cefuroxime

MIMS Class : Cephalosporins

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Indication & Oral
Dosage Uncomplicated urinary tract infections
Adult: 125 mg bid.
Oral
Respiratory tract infections
Adult: 250-500 mg bid.
Child: >3 mth: 125 mg bid or 10 mg/kg bid. Max dose: 250 mg daily.
Oral
Uncomplicated gonorrhoea
Adult: 1 g as a single dose. 1 g oral probenecid may be given concurrently.
Oral
Otitis media
Child: >2 yr: 250 mg bid or 15 mg/kg bid up to 500 mg daily.
Intravenous
Meningitis
Adult: 3 g every 8 hr.
Child: 200-240 mg/kg/day in 3-4 divided doses, decreased to 100
mg/kg/day after 3 days or once symptoms have improved. Neonate: 100
mg/kg/day, decreased to 50 mg/kg/day when control has been achieved.
Renal impairment: Patients undergoing haemodialysis should receive an
additional 750-mg dose after each dialysis; those undergoing continuous
peritoneal dialysis may be given 750 mg bid.
CrCl (ml/min) Dosage Recommendation
10-20 750 mg bid.
<10 750 mg once daily.

Intramuscular
Gonorrhoea
Adult: 1.5 mg as a single dose divided between 2 inj sites. 1 g oral
probenecid may be given concurrently.
Renal impairment: Patients undergoing haemodialysis should receive an
additional 750-mg dose after each dialysis; those undergoing continuous
peritoneal dialysis may be given 750 mg bid.
CrCl (ml/min) Dosage Recommendation
 10-20 750 mg bid.
<10 750 mg once daily.

Parenteral
Prophylaxis of surgical infections
Adult: 1.5 g IV before the procedure followed by 750 mg IM every 8 hr for
up to 24-48 hr depending on the procedure. For total joint replacement, 1.5
g of cefuroxime may be mixed with methylmethacrylate cement.
Renal impairment: Patients undergoing haemodialysis should receive an
additional 750-mg dose after each dialysis; those undergoing continuous
peritoneal dialysis may be given 750 mg bid.
CrCl (ml/min) Dosage Recommendation
10-20 750 mg bid.
<10 750 mg once daily.

Parenteral
Susceptible infections
Adult: 750 mg every 8 hr given as deep IM or slow IV inj over 3-5 min or
IV infusion, increased to 1.5 g every 6-8 hr in severe infections.
Child: 30-60 mg/kg/day, may increase to 100 mg/kg/day if necessary. To be
given in 3-4 divided doses or 2-3 divided doses in neonates.
Renal impairment: Patients undergoing haemodialysis should receive an
additional 750-mg dose after each dialysis; those undergoing continuous
peritoneal dialysis may be given 750 mg bid.
CrCl (ml/min) Dosage Recommendation
10-20 750 mg bid.
<10 750 mg once daily.

Incompatibility: Incompatible with aminoglycosides.

Administration Should be taken with food.
Contraindications Hypersensitivity to cephalosporins.
Special Severe renal impairment; pregnancy, lactation; hypersensitivity to
Precautions penicillins.
Adverse Drug Large doses can cause cerebral irritation and convulsions; nausea, vomiting,
Reactions diarrhoea, GI disturbances; erythema multiforme, Stevens-Johnson
syndrome, epidermal necrolysis.
Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.
Drug Interactions Probenecid decreases renal clearance of cefuroxime.
Potentially Fatal: Nephrotoxicity with aminoglycosides and furosemide.
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Food Interaction Oral cefuroxime axetil is better absorbed after food intake.
Lab Interference False-positive for Coombs' test. It may interfere with urine-sugar estimation.
Pregnancy
Category (US
FDA) Category B: Either animal-reproduction studies have not demonstrated a
foetal risk but there are no controlled studies in pregnant women or animal-
reproduction studies have shown an adverse effect (other than a decrease in
fertility) that was not confirmed in controlled studies in women in the 1st
trimester (and there is no evidence of a risk in later trimesters).
Storage Intramuscular: Store at 15-30°C. Intravenous: Store at 15-30°C. Oral:
Store at 15-30°C. Parenteral: Inj: Store at 15-30°C.
Mechanism of Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs)
Action which inhibits the final transpeptidation step of peptidoglycan synthesis in
bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall
assembly resulting in bacterial cell death.
Absorption: Absorbed from the GI tract with peak plasma concentrations
after 2-3 hr (oral); may be enhanced by the presence of food.
Distribution: Pleural and synovial fluid, sputum, bone and aqueous fluids;
CSF (therapeutic concentrations). Crosses the placenta and enters breast
milk. Protein-binding: Up to 50%.
Metabolism: Rapidly hydrolysed (intestinal mucosa and blood).
Excretion: Via the urine by glomerular filtration and renal tubular secretion
(as unchanged); via bile (small amounts); 70 min (elimination half-life);
prolonged in neonates and renal impairment.