Ceftin


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Related to Ceftin: cefuroxime

cefuroxime

(se-fyoor-ox-eem) ,

Ceftin

(trade name),

Zinacef

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: second generation cephalosporins
Pregnancy Category: B

Indications

Treatment of:
  • 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).
Perioperative prophylaxis (IV).

Action

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects

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,
  • Neisseria,
  • Proteus,
  • Moraxella catarrhalis,
  • Borrelia burgdorferi.
Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics

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).

Time/action profile

ROUTEONSETPEAKDURATION
POunknown2–3 hr8–12 hr
IMrapid15–60 min6–12 hr
IVrapidend of infusion6–12 hr

Contraindications/Precautions

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)

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea
  • nausea
  • vomiting
  • cramps

Dermatologic

  • rashes (most frequent)
  • urticaria
  • diaper dermatitis

Hematologic

  • bleeding
  • eosinophilia
  • hemolytic anemia
  • leukopenia

Local

  • pain at IM site (most frequent)
  • phlebitis at IV site (most frequent)

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • superinfection

Interactions

Drug-Drug interaction

Probenecid decreases excretion and increases blood levels.Aminoglycosides and loop diuretics may increase the risk of nephrotoxicity.

Route/Dosage

Note: 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 Impairment

Intramuscular 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

Nursing implications

Nursing assessment

  • 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 Diagnoses

Risk for infection (Indications,  Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • 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.
  • Intravenous Administration
  • 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

Patient/Family Teaching

  • 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.

Evaluation/Desired Outcomes

  • 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.

Ceftin

(sĕf′tn)
A trademark for an ester of the drug cefuroxime.
References in periodicals archive ?
After adjusting for the impact of the Ceftin reserve: * 2004 revenue of $366.
Using a core services driven strategy, we posted an 18% increase in operating income for 2004 after adjusting for Ceftin and Xylos.
2003 operating income and net income per share results, excluding the litigation settlement recorded in the first quarter and Ceftin reserve increase recorded in the fourth quarter, are as follows:
Excluding the Ceftin reserve increase referred to above, operating income for the fourth quarter of 2003 exceeded our previous estimates for the quarter by approximately $12 million.
The decline in revenue was predominantly caused by the discontinuation of PDI's sales, marketing and distribution agreement with GSK for Ceftin in February 2002.
The year began on a challenging note as we mutually agreed with GSK to terminate our sales, marketing and distribution agreement for Ceftin due to an earlier than expected generic entry", added Mr.
Glaxo Wellcome retains certain regulatory responsibilities for Ceftin and ownership of all intellectual property relevant to Ceftin.
Additionally, LCV will partner on Ceftin with CommonHealth, the well-known healthcare advertising and marketing organization.
PDI has provided contract sales services to Glaxo Wellcome since 1993 and has promoted Ceftin since 1997.
Saldarini, Vice Chairman and Chief Executive Officer stated, "The improved results for Ceftin in the 4th quarter reflects our success in a difficult selling environment as well as the lack of a generic entrant.
Commenting further on the Company's experience with Ceftin, Saldarini noted, "Over the abbreviated life of the deal, Ceftin produced a positive financial outcome.
The strong Ceftin program results more than offset the Services segment shortfall.