Cefuroxime: Difference between revisions

(Remove disease-specific entries now covered by AntibioticDose (4 sections))
(Fix corrupted content: restore correct Cefuroxime (2nd gen cephalosporin) content, was incorrectly showing Cefditoren)
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==General==
==General==
*Type: [[Is Generation::3rd generation]] [[Is DrugClass::cephalosporin]]
*Type: [[Is Generation::2nd generation]] [[Is DrugClass::cephalosporin]]
*Dosage Forms: tablet  
*Dosage Forms: tablet, powder for injection
*Dosage Strengths: 200, 400mg
*Dosage Strength: tablet: 250mg, 500mg; powder for injection: 750mg, 1.5g, 7.5g, 75g, 225g
*Routes of Administration: PO
*Routes of Administration: PO, IV, IM
*Common Trade Names: Spectracef
*Common Trade Names: Ceftin, Zinacef, Kefurox


==Adult Dosing==
==Adult Dosing==
===Skin infection===
===Mild-Moderate Bacterial infections===
*200 mg PO bid x10 days
*250-500mg PO BID x5-10 days
===Steptococcal [[Pharyngitis]]/Tonsillitis===
*250mg PO BID x10 days
===Acute [[Sinusitis|Maxillary Sinusitis]]===
*250mg PO BID x10 days; Info: not recommended per IDSA guidelines
===Uncomplicated [[Gonococcal]] Infections===
*1000mg PO x1; Info: for infections of cervix, urethra, rectum; dual treatment for chlamydial co-infection recommended
===Early [[Lyme Disease]]===
*500mg PO BID x20 days
===Renal Dosing===
*no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
===Hepatic Dosing===
*not defined
 




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==Pediatric Dosing==
==Pediatric Dosing==
===Mild-Moderate Bacterial Infections===
*3 mo-12 yo: Dose: 30mg/kg/day susp PO divided q12h x10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x10 days; Info: give susp with food
*>13 yo: Dose: 250-500mg tab PO BID x5-10 days; Info: dose, duration varies by infection type, severity
===[[Otitis Media (Peds)|Acute Otitis Media]]===
*2 mo-5 yo Dose: 30mg/kg/day susp PO divided q12h x10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x10 days; Info: give susp with food
*6-12 yo: Dose: 30mg/kg/day susp PO divided q12h x5-10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x5-10 days; Info: give susp with food
===Acute Maxillary [[Sinusitis]]===
*3 mo-12 yo: Dose: 30mg/kg/day susp PO divided q12h x10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x10 days; Info: not recommended per IDSA guidelines; give susp with food
*>13 yo: Dose: 250mg tab PO BID x10 days; Info: not recommended per IDSA guidelines
===Streptococcal [[Pharyngitis]]/Tonsillitis===
*3 mo-12 yo: Dose: 20mg/kg/day susp PO divided q12h x10 days; Max: 500mg/day; Info: give with food
*>13 yo: Dose: 250mg tab PO BID x10 days
===Uncomplicated [[Gonococcal]] Infections===
*adolescents: Dose: 1000mg tab PO x1; Info: for infections of cervix, urethra, rectum; dual treatment for [[chlamydial]] co-infection recommended
===Early [[Lyme Disease]]===
*>13 yo: Dose: 500mg tab PO BID x20 days
===Renal Dosing===
*3 mo-12 yo: CrCl <10: 15mg/kg PO susp q24h; HD: give dose after dialysis, no supplement; PD: no supplement
*>13 yo: renal impairment: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
===Hepatic Dosing===
*not defined




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==Special Populations==
==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B; May use during pregnancy
*Pregnancy: B
*Lactation: May use while breastfeeding
*Lactation: Probably Safe
*Renal Dosing
*Renal Dosing
**Adult
**Adult: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
***CrCl 30-49: Max 200mg bid
**Pediatric: 3 mo-12 yo: CrCl <10: 15mg/kg susp q24h; HD: give dose after dialysis, no supplement; PD: no supplement; >13 yo: renal impairment: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
***CrCl <30:   Max 200mg qd
***ESRD/HD:   Not defined
**Pediatric
***CrCl 30-49: Max 200mg bid
***CrCl <30:   Max 200mg qd
***ESRD/HD:   Not defined
*Hepatic Dosing
*Hepatic Dosing
**Adult
**Adult: Not defined
***Child-Pugh Class A or B: No adjusment
**Pediatric: Not defined
***Child-Pugh Class C: Not defined
**Pediatric
***Child-Pugh Class A or B: No adjusment
***Child-Pugh Class C: Not defined


==Contraindications==
==Contraindications==
*Allergy to class/drug
*Allergy to class/drug (See [[Cephalosporin Cross-reactivity]])
*Hypersensitivity to milk proteins
*Caution if hypersensitive to [[PCN]]
*Carnitine deficiency
*Caution if renal impairment
*Caution:
*Caution if hepatic impairment
**Hypersensitivity to PCN
*Caution if seizure disorder
**Renal impairment
*Caution if malnutrition
**Decreased muscle mass
*Caution if recent antibiotic-associated colitis history
**Recent abx-associated colitis


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*[[Anaphylaxis]]
*[[Anaphylaxis]]
*Serum-sickness like reaction
*[[Angioedema]]
*[[Stevens-Johnson syndrome]]
*[[TEN|Toxic epidermal necrolysis]]
*[[Erythema multiforme]]
*[[Stevens-Johnson Syndrome|Stevens-Johnson syndrome]]
*[[Toxic epidermal necrolysis]]
*Interstitial nephritis
*[[Leukopenia]]
*Pancytopenia
*[[Neutropenia]]
*[[Thrombocytopenia]]
*[[Thrombocytopenia]]
*[[Anemia]], hemolytic
*Agranulocytosis
*[[Seizure]]
*Leukopenia
*Nephrotoxicity
*Neutropenia
*Cholestatic [[jaundice]]
*Hemolytic Anemia
*C. difficle-associated diarrhea
*[[Seizures]]
*Super infection
*[[Clostridium difficile]] associated diarrhea
*Carnitine deficiency (long-term use)
 
===Common===
===Common===
*[[Diarrhea]]
*[[Diarrhea]]
*[[Nausea]]
*Nausea/Vomiting
*[[Headache]]
*Jarisch-Herxheimer reaction
*[[Abdominal pain]]
*[[Vaginitis]]
*Candidiasis, vulvovaginal
*Diaper Rash
*Dyspepsia
*ALT, AST elevated
*Renal Impairment
*Anemia


==Pharmacology==
==Pharmacology==
*Half-life: 1.6h; 4.7h in severe renal impairment
*Half-life: 1.4 hours, 3.5 hours (CrCl 35),
*Metabolism: Minimal
*Metabolism: Minimal; CYP 450: unknown
*Excretion: Urine primarily
*Excretion: Urinary primarily (Up to 100% unchanged)
*Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis
*Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis


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| ||[[Staph. Epidermidis]]||I
| ||[[Staph. Epidermidis]]||I
|-
|-
| ||[[C. jeikeium]]||X1
| ||[[C. jeikeium]]||R
|-
|-
| ||[[L. monocytogenes]]||R
| ||[[L. monocytogenes]]||R
|-
|-
| Gram Negatives||[[N. gonorrhoeae]]||'''S'''
| Gram Negatives||[[N. gonorrhoeae]]||I
|-
|-
| ||[[N. meningitidis]]||X1
| ||[[N. meningitidis]]||'''S'''
|-
|-
| ||[[Moraxella catarrhalis]]||'''S'''
| ||[[Moraxella catarrhalis]]||'''S'''
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| ||E coli/Klebsiella KPC+||R
| ||E coli/Klebsiella KPC+||R
|-
|-
| ||[[Enterobacter]] sp, AmpC neg||R
| ||[[Enterobacter]] sp, AmpC neg||I
|-
|-
| ||[[Enterobacter]] sp, AmpC pos||R
| ||[[Enterobacter]] sp, AmpC pos||R
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| ||Serratia marcescens||X1
| ||Serratia marcescens||X1
|-
|-
| ||[[Salmonella]] sp||'''S'''
| ||[[Salmonella]] sp||X1
|-
|-
| ||[[Shigella]] sp||'''S'''
| ||[[Shigella]] sp||X1
|-
|-
| ||[[Proteus mirabilis]]||'''S'''
| ||[[Proteus mirabilis]]||'''S'''
|-
|-
| ||[[Proteus vulgaris]]||I
| ||[[Proteus vulgaris]]||'''S'''
|-
|-
| ||[[Providencia sp.]]||X1
| ||[[Providencia sp.]]||R
|-
|-
| ||[[Morganella sp.]]||R
| ||[[Morganella sp.]]||I
|-
|-
| ||[[Citrobacter freundii]]||R
| ||[[Citrobacter freundii]]||R
|-
|-
| ||[[Citrobacter diversus]]||X1
| ||[[Citrobacter diversus]]||I
|-
|-
| ||[[Citrobacter sp.]]||'''S'''
| ||[[Citrobacter sp.]]||I
|-
|-
| ||[[Aeromonas sp]]||X1
| ||[[Aeromonas sp]]||'''S'''
|-
|-
| ||[[Acinetobacter sp.]]||X1
| ||[[Acinetobacter sp.]]||R
|-
|-
| ||[[Pseudomonas aeruginosa]]||R
| ||[[Pseudomonas aeruginosa]]||R
|-
|-
| ||[[Burkholderia cepacia]]||X1
| ||[[Burkholderia cepacia]]||R
|-
|-
| ||[[Stenotrophomonas maltophilia]]||X1
| ||[[Stenotrophomonas maltophilia]]||R
|-
|-
| ||[[Yersinia enterocolitica]]||X1
| ||[[Yersinia enterocolitica]]||I
|-
|-
| ||[[Francisella tularensis]]||X1
| ||[[Francisella tularensis]]||X1
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| Anaerobes||[[Actinomyces]]||X1
| Anaerobes||[[Actinomyces]]||X1
|-
|-
| ||[[Bacteroides fragilis]]||X1
| ||[[Bacteroides fragilis]]||R
|-
|-
| ||[[Prevotella melaninogenica]]||X1
| ||[[Prevotella melaninogenica]]||'''S'''
|-
|-
| ||[[Clostridium difficile]]||X1
| ||[[Clostridium difficile]]||X1
|-
|-
| ||[[Clostridium (not difficile)]]||X1
| ||[[Clostridium (not difficile)]]||'''S'''
|-
|-
| ||[[Fusobacterium necrophorum]]||X1
| ||[[Fusobacterium necrophorum]]||X1
|-
|-
| ||[[Peptostreptococcus sp.]]||X1
| ||[[Peptostreptococcus sp.]]||'''S'''
|}
|}


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<references/>
<references/>


[[Category:Pharmacology]] [[Category:ID]]
[[Category:Pharmacology]]
[[Category:ID]]

Revision as of 12:13, 20 March 2026

General

  • Type: 2nd generation cephalosporin
  • Dosage Forms: tablet, powder for injection
  • Dosage Strength: tablet: 250mg, 500mg; powder for injection: 750mg, 1.5g, 7.5g, 75g, 225g
  • Routes of Administration: PO, IV, IM
  • Common Trade Names: Ceftin, Zinacef, Kefurox

Adult Dosing

Mild-Moderate Bacterial infections

  • 250-500mg PO BID x5-10 days

Steptococcal Pharyngitis/Tonsillitis

  • 250mg PO BID x10 days

Acute Maxillary Sinusitis

  • 250mg PO BID x10 days; Info: not recommended per IDSA guidelines

Uncomplicated Gonococcal Infections

  • 1000mg PO x1; Info: for infections of cervix, urethra, rectum; dual treatment for chlamydial co-infection recommended

Early Lyme Disease

  • 500mg PO BID x20 days

Renal Dosing

  • no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement

Hepatic Dosing

  • not defined


Indications by Disease

DiseaseDoseContext
Lyme disease500mg PO BID x 20 daysEarly Lyme disease, alternative
Neisseria gonorrhoeae1000mg PO x 1Uncomplicated urethral/cervical/rectal infection, alternative regimen
Pharyngitis250mg PO bid x10 daysPharyngitis/Tonsillitis, streptococcal
Pneumonia (main)500 mg BIDOutpatient, Unhealthy
Sinusitis250mg PO BID x 10 daysAlternative, not recommended per IDSA guidelines

Pediatric Dosing

Mild-Moderate Bacterial Infections

  • 3 mo-12 yo: Dose: 30mg/kg/day susp PO divided q12h x10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x10 days; Info: give susp with food
  • >13 yo: Dose: 250-500mg tab PO BID x5-10 days; Info: dose, duration varies by infection type, severity

Acute Otitis Media

  • 2 mo-5 yo Dose: 30mg/kg/day susp PO divided q12h x10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x10 days; Info: give susp with food
  • 6-12 yo: Dose: 30mg/kg/day susp PO divided q12h x5-10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x5-10 days; Info: give susp with food

Acute Maxillary Sinusitis

  • 3 mo-12 yo: Dose: 30mg/kg/day susp PO divided q12h x10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x10 days; Info: not recommended per IDSA guidelines; give susp with food
  • >13 yo: Dose: 250mg tab PO BID x10 days; Info: not recommended per IDSA guidelines

Streptococcal Pharyngitis/Tonsillitis

  • 3 mo-12 yo: Dose: 20mg/kg/day susp PO divided q12h x10 days; Max: 500mg/day; Info: give with food
  • >13 yo: Dose: 250mg tab PO BID x10 days

Uncomplicated Gonococcal Infections

  • adolescents: Dose: 1000mg tab PO x1; Info: for infections of cervix, urethra, rectum; dual treatment for chlamydial co-infection recommended

Early Lyme Disease

  • >13 yo: Dose: 500mg tab PO BID x20 days

Renal Dosing

  • 3 mo-12 yo: CrCl <10: 15mg/kg PO susp q24h; HD: give dose after dialysis, no supplement; PD: no supplement
  • >13 yo: renal impairment: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement

Hepatic Dosing

  • not defined


Indications by Disease

DiseaseDoseContext
Acute otitis media15mg/kg PO BID x7-10 daysPrior Month Treatment
Lyme disease30mg/kg/day PO divided BID x 20 days (max 500mg/dose)Early Lyme disease, alternative, >13yo
Pharyngitis250mg PO bid x10 days12+ yo, Pharyngitis/Tonsillitis, streptococcal
Sinusitis30mg/kg/day PO divided BID x 10 days (max 500mg/dose)Alternative, not recommended per IDSA guidelines

Special Populations

  • Pregnancy: B
  • Lactation: Probably Safe
  • Renal Dosing
    • Adult: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
    • Pediatric: 3 mo-12 yo: CrCl <10: 15mg/kg susp q24h; HD: give dose after dialysis, no supplement; PD: no supplement; >13 yo: renal impairment: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
  • Hepatic Dosing
    • Adult: Not defined
    • Pediatric: Not defined

Contraindications

  • Allergy to class/drug (See Cephalosporin Cross-reactivity)
  • Caution if hypersensitive to PCN
  • Caution if renal impairment
  • Caution if hepatic impairment
  • Caution if seizure disorder
  • Caution if malnutrition
  • Caution if recent antibiotic-associated colitis history

Adverse Reactions

Serious

Common

  • Diarrhea
  • Nausea/Vomiting
  • Jarisch-Herxheimer reaction
  • Vaginitis
  • Diaper Rash
  • ALT, AST elevated
  • Renal Impairment
  • Anemia

Pharmacology

  • Half-life: 1.4 hours, 3.5 hours (CrCl 35),
  • Metabolism: Minimal; CYP 450: unknown
  • Excretion: Urinary primarily (Up to 100% unchanged)
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium X1
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis I
C. jeikeium R
L. monocytogenes R
Gram Negatives N. gonorrhoeae I
N. meningitidis S
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg I
Enterobacter sp, AmpC pos R
Serratia sp R
Serratia marcescens X1
Salmonella sp X1
Shigella sp X1
Proteus mirabilis S
Proteus vulgaris S
Providencia sp. R
Morganella sp. I
Citrobacter freundii R
Citrobacter diversus I
Citrobacter sp. I
Aeromonas sp S
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica I
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp X1
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis R
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum X1
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014
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