Review and reassessment of dosing schedules for cefotaxime in selected medical indications.

Cefotaxime, the first widely used "third-generation" cephalosporin, has established efficacy against a variety of serious bacterial pathogens. Some of the initial clinical studies in the United States using this agent employed large doses of the compound, up to 12 g/day, for adults. In contrast, however, initial European studies were largely with low doses of 1 to 2 g every 12 h. In the recent past, however, an effort has been made, both in the United States and in Europe to reevaluate the dosage of cefotaxime. In various clinical studies, lower doses of cefotaxime have been successfully employed for infections of the urinary tract, peritoneum, biliary tract, lung, and skin and soft tissues. The results of a number of these studies will be reviewed, including a large postmarketing surveillance study carried out in Germany during 1992. The results suggest that cefotaxime doses as low as 1 g, at intervals as long as every 12 h, can be adequate for treatment of the most commonly encountered infections, such as those caused by some hemolytic streptococci, Staphylococcus aureus, Haemophilus spp., and enteric bacilli in nonimmunocompromised patients.