Cefoxitin Sodium and Inderide

• Generic Name: cefoxitin
• Dosage Forms: n.a.
• Other Brand Names: Mefoxin

Treatment of bone and joint infections caused by susceptible Staphylococcus aureus (including penicillinase-producing strains).

Gynecologic Infections

Treatment of gynecologic infections (including endometritis, pelvic cellulitis, pelvic inflammatory disease [PID]) caused by susceptible Streptococcus agalactiae (group B streptococci), Escherichia coli, Neisseria gonorrhoeae, Bacteroides (including B. fragilis), Clostridium, Peptococcus niger, or Peptostreptococcus.

Cefoxitin (or cefotetan) in conjunction with doxycycline considered a regimen of choice by CDC and others when a parenteral regimen indicated for treatment of PID.

When an oral regimen is used for treatment of mild to moderately severe acute PID, CDC recommends a single IM dose of ceftriaxone, cefoxitin (with oral probenecid), or other parenteral third-generation cephalosporin (e.g., cefotaxime) given in conjunction with a 14-day regimen of oral doxycycline.

Because cefoxitin (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 (including peritonitis and intra-abdominal abscess) caused by susceptible E. coli, Klebsiella, Bacteroides (including B. fragilis), or Clostridium.

Has been effective in mixed aerobic-anaerobic infections. However, cefoxitin may no longer provide reliable coverage against B. fragilis, and metronidazole is recommended by many clinicians to provide coverage against B. fragilis in combination anti-infective regimens used for empiric treatment of intra-abdominal infections.

For initial empiric treatment of mild to moderate community-acquired, extrabiliary, complicated intra-abdominal infections in adults (e.g., perforated or abscessed appendicitis), IDSA recommends either monotherapy with cefoxitin, ertapenem, moxifloxacin, tigecycline, or the fixed combination of ticarcillin and clavulanic acid, or a combination regimen that includes either a cephalosporin (cefazolin, cefotaxime, ceftriaxone, cefuroxime) or fluoroquinolone (ciprofloxacin, levofloxacin) in conjunction with metronidazole.

Respiratory Tract Infections

Treatment of lower respiratory tract infections (including pneumonia and lung abscess) caused by susceptible S. aureus (including penicillinase-producing strains), S. pneumoniae, or other streptococci (except enterococci), Haemophilus influenzae, E. coli, Klebsiella, or Bacteroides.

Septicemia

Treatment of septicemia caused by susceptible S. aureus (including penicillinase-producing strains), S. pneumoniae, E. coli, Klebsiella, or Bacteroides (including B. fragilis).

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), or other streptococci (except enterococci), E. coli, Klebsiella, Proteus mirabilis, Bacteroides (including B. fragilis), Clostridium, P. niger, or Peptostreptococcus.

Urinary Tract Infections (UTIs)

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

Gonorrhea and Associated Infections

Alternative for treatment of uncomplicated cervical, urethral, or rectal gonorrhea caused by susceptible Neisseria gonorrhoeae in adults or adolescents.

Regimen of choice is IM ceftriaxone and either azithromycin or doxycycline. Although IM cefoxitin (with probenecid) may be effective for uncomplicated urogenital and anorectal gonorrhea, CDC states it offers no advantage over IM ceftriaxone for urogenital infections and has uncertain efficacy for pharyngeal gonorrhea.

Mycobacterial Infections

Treatment of infections caused by Mycobacterium abscessus or M. fortuitum; used in conjunction with other antimycobacterial anti-infectives.

For serious skin, soft tissue, and bone infections caused by M. abscessus, ATS and IDSA recommend a multiple-drug regimen of oral clarithromycin (or azithromycin) used in conjunction with parenteral anti-infectives (e.g., amikacin, cefoxitin, imipenem). This multiple-drug regimen also used in treatment of M. abscessus lung disease; however, anti-infectives may help control symptoms and disease progression, but long-term sputum conversion is unlikely. In patients with focal infections and limited lung disease, curative therapy may be possible if surgical resection is used in conjunction with a multiple-drug treatment regimen.

Although optimum regimens not identified for treatment of M. fortuitum infections, ATS and IDSA recommend that pulmonary infections be treated with a regimen consisting of at least 2 anti-infectives selected based on results of in vitro susceptibility testing and tolerability (e.g., amikacin, clarithromycin, cefoxitin, ciprofloxacin or ofloxacin, a sulfonamide, imipenem, doxycycline). In serious skin, bone, and soft tissue infections, ≥4 months of treatment with ≥2 anti-infectives active against the clinical isolate is necessary to provide a high likelihood of cure; 6 months of treatment recommended for bone infections. Surgery usually indicated for extensive disease, abscess formation, or when drug therapy is difficult.

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.

• Generic Name: hydrochlorothiazide / propranolol
• Dosage Forms: Tablets
• Other Brand Names: Inderide, Inderide LA

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Propranolol is a beta-blocker. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

Inderide is a combination medicine used to treat high blood pressure (hypertension).

Inderide may also be used for purposes not listed in this medication guide.