Zinacef

Zin·a·cef (zn-sf)

A trademark for the drug cefuroxime.

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Zinacef,

trademark for a cephalosporin antibiotic (cefuroxime sodium).

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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.