cefuroxime

sef-ue-rox-eem

Do not confuse cefuroxime with cefotaxime, cefprozil, or deferoxamine.

• PHARMACOTHERAPEUTIC:Second-generation cephalosporin. CLINICAL:Antibiotic.

Treatment of bone and joint infections. COPD (acute exacerbation), lower respiratory tract infections, Lyme disease, otitis media, septicemia, bacterial sinusitis, skin and skin structure infections, Streptococcal pharyngitis, surgical prophylaxis, UTI caused by susceptible strains of microorganisms including S. pneumoniae, H. influenzae (including am-picillin-resistant strains), Enterobacter spp., Klebsiella spp., S. aureus (penicillinase- and non-penicillinase-producing strains), S. pyogenes, E. coli. OFF-LABEL: Bite wound infection, intra-abdominal infection. Otitis media (acute).

Contraindications: History of hypersensitivity/anaphylactic reaction to cefuroxime, cephalosporins. Cautions: Severe renal impairment, history of penicillin allergy. Pts with hx of colitis, GI malabsorption, seizures.

Binds to bacterial cell membranes, inhibits cell wall synthesis. Therapeutic Effect: Bactericidal.

Rapidly absorbed from GI tract. Protein binding: 33%–50%. Widely distributed, including to CSF. Primarily excreted unchanged in urine. Moderately removed by hemodialysis. Half-life: 1.3 hrs (increased in renal impairment).

Pregnancy/Lactation: Readily crosses placenta. Distributed in breast milk. Children: No age-related precautions noted. Elderly: Age-related renal impairment may require dosage adjustment.

DRUG: Probenecid may increase concentration/effect. Antacids, H₂-receptor antagonists (e.g., famotidine), proton pump inhibitors (e.g., pantoprazole) may decrease absorption. May decrease therapeutic effect of BCG (intravesical). HERBAL: None significant. FOOD: None known. LAB VALUES: May increase serum BUN, creatinine, alkaline phosphatase, bilirubin, LDH, ALT, AST. May cause positive direct/indirect Coombs' test.

Injection Powder for Reconstitution: 750 mg, 1.5 g. Tablets: 250 mg, 500 mg.

IV

Reconstitution · Reconstitute 750 mg in 8 mL (1.5 g in 14 mL) Sterile Water for Injection to provide a concentration of 100 mg/mL. · For intermittent IV infusion (piggyback), further dilute with 50–100 mL 0.9% NaCl or D₅W.

Rate of administration · For IV push, administer over 3–5 min. · For intermittent IV infusion (piggyback), infuse over 15–30 min.

Storage · Solution appears light yellow to amber (may darken, but color change does not indicate loss of potency). · IV infusion (piggyback) is stable for 24 hrs at room temperature, 7 days if refrigerated. · Discard if precipitate forms.

IM

• To minimize discomfort, inject deep IM slowly in large muscle mass.

PO

• Give tablets without regard to food.
• If GI upset occurs, give with food, milk.
• Avoid crushing tablets due to bitter taste.

Usual Dosage

IV, IM: ADULTS, ELDERLY: 750 mg–1.5 g q8h up to 1.5 g q6h for severe infections. INFANTS, CHILDREN, ADOLESCENTS: 100–150 mg/kg/day in divided doses q8h. Maximum: 6,000 mg/day. NEONATES: 50 mg/kg/dose q8–12h. PO: ADULTS, ELDERLY: 250–500 mg twice daily INFANTS, CHILDREN, ADOLESCENTS: 20–30 mg/kg/day in 2 divided doses. Maximum: 1 g/day (500 mg/dose).

Dosage in Renal Impairment

Adult dosage frequency is modified based on creatinine clearance and severity of infection.

Dosage in Hepatic Impairment

No dose adjustment.

Frequent: Discomfort with IM administration, oral candidiasis (thrush), mild diarrhea, mild abdominal cramping, vaginal candidiasis. Occasional: Nausea, serum sickness–like reaction (fever, joint pain; usually occurs after second course of therapy and resolves after drug is discontinued). Rare: Allergic reaction (rash, pruritus, urticaria), thrombophlebitis (pain, redness, swelling at injection site).

Antibiotic-associated colitis, other superinfections (abdominal cramps, severe watery diarrhea, fever) may result from altered bacterial balance in GI tract. Nephrotoxicity may occur, esp. in pts with preexisting renal disease. Pts with history of penicillin allergy are at increased risk for developing a severe hypersensitivity reaction (severe pruritus, angioedema, bronchospasm anaphylaxis).

• BASELINE ASSESSMENTObtain CBC, renal function test. Question for history of allergies, particularly cephalosporins, penicillins.INTERVENTION/EVALUATIONAssess oral cavity for white patches on mucous membranes, tongue (thrush).Monitor daily pattern of bowel activity, stool consistency. Mild GI effects may be tolerable (increasing severity may indicate onset of antibiotic-associated colitis). Monitor I&O, renal function tests for nephrotoxicity. Be alert for superinfection: Fever, vomiting, diarrhea, anal/genital pruritus, oral mucosal changes (ulceration, pain, erythema).PATIENT/FAMILY TEACHING
• Discomfort may occur with IM injection.
• Doses should be evenly spaced.
• Continue antibiotic therapy for full length of treatment.
• May cause GI upset (may take with food, milk).

Dexmedetomidine, diltiazem, propofol.