Cefuroxime Sodium Sterile
.
 
 
Pharmacologic class: Second-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B

Action
   • Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die
   • Active against gram-negative & gram-positive bacteria with expanded activity against gram-
     negative bacteria.
   • Exhibits minimal immunosuppressant activity.

Oral suspension: 125 mg/5 ml
Powder for injection:
750 mg, 1.5 g, 7.5 g
Premixed containers: 750 mg/50 ml, 1.5 g/50 ml
Tablets: 125 mg, 250 mg, 500 mg

Indications and dosages -
> Moderate to severe infections, including those of skin, bone, joints, urinary or respiratory tract,    gynecologic infections, and septicemia.

Adults and children ages 12 and older: 750 mg to 1.5 g I.M. or I.V. q 8 hours for 5 to 10 days or 250 to 500 mg P.O. q 12 hours.

Children ages 3 months to 12 years: 50 to 100 mg/kg/day I.V. or I.M. in divided doses q 6 to 8 hours.

> Gonorrhea -
Adults: 750 mg to 1.5 g I.M. or I.V. as a single dose, or 1.5 g I.M. (750 mg in two separate sites), given with 1 g probenecid P.O.

> Bacterial meningitis -
Adults and children ages 12 and older: Up to 3 g I.V. or I.M. q 8 hours
Children ages 3 months to 12 years:
200 to 240 mg/kg I.V. daily in divided doses q 6 to 8 hours.

> Otitis Media -
Children ages 3 months to 12 years: 15 mg/kg P.O. q 12 hours (oral suspension) for 10 days, or 250 mg (tablets) P.O. q 12 hours for 10 days.

> Pharyngitis; Tonsillitis -
Adults and children ages 13 and older: 250 mg P.O. b.i.d. for 10 days
Children ages 3 months to 12 years: 125 mg P.O. q 12 hours for 10 days, or 20 mg/kg/day P.O. in two divided doses for 10 days as oral suspension (maximum 500 mg/day)

Dosage adjustment
   • Renal impairment

Contraindications
   • Hypersensitivity to cephalosporins or penicillin
   • Carnitine deficiency

Precautions
Use cautiously in:
   • Renal or hepatic impairment
   • Pregnant or breastfeeding patients
   • Children.

Administration
   • Reconstitute drug in vial with sterile water for injection.
   • Give by direct I.V. injection over 3 to 5 minutes into large vein or flowing I.V. line.
   • For intermittent I.V. infusion, reconstitute drug with 100 ml of dextrose 5% in water or normal saline      solution; administer over 15 minutes to 1 hour. For continuous infusion, give in 500 to 1,000 ml of      compatible solution; infuse over 6 to 24 hours.
   • Inject I.M. doses deep into large muscle mass.
   • Give oral form with food.
   • Be aware that tablets and oral suspension are exchangeable on a milligram-for-milligram basis.
 
 
Route Onset Peak Duration
P.O. Unknown 2 hr 8-12 hr
I.V., I.M. Rapid End of infusion 6-12 hr
 
     
 
 
Adverse reactions -

CNS: headache, hyperactivity, hypertonia, seizures

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, pseudo membranous colitis

GU: hematuria, vaginal candidacies, renal dysfunction, acute renal failure

Hematologic: hemolytic anemia, aplastic anemia, hemorrhage

Hepatic: hepatic dysfunction

Metabolic: hyperglycemia

Skin: toxic epidermal necrolysis, erythema multiforme, Stevens-Johnson syndrome

Other: allergic reaction, drug fever, super infection, anaphylaxis

Interactions
-

Drug-drug. Antacids containing aluminum or magnesium, histamine2-receptor antagonists: increased cefuroxime absorption Probenecid: decreased excretion and increased blood level of cefuroxime.

Probenecid: decreased excretion and increased blood level of cefuroxime

Drug-diagnostic tests. Blood glucose, Coombs' test, urine glucose tests using Benedict's solution: false-positive results
Glucose, hematocrit: decreased levels
White blood cells in urine: increased level

Drug-food. Moderate- or high-fat meal: increased drug bioavailability.

Patient monitoring -
   • Monitor patient for life-threatening adverse effects, including anaphylaxis, Stevens-Johnson
     syndrome, and pseudo membranous colitis.
   • Monitor neurologic status, particularly for signs of impending seizures.
   • Monitor kidney and liver function test results and intake and output.
   • Monitor CBC with differential & prothrombin time; watch for signs & symptoms of blood dyscrasias.
   • Monitor temperature; watch for signs and symptoms of super infection.

Patient teaching -
   • Advise patient to immediately report rash or bleeding tendency.
   • Instruct patient to take drug with food every 12 hours as prescribed.
   • Teach patient how to recognize signs and symptoms of super infection. Instruct him to report these      right away.
   • Advise patient to report CNS changes.
   • As appropriate, review all other significant and life-threatening adverse reactions and interactions,
     especially those related to the drugs, tests, and foods mentioned above.
 
 
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