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Pharmacologic class: Second-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
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.
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
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)
• Renal impairment (for injectable formulation)
• Hypersensitivity to cephalosporins or penicillins
• Carnitine deficiency
Use cautiously in:
• renal or hepatic impairment
• pregnant or breastfeeding patients
• 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.
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
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
• 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.
• 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.
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).
- Haemophilus influenzae (including β-lactamase-producing strains),
- Haemophilus parainfluenzae,
- Escherichia coli,
- Klebsiella pneumoniae,
- Moraxella catarrhalis,
- Borrelia burgdorferi.
|PO||unknown||2–3 hr||8–12 hr|
|IM||rapid||15–60 min||6–12 hr|
|IV||rapid||end of infusion||6–12 hr|
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
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)
- 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.