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Related to Ceftin: cefuroxime
Pregnancy Category: B
Pharmacologic: second generation cephalosporins
ClassificationTherapeutic: anti infectives
Pharmacologic: second generation cephalosporins
- Respiratory tract infections,
- Skin and skin structure infections,
- Bone and joint infections (IV),
- Urinary tract infections,
- Gynecological infections,
- Septicemia (IV),
- Otitis media (PO),
- Meningitis (IV),
- Lyme disease (PO).
Binds to bacterial cell wall membrane, causing cell death.
Bactericidal action against susceptible bacteria.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),
- Haemophilus parainfluenzae,
- Escherichia coli,
- Klebsiella pneumoniae,
- Moraxella catarrhalis,
- Borrelia burgdorferi.
Absorption: Well absorbed after oral and IM administration; IV administration results in complete bioavailability.
Distribution: Widely distributed. Penetrates into CSF with IV administration. Crosses the placenta and enters breast milk in low concentrations.
Protein Binding: 50%.
Metabolism and Excretion: Excreted primarily unchanged in the urine.
Half-life: 1–2 hr (↑ in renal impairment).
|PO||unknown||2–3 hr||8–12 hr|
|IM||rapid||15–60 min||6–12 hr|
|IV||rapid||end of infusion||6–12 hr|
Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins.
Use Cautiously in: Renal impairment (dose reduction/increased dosing interval recommended if CCr ≤20 mL/min); History of GI disease, especially colitis; Geriatric patients (dose adjustment may be required due to age-related ↓ in renal function); Pregnancy and lactation (has been used safely).
Adverse Reactions/Side Effects
Central nervous system
- seizures (high doses) (life-threatening)
- pseudomembranous colitis (life-threatening)
- rashes (most frequent)
- diaper dermatitis
- hemolytic anemia
- pain at IM site (most frequent)
- phlebitis at IV site (most frequent)
- allergic reactions including anaphylaxis (life-threatening)
Drug-Drug interactionProbenecid decreases excretion and increases blood levels.Aminoglycosides and loop diuretics may increase the risk of nephrotoxicity.
Route/DosageNote: Cefuroxime oral tablets and oral suspension are not bioequivalent and are not substitutable on a mg/mg basis
Oral (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.
Oral (Children 3 mo–12 yr) Otitis media, acute bacterial maxillary sinusitis, impetigo—15 mg/kg every 12 hr as oral suspension (not to exceed 1 g/day) or 250 mg every 12 hr as tablets. Pharyngitis/tonsillitis—10 mg/kg every 12 hr as oral suspension, not to exceed 500 mg/day.
Intramuscular Intravenous (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.
Intramuscular Intravenous (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 ImpairmentIntramuscular Intravenous (Adults) CCr 10–20 mL/min—750 mg every 12 hr; CCr <10 mL/min—750 mg every 24 hr.
Availability (generic available)
Tablets: 250 mg, 500 mg
Oral suspensiontutti-frutti: 125 mg/5 mL, 250 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
- Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout 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 pseudomembranous colitis. May begin up to several weeks 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 creatinine.
- May rarely cause leukopenia, neutropenia, and eosinophilia.
Potential Nursing DiagnosesRisk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- Oral: Administer around the clock. Tablets can be administered on full or empty stomach. Administration with food may minimize GI irritation. Suspension must be administered with food.
- Tablets should be swallowed whole, not crushed; crushed tablets have a strong, persistent bitter taste. Shake well each time before using. Tablets and suspension are not interchangeable. Store reconstituted suspension in refrigerator for up to 10 days.
- Intramuscular: Reconstitute IM doses with sterile water for injection.
- Inject deep into a well-developed muscle mass; massage well.
- pH: 5.0–8.5.
- Intravenous: 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.
- Reconstitute vial with sterile water for injection. Do not use preparations containing benzyl alcohol for neonates.
- Rate: Administer slowly over 3–5 min.
- Intermittent Infusion: Diluent: Solution may be further diluted in 50–100 mL of 0.9% NaCl, D5W, D10W, D5/0.45% NaCl, or D5/0.9% NaCl. Stable for 24 hr at room temperature and 48 hrif refrigerated. Concentration: 10–40 mg/mL.
- Rate: Administer over 15–60 min.
- Y-Site Compatibility: acyclovir, alfentanil, allopurinol, amifostine, aminocaproic acid, aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, chloramphenicol, cisplatin, clindamycin, cyclophosphamide, cyanocobalamin, cyclosporine, cytarabine, dactinomycin, daptomycin, dexmedetomidine, digoxin, diltiazem, docetaxel, dopamine, doxacurium, enalaprilat, ephedrine, epinephrine, epoetin alfa, eptifibatide, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, ifosfamide, imipenem/cilastatin, indomethacin, insulin, irinotecan, isoproterenol, ketamine, ketorolac, levofloxacin, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pancuronium, pantoprazole, pemetrexed, penicillin G, perphenazine, phenylephrine, phytonadione, potassium acetate, potassium chloride, procainamide, propofol, propranolol, pyridoxine, ranitidine, remifentanil, rituximab, rocuronium, sargramostim, sodium acetate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tolazoline, trastuzumab, trimetaphan, vasopressin, vecuronium, verapamil, vincristine, voriconazole, zoledronic acid
- Y-Site Incompatibility: alemtuzumab, azathioprine, azithromycin, calcium chloride, caspofungin, chlorpromazine, dantrolene, dexamethasone, diazepam, diazoxide, diphenhydramine, dobutamine, doxorubicin hydrochloride, doxycycline, epirubicin, filgrastim, ganciclovir, haloperidol, hydralazine, hydroxyzine, labetalol, magnesium sulfate, midazolam, mitoxantrone, mycophenolate, papaverine, pentamidine, penatzocine, pentobarbital, phenobarbital, phentolamine, phenytoin, prochlorperazine, promethazine, protamine, quinupristin/dalfopristin, sodium bicarbonate, trimethoprim/sulfamethoxazole, vinorelbine
- Instruct patient to take medication around the clock at evenly spaced times and to finish the medication completely, even if feeling better. Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses. Advise patient that sharing of this medication may be dangerous. Pediatric: Tell parents or cargeivers to use calibrated measuring device with liquid preparations.
- 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.
- Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
- Decreased incidence of infection when used for prophylaxis.
A trademark for an ester of the drug cefuroxime.