Cefotetan Disodium and Sodium Chloride Irrigation

• Generic Name: cefotetan
• Dosage Forms: n.a.
• Other Brand Names: Cefotan

Treatment of bone and joint infections caused by Staphylococcus aureus.

Gynecologic Infections

Treatment of gynecologic infections caused by susceptible S. aureus (including penicillinase-producing strains), S. epidermidis, Streptococcus agalactiae (group B streptococci), other streptococci (except enterococci), Escherichia coli, Neisseria gonorrhoeae, Proteus mirabilis, Bacteroides (except B. distasonis, B. ovatus, B. thetaiotaomicron), Fusobacterium, and gram-positive anaerobic cocci (including Peptococcus and Peptostreptococcus).

Treatment of pelvic inflammatory disease (PID). Cefotetan (or cefoxitin) in conjunction with doxycycline considered a regimen of choice by CDC and others when a parenteral regimen indicated for treatment of PID. Because cefotetan (like cephalosporins) is not active against Chlamydia, concomitant use of a drug active against Chlamydia (e.g., doxycycline) is necessary when these organisms are suspected pathogens.

Intra-abdominal Infections

Treatment of intra-abdominal infections caused by susceptible Streptococcus (except enterococci), E. coli, Klebsiella (including K. pneumoniae), Bacteroides (except B. distasonis, B. ovatus, B. thetaiotaomicron), or Clostridium.

May be effective for treatment of mild to moderate infections caused by B. fragilis, but other anti-infectives (e.g., metronidazole, clindamycin) preferred, especially for severe or life-threatening infections.

IDSA states cefotetan not recommended for empiric treatment of intra-abdominal infections because of increasing prevalence of B. fragilis resistant to the drug.

Respiratory Tract Infections

Treatment of lower respiratory tract infections caused by susceptible S. pneumoniae, S. aureus (including penicillinase-producing strains), Haemophilus influenzae (including ampicillin-resistant strains), E. coli, Klebsiella (including K. pneumoniae), P. mirabilis, or Serratia marcescens.

Skin and Skin Structure Infections

Treatment of skin and skin structure infections caused by susceptible S. aureus (including penicillinase-producing strains), S. epidermidis, S. pyogenes (group A β-hemolytic streptococci), other streptococci (except enterococci), E. coli, K. pneumoniae, Peptococcus niger, or Peptostreptococcus.

Urinary Tract Infections (UTIs)

Treatment of UTIs caused by susceptible E. coli, Klebsiella (including K. pneumoniae), P. mirabilis, P. vulgaris, Providencia rettgeri, or Morganella morganii.

Should not be used alone for UTIs if Pseudomonas aeruginosa is a possible pathogen since most strains are resistant.

Perioperative Prophylaxis

Perioperative prophylaxis in women undergoing hysterectomy or cesarean section. Cefazolin, cefotetan, cefoxitin, or ampicillin and sulbactam usually recommended for women undergoing vaginal, abdominal, or laparoscopic hysterectomy; cefazolin usually recommended for women undergoing cesarean section.

Perioperative prophylaxis in patients undergoing colorectal or other GI surgery. Cefoxitin, cefotetan, cefazolin (in conjunction with metronidazole), ampicillin and sulbactam, or ertapenem usually recommended. Many clinicians recommend using both a parenteral and oral regimen (i.e., neomycin in conjunction with erythromycin or metronidazole and mechanical bowel preparation) for perioperative prophylaxis in patients undergoing colorectal surgery.

Perioperative prophylaxis in patients undergoing uncomplicated (nonperforated) appendectomy. Cefoxitin, cefotetan, or cefazolin (in conjunction with metronidazole) usually recommended for patients undergoing appendectomy.

Perioperative prophylaxis in patients undergoing biliary tract surgery. Cefazolin usually recommended for high-risk patients undergoing open biliary tract surgery; alternatives include cefotetan, cefoxitin, or ampicillin and sulbactam. Prophylaxis not considered necessary for low-risk patients undergoing elective laparoscopic cholecystectomy.

Has been used for perioperative prophylaxis in patients undergoing transurethral surgery; not usually recommended for urinary tract surgery.

• Generic Name: sodium chloride
• Dosage Forms: irrigation
• Other Brand Names:

  BD PosiFlush SF, Normal Saline flush, Swabflush, Syrex, Thermoject, Tip-Lok Diluent, Hyper-Sal, Nebusal, Sodium chloride, Inhalation, HyperSal, Nebusal, PulmoSal, Altachlore, Muro 128, Sochlor, Adsorbonac, AK-NaCl

Maintenance or replacement of sodium chloride and water for hydration.

Prevention of muscle cramps and heat prostration secondary to fluid loss from excessive perspiration during exposure to high temperatures.

Prevention or treatment of deficiencies of sodium and chloride ions (e.g., caused by excessive diuresis or excessive salt restriction).

Extracellular fluid replacement (isotonic [0.9%] sodium chloride injection).

Management of metabolic alkalosis in the presence of fluid loss and mild sodium depletion (0.9% sodium chloride injection).

Management of severe sodium chloride depletion (e.g., presence of heart failure, renal impairment, during surgery, postoperatively) when rapid electrolyte restoration is essential (hypertonic [3 or 5%] sodium chloride injection).

Management of hyponatremia and hypochloremia resulting from administration of sodium-free fluids during fluid and electrolyte therapy (3 or 5% sodium chloride injection).

Management of extreme dilution of extracellular fluid following excessive water intake (e.g., resulting from multiple enemas or perfusion of irrigating solutions into open venous sinuses during transurethral prostatic resections) (3 or 5% sodium chloride injection).

Emergency treatment of severe sodium chloride depletion resulting from excessive sweating, vomiting, diarrhea, and other conditions (3 or 5% sodium chloride injection).

In general, isotonic sodium chloride solutions are used for parenteral replacement of chloride losses equal to or exceeding sodium losses; hypotonic sodium chloride solutions are used for parenteral maintenance of hydration requirements when only small quantities of salt are desired; hypertonic sodium chloride solutions are used for repletion in severe salt depletion syndrome.

Management of hyperosmolar diabetes (hypotonic [0.45%] sodium chloride injection).

Assessment of renal function status (0.45% sodium chloride injection).

Priming fluid for hemodialysis procedures (0.9% sodium chloride injection).

Initiate and terminate blood transfusions without hemolyzing RBCs (0.9% isotonic sodium chloride injection).

Pharmaceutical aid, diluent, and delivery system for the infusion of compatible drug additives.

Measurement of cardiac output by the thermodilution method (0.9% sodium chloride injection as Thermoject system).

Inhalation via nebulization, dilution of compatible drugs for nebulization, and tracheal lavage and irrigation (0.9% sodium chloride inhalation solution).

An inhalation for cystic fibrosis patients to produce a sustained acceleration of mucus clearance and improve lung function (7% sodium chloride solution).