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| Cefuroxime Sodium Sterile |
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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.
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| Route |
Onset |
Peak |
Duration |
| P.O. |
Unknown |
2 hr |
8-12 hr |
| I.V., I.M. |
Rapid |
End of infusion |
6-12 hr |
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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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