CEFUROXIME SODIUM
(se-fyoor-ox'eem)
Kefurox, Zinacef
CEFUROXIME AXETIL
Ceftin
Classifications: antiinfective; antibiotic; second-generation cephalosporin
Prototype: Cefonicid sodium
Pregnancy Category: B

Availability

125 mg, 250 mg, 500 mg tablets; 125 mg/5 mL, 250 mg/5 mL suspension; 750 mg, 1.5 g injection

Actions

Semisynthetic second-generation cephalosporin antibiotic with structure similar to that of the penicillins. Resistance against beta-lactamase-producing strains exceeds that of first generation cephalosporins. Antimicrobial spectrum of activity resembles that of cefonicid. Preferentially binds to one or more of the penicillin-binding proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall synthesis, thus killing the bacterium. Partial cross-allergenicity between other beta-lactam antibiotics and cephalosporins has been reported.

Therapeutic Effects

Effectively treats bone and joint infections, bronchitis, meningitis, gonorrhea, otitis media, pharyngitis/tonsillitis, sinusitis, lower respiratory tract infections, skin and soft tissue infections, urinary tract infections, and is used for surgical prophylaxis, reducing or eliminating infection.

Uses

Infections caused by susceptible organisms in the lower respiratory tract, urinary tract, skin, and skin structures; also used for treatment of meningitis, gonorrhea, and otitis media and for perioperative prophylaxis (e.g., open-heart surgery), early Lyme disease.

Contraindications

Hypersensitivity to cephalosporins and related antibiotics; pregnancy (category B), lactation.

Cautious Use

History of allergy, particularly to drugs; penicillin sensitivity; renal insufficiency; history of colitis or other GI disease; potent diuretics.

Route & Dosage

Moderate to Severe Infections
Adult: PO 250–500 mg q12h IV/IM 750 mg–1.5 g q6–8h
Child (3 mo–12 y) : PO 10–15 mg/kg (125–250 mg) q12h IV/IM 75–100 mg/kg/d divided q8h (max: 6 g/d)
Neonate: IM/IV 20–100 mg/kg/d divided q12h

Bacterial Meningitis
Adult: IV/IM 3 g q8h
Child: IV/IM 200–240 mg/kg/d divided q6–8h; reduced to 100 mg/kg/d upon improvement

Surgical Prophylaxis
Adult: IV/IM 1.5 g 30–60 min before surgery, then 750 mg q8h for 24 h
Child: IV/IM Same as for adult

Administration

Oral

Cefuroxime tablets and oral suspension are not substitutable on a mg-for-mg basis.
The oral suspension is for infants and children 3 mo to 12 y. Each teaspoon (5 mL) contains the equivalent of 125 mg cefuroxime. Shake oral suspension well before each use.

Intramuscular

Shake IM suspension gently before administration. IM injections should be made deeply into large muscle mass. Rotate injection sites.

Intravenous

IV administration to neonates, infants and children: Verify correct IV concentration and rate of infusion/injection with physician.

PREPARE: Direct: Dilute each 750 mg with 9 mL sterile water, D5W, or NS. Intermittent: Further dilute in 50–100 mL of compatible solution. Continuous: May be added to 1000 mL of IV compatible solution.

ADMINISTER: Direct: Give slowly over 3–5 min. Intermittent: Give over 30 min. Continuous: Give over 6–24 h.

INCOMPATIBILITIES Solution/additive: aminoglycosides, doxapram, ranitidine, sodium bicarbonate. Y-site: Amiodarone, aminoglycosides, azithromycin, filgrastim, fluconazole, midazolam, sodium bicarbonate, vancomycin, vinorelbine.

Cefuroxime powder and solutions of the drug may range in color from light yellow to amber without adversely affecting product potency.

Store powder protected from light unless otherwise directed. After reconstitution, store suspension at 2°–30° C (36°–86° F). Discard after 10 d.

Adverse Effects (1%)

Body as a Whole: Thrombophlebitis (IV site); pain, burning, cellulitis (IM site); superinfections, positive Coombs' test. GI: Diarrhea, nausea, antibiotic-associated colitis. Skin: Rash, pruritus, urticaria. Urogenital: Increased serum creatinine and BUN, decreased creatinine clearance.

Diagnostic Test Interference

Cefuroxime causes false-positive (black-brown or green-brown color) urine glucose reaction with copper reduction reagents, e.g., Benedict's or Clinitest, but not with enzymatic glucose oxidase reagents, e.g., Clinistix, TesTape. False-positive direct Coombs' test (may interfere with cross-matching procedures and hematologic studies) has been reported.

Interactions

Drug: Probenecid decreases renal elimination of cefuroxime, thus prolonging its action.

Pharmacokinetics

Absorption: Axetil salt well absorbed from GI tract; hydrolyzed to active drug in GI mucosa. Peak: PO 2 h; IM 30 min. Distribution: Widely distributed in body tissues and fluids; adequate CNS penetration with inflamed meninges; crosses placenta. Elimination: 66–100% excreted in urine in 24 h; excreted in breast milk. Half-Life: 1–2 h.

Nursing Implications

Assessment & Drug Effects

Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to drugs, before therapy is initiated.
Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated. Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance.
Inspect IM and IV injection sites frequently for signs of phlebitis.
Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms, Appendix F) rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy.
Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their appearance promptly.
Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant changes.

Patient & Family Education

Report loose stools or diarrhea promptly.
Report any signs or symptoms of hypersensitivity (see Appendix F).
Do not breast feed while taking this drug.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug