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Cefotaxime is an injectable third generation cephalosporin used for bacterial meningitis, sepsis, pneumonia and complicated urinary, bone and joint infection.
- Cefotaxime was the first third-generation cephalosporin and is the compound after which the CTX-M family of extended-spectrum beta-lactamases is named, since those enzymes preferentially hydrolyse cefotaxime.
- The 1985 J Pediatr randomised trial showed cefotaxime matched ampicillin plus chloramphenicol for childhood bacterial meningitis while avoiding chloramphenicol's toxicity, changing empirical practice [1].
- The 2007 Cochrane review of 19 trials found no clinically important difference in death or deafness between third-generation cephalosporins and conventional ampicillin-chloramphenicol regimens for acute bacterial meningitis, but fewer treatment failures with the cephalosporins [4].
- Sort's NEJM trial showed that adding intravenous albumin to cefotaxime in spontaneous bacterial peritonitis cut renal impairment from 33% to 10% and in-hospital mortality from 29% to 10%; a landmark that made albumin standard care alongside the antibiotic [3].
- Unlike ceftriaxone, cefotaxime does not displace bilirubin from albumin and does not form insoluble calcium precipitates, so it is the preferred third-generation cephalosporin in neonates, in hyperbilirubinaemia and in patients receiving calcium-containing intravenous fluids.
- Cefotaxime achieves reliable cerebrospinal fluid concentrations when the meninges are inflamed, which is the basis for its meningitis dosing; its active desacetyl metabolite extends the effective activity.
Mechanism
It binds penicillin binding proteins and blocks the transpeptidase cross linking step of peptidoglycan synthesis, so dividing bacteria cannot build a competent cell wall and lyse under their own osmotic pressure. Third generation agents resist most Gram negative beta lactamases and cross into cerebrospinal fluid, which is what made cefotaxime a meningitis drug.
receptor fingerprint
Penicillin-binding protein 3 (PBP3, FtsI) in Gram-negative bacilliCovalent acylation of the active-site serine, irreversibly inhibiting transpeptidase activity
Penicillin-binding protein 2x (PBP2x) in Streptococcus pneumoniaeAcylated and inhibited
Extended-spectrum beta-lactamases of the CTX-M familyHydrolysed by the enzyme (a resistance mechanism, not a drug target)
Penicillin-binding proteins 1a and 1bSecondary acylation targets
Desacetylcefotaxime (active )Deacetylation by hepatic esterases yields a metabolite with independent antibacterial activity
Safetyrisks and cautions, not medical advice
an intravenous or intramuscular third generation cephalosporin for meningitis, sepsis and gonorrhoea; it must be reconstituted and injected, anaphylaxis is a real risk, and the conditions it treats need a hospital rather than a parcel
Subjective profileweighing the evidence above
The refusal here is about the illnesses rather than the molecule. Meningitis and sepsis are conditions where the gap between suspicion and the first antibiotic is measured in minutes, and where cultures, imaging and organ support matter at least as much as the drug; a vial in a cupboard helps nobody. Self administered injectable antibiotics also carry the two failure modes that manufacture resistance, which are the wrong organism and the abandoned course. Anaphylaxis to a cephalosporin needs adrenaline and an airway in the room, which is the last argument against a vial arriving by post.
Resources
No suppliers are provided for compounds like this. This entry is here for reference.
Research
- 1985first citedA prospective randomized comparison of cefotaxime vs ampicillin and chloramphenicol for bacteri…
- 2007meta-analysisThird generation cephalosporins versus conventional antibiotics for treating acute bacterial me…
- 2022most recentTreatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins
- 1.A prospective randomized comparison of cefotaxime vs ampicillin and chloramphenicol for bacterial meningitis in children
- 2.Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis. Meropenem Meningitis Study Group
- 3.Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis
- 4.Third generation cephalosporins versus conventional antibiotics for treating acute bacterial meningitis
- 5.Treatment of enteric fever (typhoid and paratyphoid fever) with cephalosporins
5 listed here; entry last updated August 2026
Reviews
My notesprivate to this device
Notes and cautions
- Cefotaxime carries no boxed warning.
- It is contraindicated in patients with a history of immediate hypersensitivity to cephalosporins, and true cross-reactivity with penicillin allergy is real but much lower than historically taught, being driven largely by shared R1 side chains rather than the beta-lactam ring.
- As a broad-spectrum third-generation cephalosporin it is a high-risk agent for Clostridioides difficile-associated diarrhoea and pseudomembranous colitis, which can present during therapy or up to two months after it ends.
- Granulocytopenia and, rarely, agranulocytosis have been reported with courses longer than about ten days, so blood counts should be monitored in prolonged treatment; interstitial nephritis and, uncommonly, arrhythmias after rapid bolus through a central line have also been described.
- Dose reduction is required in significant renal impairment.
- It avoids the biliary sludging and the fatal neonatal calcium-ceftriaxone precipitation hazard that constrain ceftriaxone, which is precisely why it is preferred in the newborn.