Zinacef


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Related to Zinacef: cefuroxime

cefuroxime sodium

Zinacef

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, 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

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
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 (for injectable formulation)

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.

Adverse reactions

CNS: headache, hyperactivity, hypertonia, seizures

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, pseudomembranous colitis

GU: hematuria, vaginal candidiasis, renal dysfunction, acute renal failureHematologic: 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 usingBenedict'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.

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.

Zinacef

(zĭn′ə-sĕf′)
A trademark for the drug cefuroxime.

Zinacef

a trademark for a cephalosporin antibiotic (cefuroxime sodium).
References in periodicals archive ?
22 December 2011 - Swiss Covis Pharma Sarl said today it had agreed to acquire the US and Puerto Rican rights from UK GlaxoSmithKline (LON:GSK) to Fortaz (ceftazidime), Zinacef (cefuroxime), Lanoxin (digoxin), Parnate (tranylcypromine sulfate), and Zantac Injection (ranitidine hydrochloride).
In April PPC launched injectable versions of cefuroxime and ifosfamide, the generic equivalents of GlaxoSmithKline PLC's anti-infective Zinacef and Bristol-Myers Squibb Co.
Products Mentioned: Enbrel Humira Lipitor Nexium Risperdal Seretide Seroquel Taxotere Zinacef Zyprexa Companies Mentioned: Orion Pharma Pfizer Astrazeneca Glaxosmithkline Sanofi-Aventis Novartis Pharma Msd Roche Lilly Janssen-Cilag Wyeth Leiras Finland Novo Nordisk Schering Boehringer I Abbott Ratiopharm Amgen Lundbeck Baxter Paranova Organon Hexal Schering-Plough B.