So, we are facing yet another drug shortage. This time it is cefotaxime an antibiotic commonly used in the Emergency Department and in inpatient pediatric settings, specifically in the febrile neonate. The FDA has reported shortages for cefotaxime since 2015, and many of you are likely facing limited to no availability.
Alternatives cephalosporins to consider
Ceftazidime
Per the AAP ceftazidime “offers virtually the same coverage for enteric bacilli and is FDA approved for all pediatric age groups, including neonates.” You can therefore use it in place of cefotaxime. The dosing is 50 mg/kg IV/IM; q12h for babies less than 7 days of age and q8h for babies 8-60 days old.
Ceftriaxone
Ceftriaxone is appropriate for infants older than 60 days. It concentrates well in the CSF and is effective for meningitis. Per the AAP it is not appropriate for infants <60days of age for the following reasons;
- Cefriaxone is highly protein bound and can displace bilirubin from serum albumin – theoretically increasing the risk for kernicterus, which is bad
- Reports of sudden death in neonates concurrently receiving calcium because of calcium-ceftriaxone deposition in blood vessels
The dose is 50 mg/kg every 24 hours, IV or IM.
References
Red Book: Tables of Antibacterial Drug Dosages
FDA Drug Shortages: cefotaxime
Bradley, AAP News. Alternative to consider during cefotaxime shortage, 2015.
