Cefotetan
Beta-lactams
Beta-lactams
Injectable second-generation cephamycin that also covers anaerobes such as Bacteroides fragilis; used for surgical prophylaxis and pelvic infections.
Also called: cefotetan disodium
Quick facts
- Group
- Beta-lactams
- Target
- Penicillin-binding proteins (bacterial transpeptidases)
- Used for
- Gynaecological infections · Urinary tract infections
- Key effects
- Diarrhoea and nausea · Pain · Rash and itching
- Monitor
- Prothrombin time · Blood count and signs of haemolysis
- ATC
- J01DC05
No doses: the clinician sets them by the current guideline.
Mechanism of action
No structure of cefotetan bound to a PBP is published; the figure shows cefoxitin, another cephamycin with the same 7-alpha-methoxy group, acylating E. coli PBP5.
Cefotetan acylates the penicillin-binding proteins and stops peptidoglycan cross-linking, so the bacterium lyses. Its 7-alpha-methoxy group (typical of cephamycins) protects it from many beta-lactamases and gives it activity against gut anaerobes such as B. fragilis as well as Enterobacterales.
- The 7-alpha-methoxy group resists many beta-lactamases
- Acylates the PBPs of the bacterial wall
- Peptidoglycan cross-linking stops
- The bacterium lyses (bactericidal)
Indications
- Gynaecological infections, including pelvic inflammatory disease in combination regimens Pelvic inflammatory disease →
- Intra-abdominal infections involving anaerobes Intra-abdominal abscess →
- Urinary tract infections by susceptible bacteria Urinary tract infection (acute cystitis) →
- Skin, soft-tissue, bone, joint and lower respiratory tract infections
- Prophylaxis before clean-contaminated or contaminated surgery (for example colorectal or gynaecological)
Adverse effects
Common
- Diarrhoea and nausea
- Pain, redness or phlebitis at the injection site
- Rash and itching
- Eosinophilia and transient rise in liver enzymes
Contraindications
- Allergy to cephalosporins
- History of cephalosporin-associated haemolytic anaemia
Key interactions
- Alcohol
- Disulfiram-like reaction (flushing, sweating, headache, tachycardia) during treatment and up to 72 hours after the last dose.
- Aminoglycosides
- Nephrotoxicity may increase; kidney function is watched and the two are not mixed in the same solution.
- Copper-reduction urine glucose tests
- False positives; enzymatic (glucose oxidase) methods are used instead.
What is monitored
- Prothrombin time, above all in malnourished people, liver disease or anticoagulation
- Blood count and signs of haemolysis (pallor, dark urine, jaundice)
- Kidney function when combined with an aminoglycoside
Administration and safety
- IV or IM; the powder is reconstituted following the product instructions
- Not mixed in the same solution with aminoglycosides
- Name looks like cefoxitin, cefotaxime and ceftazidime: the label is checked before giving it
Pregnancy and breastfeeding
Animal studies showed no fetal harm, but adequate human studies are lacking; it is used only when clearly needed.
Nursing care
- Ask about penicillin and cephalosporin allergy before the first dose
- Explain that alcohol is avoided during treatment and for three days afterwards
- Watch for bleeding, pallor, dark urine or jaundice
- Watch for watery or bloody diarrhoea, even weeks later
- Warn that it may lower the effect of hormonal contraceptives
Pharmacokinetics
- Absorption
- Not absorbed by mouth; given IV or IM.
- Elimination
- Mainly renal: 51% to 81% leaves unchanged in the urine within 24 hours; removed by haemodialysis.
- Half-life
- 3 to 4.6 hours; longer when kidney function falls.
Test yourself
Think of the answer, then tap the question to see it.
Which chemical group lets cefotetan resist many beta-lactamases and cover B. fragilis?
The 7-alpha-methoxy group of the cephamycins, the same one cefoxitin has.
A patient has flushing, sweating and tachycardia after drinking alcohol two days after cefotetan. What happened?
A disulfiram-like reaction, linked to cefotetan's thiotetrazole group; it can appear up to 72 hours after the dose.
Which clotting test is watched with cefotetan, and why?
The prothrombin time, because cefotetan can cause hypoprothrombinaemia and bleeding, above all with vitamin K deficiency.
Which serious blood reaction is more frequent with cefotetan than with other cephalosporins?
Immune haemolytic anaemia, which can be fatal; a history of it is a contraindication.
Connections
← Back to the class: Beta-lactams
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - CEFOTETAN injection, powder, for solution (DailyMed (U.S. National Library of Medicine), 2026); Cefotetan Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); Structure of penicillin-binding protein 5 from E.coli: cefoxitin acyl-enzyme complex (RCSB Protein Data Bank, 2026).
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Representative model, for educational purposes only.