Céfoxitine, seconde jeunesse ?

Cefoxitin is a cephamycin antibiotic, often grouped with the second-generation cephalosporins with activity against Gram-negative anaerobes. Replaced in most of its indications by third generation cephalosporins, cefoxitin is not currently used except for chemoprophylaxis in colorectal surgery. No oral bioavailability, short half-life, high protein binding and almost exclusively urinary excretion characterize pharmacokinetics of cefoxitin. Like other cephamycins, it has the great advantage of not being hydrolyzed by extended spectrum β-lactamases (ESBL). At a time of global spread of ESBL-producing Escherichia coli in the community, alternatives to carbapenems are required, and cefoxitin use seems very interesting, especially in urinary tract infections. However, the literature data on the use of cefoxitin in ESBL-producing Gram-negative bacterial infection are very limited. Indications of cefoxitin in the treatment of these infections should be clarified by further studies.