cefuroxime sodium

cefuroxime sodium

[sef′o̅o̅rok′zēm]

a cephalosporin antibiotic.

indications It is prescribed in the treatment of lower respiratory tract, urinary tract, skin, and gonococcal infections; bacterial septicemia; and meningitis and for the prevention of postoperative infections.

contraindications Hypersensitivity to the cephalosporins or known sensitivity to this drug prohibits its use.

adverse effects Among the most serious adverse reactions are pruritus, urticaria, transient eosinophilia, neutropenia, leukopenia, and injection site reactions.

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cefuroxime sodium

Zinacef, Zinnat (UK)

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 and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

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 penicillins
• 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, pseudomembranous colitis

GU: hematuria, vaginal candidiasis, 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, superinfection, anaphylaxis

Interactions

Drug-drug. Antacids containing aluminum or magnesium, histamine₂-receptor antagonists: increased cefuroxime absorption

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 pseudomembranous 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 and prothrombin time; watch for signs and symptoms of blood dyscrasias.
• Monitor temperature; watch for signs and symptoms of superinfection.

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 superinfection. 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.