cefuroxime

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.

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

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.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

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.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification: second generation cephalosporins

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).

Canadian Brand Names ⬆ ⬇

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

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.

Pronunciation ⬆ ⬇

Code ⬆

NDC Code

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9567- Cefuroxime
  - 0143-9567-25- 25 VIAL in 1 CARTON (0143-9567-25) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (0143-9567-01)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9568- Cefuroxime
  - 0143-9568-25- 25 VIAL in 1 CARTON (0143-9568-25) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (0143-9568-01)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9569- Cefuroxime
  - 0143-9569-10- 10 VIAL in 1 CARTON (0143-9569-10) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (0143-9569-01)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9976- Cefuroxime
  - 0143-9976-03- 10 VIAL, PHARMACY BULK PACKAGE in 1 CARTON (0143-9976-03) / 82.5 mL in 1 VIAL, PHARMACY BULK PACKAGE (0143-9976-91)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9977- Cefuroxime
  - 0143-9977-22- 25 VIAL in 1 CARTON (0143-9977-22) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (0143-9977-90)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9979- Cefuroxime
  - 0143-9979-22- 25 VIAL in 1 CARTON (0143-9979-22) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL (0143-9979-90)

25021- Sagent Pharmaceuticals
- 25021-118- Cefuroxime sodium
  - 25021-118-10- 25 VIAL in 1 CARTON (25021-118-10) / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL

25021- Sagent Pharmaceuticals
- 25021-119- Cefuroxime sodium
  - 25021-119-20- 25 VIAL in 1 CARTON (25021-119-20) / 16 mL in 1 VIAL

52946- ACS Dobfar S.p.A
- 52946-0905-
  - 52946-0905-0- 20 kg in 1 BOX (52946-0905-0)

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Indications ⬇

Contraind./Precautions ⬆ ⬇