Cefuroxime

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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 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