Cefuroxime: Difference between revisions
 
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==General==
==General==
*Type: 2nd generation [[cephalosporin]]
*Type: 2nd generation [[cephalosporin]]
*Dosage Forms: PO
*Dosage Forms: tablet, powder for injection
*Common Trade Names: Ceftin
*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


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


==Special Populations==
==Special Populations==
*Pregnancy:
*Pregnancy: B
*Lactation:
*Lactation: Probably Safe
*Renal Dosing
*Renal Dosing
**Adult
**Adult: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
**Pediatric
**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
*Hepatic Dosing
**Adult
**Adult: Not defined
**Pediatric
**Pediatric: Not defined


==Contraindications==
==Contraindications==
*Allergy to class/drug
*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==
==Adverse Reactions==
===Serious===
===Serious===
 
*[[Anaphylaxis]]
*[[Angioedema]]
*[[TEN|Toxic epidermal necrolysis]]
*[[Stevens-Johnson Syndrome|Stevens-Johnson syndrome]]
*Interstitial nephritis
*Pancytopenia
*[[Thrombocytopenia]]
*Agranulocytosis
*Leukopenia
*Neutropenia
*Hemolytic Anemia
*[[Seizures]]
*[[Clostridium difficile]] associated diarrhea
===Common===
===Common===
*[[Diarrhea]]
*Nausea/Vomiting
*Jarisch-Herxheimer reaction
*[[Vaginitis]]
*Diaper Rash
*ALT, AST elevated
*Renal Impairment
*Anemia


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 1.4 hours, 3.5 hours (CrCl 35),
*Metabolism:  
*Metabolism: Minimal; CYP 450: unknown
*Excretion:  
*Excretion: Urinary primarily (Up to 100% unchanged)
*Mechanism of Action:
*Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''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===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
<references/>


<references/>
[[Category:Pharmacology]]
[[Category:Drugs]]
[[Category:ID]]

Latest revision as of 22:04, 19 September 2019

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

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

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

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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