redosing).
Side effects
- !DISULFIRAM-LIKE reaction with alcohol (NMTT side-chain)
- !Hypoprothrombinemia/bleeding (NMTT → vitamin K interference)
- !Allergy
Contraindications
- ×Cephalosporin allergy
- ×Recent alcohol (disulfiram reaction)
Clinical pearls
- ★NMTT side-chain → disulfiram-like reaction with alcohol + hypoprothrombinemia (bleeding) — the two board facts.
- ★Anaerobic coverage makes it a colorectal/GYN prophylaxis choice.
Other drugs in Antibiotics
- Cefazolin
β-lactam — inhibits bacterial cell wall PBPs.
- Vancomycin
Inhibits cell wall synthesis (binds D-Ala-D-Ala). Active against MRSA + gram-positives.
- Clindamycin
Binds 50S ribosomal subunit, blocks peptide-bond formation. Bacteriostatic against most organisms; bactericidal against susceptible streptococci. Excellent activity against anaerobes and gram-positive cocci including community-acquired MRSA.
- Gentamicin
Binds 30S ribosomal subunit, causes misreading of mRNA → defective bacterial protein synthesis. Bactericidal, concentration-dependent killing. Synergy with cell-wall agents (β-lactams, vancomycin) for gram-positive endocarditis.
- Cefuroxime
β-lactam — inhibits cell-wall synthesis (PBP binding). 2nd-gen: gram-positive + expanded gram-negative.
- Cefepime
β-lactam cell-wall inhibitor. Broad gram-negative (incl. Pseudomonas) + gram-positive coverage.
- Cefotaxime
β-lactam cell-wall inhibitor. Broad gram-negative + CNS penetration.
- Cefoxitin
β-lactam with anaerobic (B. fragilis) activity → colorectal/GYN prophylaxis.
Browse all classes: /reference/drugs
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
