cefuroxime

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Similar to that of first-generation cephalosporins but has increased activity against several other gram-negative pathogens including:
- Haemophilus influenzae (including β-lactamase-producing strains),
- Enterobacter,
- Escherichia coli,
- Klebsiella,
- Neisseria gonorrhoeae,
- Neisseria meningitidis,
Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed after oral and IM administration; IV administration results in complete bioavailability.

Distribution: Widely distributed. Penetrates into CSF with IV administration.

Metabolism/Excretion: Excreted primarily unchanged in the urine.

Half-Life: 1–2 hr (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–3 hr	8–12 hr
IM	rapid	15–60 min	6–12 hr
IV	rapid	end of infusion	6–12 hr

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to cephalosporins;
Serious hypersensitivity to penicillins.

Use Cautiously in:

Renal impairment (↑ dosing interval recommended if CCr <30 mL/min);
History of GI disease, especially colitis;
OB: Safety not established in pregnancy;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children 3 mo (safety and effectiveness not established);
Geri: Dose adjustment may be required due to age-related in renal function.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash, diaper dermatitis, urticaria

GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), cramps, diarrhea, nausea, vomiting

Hemat: bleeding, eosinophilia, hemolytic anemia, leukopenia

Local: pain at IM site, phlebitis at IV site

Neuro: SEIZURES (HIGH DOSES)

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS, ANGIOEDEMA, OR MYOCARDIAL ISCHEMIA), superinfection

Interactions ⬆ ⬇

Drug-drug:

Probenecid ↓excretion and ↑ levels.
Aminoglycosides and loop diureticsmay ↑ the risk of nephrotoxicity.

Route/Dosage ⬆ ⬇

PO (Adults and Children >12 yr): Pharyngitis/tonsillitis, maxillary sinusitis, uncomplicated urinary tract infections: 250 mg every 12 hr. Bronchitis, uncomplicated skin/skin structure infections: 250–500 mg every 12 hr. Gonorrhea: 1 g single dose. Lyme disease: 500 mg every 12 hr for 20 days.
PO (Children 3 mo–12 yr): Otitis media, acute bacterial maxillary sinusitis, impetigo: 250 mg every 12 hr.
IM IV (Adults ): Uncomplicated urinary tract infections, skin/skin structure infections, disseminated gonococcal infections, uncomplicated pneumonia: 750 mg every 8 hr. Bone/joint infections, severe or complicated infections: 1.5 g every 8 hr. Life-threatening infections: 1.5 g every 6 hr. Meningitis: 3 g every 8 hr. Perioperative prophylaxis: 1.5 g IV 30–60 min before initial incision; 750 mg IM/IV every 8 hr can be given when procedure prolonged. Prophylaxis during open-heart surgery: 1.5 g IV at induction of anesthesia and then every 12 hr for 3 additional doses.Gonorrhea: 1.5 g IM (750 mg in two sites) with 1 g probenecid PO.
IM IV (Children and Infants >3 mo): Most infections: 50–100 mg/kg/day divided every 6–8 hr (maximum dose 6 g/day). Bone and joint infections: 150 mg/kg/day divided every 8 hr (maximum dose 6 g/day).

Renal Impairment

IM IV (Adults ): CCr 10–29 mL/min: Give standard dose every 24 hr; CCr <10 mL/min (no hemodialysis): Give standard dose every 48 hr; Hemodialysis: Give a an additional dose at end of each dialysis session.

Availability ⬆ ⬇

(Generic available)

Tablets: 250 mg; 500 mg
Powder for oral suspensiontutti frutti flavor: 125 mg/5 mL
Powder for injection: 750 mg; 1.5 g

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of CDAD. May begin up to several wk following cessation of therapy.

Lab Test Considerations:

May cause positive results for Coombs' test.
- May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and serum creatinine.
- May rarely cause leukopenia, neutropenia, and eosinophilia.

Implementation ⬆ ⬇

Do not confuse cefuroxime with sulfasalazine.
PO: Administer around the clock. Tablets can be administered on full or empty stomach. Administration with food may minimize GI irritation.
- DNC: Tablets should be swallowed whole, not crushed; crushed tablets have a strong, persistent bitter taste.
- Shake oral suspension before use. Use calibrated measuring device with oral suspension.
IM: Reconstitution: Reconstitute IM doses with Sterile Water for Injection. Stable for 24 hr at room temperature and 48 hr if refrigerated.
- Inject deep into a well-developed muscle mass; massage well.

IV Administration:

IV: Change sites every 48–72 hr to prevent phlebitis. Monitor site frequently for thrombophlebitis (pain, redness, swelling).
- If aminoglycosides are administered concurrently, administer in separate sites if possible, at least 1 hr apart. If second site is unavailable, flush line between medications.
Reconstitution: Reconstitute 750 mg vial with 8.3 mL, 1.5 g vial with 16 mL, and 7.5 g vial with 77 mL of Sterile Water for Injection, respectively. Do not use preparations containing benzyl alcohol for neonates.
Rate: Administer slowly over 3–5 min.
Intermittent Infusion: Diluent: Dilute further in 50–100 mL of 0.9% NaCl, D5W, or 0.45% NaCl. Stable for 24 hr at room temperature and 7 days if refrigerated. Concentration: 10–40 mg/mL.
Rate: Administer over 15–60 min.
May also be diluted in 500–1000 mL 0.9% NaCl, D5W, D10W, D5/0.9% NaCl, D5/.45 NaCl, or 1/6 M Sodium Lactate Injection for continuous infusion.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take medication around the clock at evenly spaced times and to finish medication completely, even if feeling better. Take missed doses as soon as possible unless almost time for next dose; do not double doses. Advise patient that sharing of this medication may be dangerous.
Pedi: Teach parents or caregivers to calculate and measure doses accurately. Reinforce importance of using measuring device supplied by pharmacy or with product, not household items.
Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breastfeeding.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇