Cefotaxime was the first '
third generation' cephalosporin to be marketed and is administered intramuscularly or intravenously. Similar to other agents of this class, it has a broad spectrum of in vitro activity, particularly against Enterobacteriaceae, including
beta-lactamase-producing strains.
Cefotaxime forms a metabolite,
desacetylcefotaxime, which is antibacterially effective against many bacteria per se and acts additively or synergistically with
cefotaxime against many strains. Since the first review of
cefotaxime in the Journal, further studies have confirmed its value in the treatment of various
infections: complicated
urinary tract infections, lower
respiratory tract infections, bacteraemia,
meningitis, uncomplicated gonorrhoea,
infections of skin and soft tissue and of bone and joints, and obstetric and gynaecological
infections.
Cefotaxime is effective as an empirical treatment of suspected
infection due to susceptible organisms in immunocompromised patients and is of proven efficacy in serious, life-threatening
infections in general.
Cefotaxime reduces the incidence of postsurgical
infection but the role of
third generation cephalosporins in prophylaxis remains to be determined. The indications for which
cefotaxime and other '
third generation' cephalosporins would be considered the most appropriate
therapy remain largely dependent upon such factors as varied as cost, local medical custom, decisions of regulatory agencies and geographical patterns of bacterial resistance.
Cefotaxime nevertheless represents a valuable '
third generation' cephalosporin of great clinical value in certain infectious conditions, in particular those which are serious and life-threatening and where resistance to
therapies is creating a clinical problem.