Adult Dosing
Bacterial infections
- 0.75-1.5 g IM/IV q8 hrs x 5-10 days; may increase to 1.5 g IM/IV q6 hrs for life threatening infections
- Max: 9 mg/day
Meningitis, bacterial
- 1.5-3 g IM/IV q8 hrs
- Max: 9 g/day
Disseminated gonococcal infections
Uncomplicated gonococcal infections
- 1.5 g IM x 1 at 2 different sites, given with probenecid 1 g PO x 1
Bone/Joint infections
Skin & skin structure infections/uncomplicated pneumonia/Uncomplicated UTI
- 750 mg IM/IV q8 hrs
- Note: In severe/complicated infections: 1.5 g IM/IV q8 hrs
Pre-operative prophylaxis
- Open-heart surgery: 1.5 g IV q12 hrs x 4; start first dose with anesthesia induction
- Other surgeries: 1.5 g IV 30-60 mins prior to surgery; then 750 mg IM/IV q8 hrs if procedure prolonged
Life threatening infections/Infections due to less susceptible organisms
Orbital cellulitis [Non-FDA Approved]
Epiglottitis [Non-FDA Approved]
Pediatric Dosing
- Note: Safety and effectiveness in pediatric patients <3 months of age have not been established
Bacterial infections
- Child >3 months: 50-100 mg/kg/day IV divided q6-8 hrs
- Note: 100 mg/kg/day should be reserved for more severe or serious infections
- Max: 9 g/day
Meningitis, bacterial
- Child >3 months: 200-240 mg/kg/day IV divided q6-8 hrs
- Max: 9 g/day
Bone/Joint infections
- Child >3 months: 150 mg/kg/day IM/IV divided q8 hrs
- Max: 9 g/day
Orbital cellulitis [Non-FDA Approved]
Epiglottitis [Non-FDA Approved]
- Neonate: 100 mg/kg/day IV/IM divided q12 hrs
- Infant (>3 mo)/child: 150 mg/kg/day IV/IM divided q8 hrs
[Outline]
Renal Dose Adjustment (Based on CrCl)
Adults
- >20 mL/min: 0.75-1.5 g q8 hrs
- 10-20 mL/min: 0.75 g q12 hrs
- <10 mL/min: 0.75 g q24 hrs
- Hemodialysis: Give dose at the end of each dialysis period, no supplement
Child
- Modify dosing consistent with recomendations for adults
Hepatic Dose Adjustment
- Hepatic impairment: Dose adjustments not defined
- Before starting therapy with cefuroxime, establish if patients have had previous hypersensitivity to cefuroxime, other cephalosporins, penicillins or other b-lactams; extreme caution required as cross reactivity among beta-lactam antibiotics is clearly documented and may occur in up to 10% of patients. Discontinue use and institute appropriate therapeutic measures in the event of allergic reaction
- Serious hypersensitivity reactions may require therapy with epinephrine and other emergency measures
- Use only for treating infections proven or strongly suspected to be susceptible to cefuroxime
- Clostridium difficile associated diarrhea which may vary in severity from mild to fatal colitis, has been reported with use of cefuroxime
- Use for prolonged or repeated periods may result in a secondary infection
- Concomitant administration with aminoglycosides is associated with risk of nephrotoxicity
- Risk of hearing impairment in pediatric patients with meningitis treated with this drug
- Monitor serum creatinine/BUN at baseline and periodically during therapy
- Monitor prothrombin time (in patients at risk), renal function
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Concurrent diuretics
- Concurrent nephrotoxic agents
- Hypersensitivity to penicillins
- Patients on anticoagulant therapy
- Hx. of GI disease esp colitis
- Seizure disorder
- Malnutrition
Pregnancy Category:B
Breastfeeding: Limited information indicates that maternal doses of cefuroxime (IV) up to 2.25 g/day produce low levels in milk which would not be expected to adversely affect the breastfed infant. This drug is compatible and considered safe with breastfeeding based upon LactMed database http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 1 October 2010). Manufacturer advises caution.
