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Cefuroxime sodium

Intravenous
Intramuscular
Class
Antibiotics
Subclass
Cephalosporins
Substance name
Cefuroxime sodium
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Treatment
Acute bacterial meningitis • Life-threatening
•
Maintenance: 1.5 g IV q6h
•
Maximum: 9 g per day
Lower respiratory tract infections
•
750-1,500 mg IV q8h for 5-10 days
UTIs
•
750-1,500 mg IV q8h for 5 to 10 days
Prevention
Prevention of postoperative infection, before cardiopulmonary bypass
•
Loading: 1,500 mg IV once
•
Maintenance: 1,500 mg IV q12h for a total delivery of 6 g of the drug
Indications for use
Labeled indications
Adults
•
Treatment of acute bacterial meningitis (life-threatening)
•
Treatment of bacterial meningitis
•
Treatment of bone and joint infections
•
Treatment of lower respiratory tract infections
•
Treatment of lower respiratory tract infections (very severe, life-threatening)
•
Treatment of SSTIs
•
Treatment of SSTIs (severe, life-threatening)
•
Treatment of UTIs
•
Prevention of postoperative infection
•
Prevention of postoperative infection, before cardiopulmonary bypass
Safety risks
Contraindications
Hypersensitivity to cefuroxime, cephalosporin or or to other β-lactams (e.g., penicillins and cephalosporins)
Warnings and precautions
Antimicrobial resistance
•
Use caution in patients using cefuroxime in absence of a proven or strongly suspected bacterial infection or a prophylactic indication.
Penicillin allergy
•
Use caution in patients with hypersensitivity to penicillin.
Pseudomembranous colitis
•
Maintain a high level of suspicion, as Clostridium difficile associated diarrhea is reported with use of cefuroxime, and may present as mild diarrhea to more severe colitis.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-20 mL/min/1.73 m²
•
Start at dose of 750 mg. Maximal dose of 1,500 mg. Do not exceed frequency of q12h.
eGFR < 10 mL/min/1.73 m²
•
Start at dose of 750 mg. Do not exceed frequency of q24h.
Renal replacement therapy
Continuous renal replacement
•
Reduce dose. Dose as in eGFR 10-20 mL/min/1.73 m². Start at a dose of 750 mg. Maximal dose of 1.5 gm. Maximal frequency of q12h.
Intermittent hemodialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Start at a dose of 750 mg. Maximal dose of 1.5 gm. Maximal frequency of q24h.
Peritoneal dialysis
•
Reduce dose. Dose as in eGFR < 10 mL/min/1.73 m². Start at a dose of 750 mg. Maximal dose of 1.5 gm. Maximal frequency of q24h.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B1
•
Use only if benefits outweigh potential risks.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
Adverse reactions
Very common > 10%
•
Diarrhea
Common 1-10%
•
Cholestasis, ↓ WBC count, ↓ blood neutrophil count, ↓ platelet count, diaper rash, erythema multiforme, hemolytic anemia, ↑ blood eosinophil count, ↑ liver enzymes, interstitial nephritis, jaundice, leukorrhea, oral ulcers, pancytopenia, phlebitis, abdominal pain, arthralgia, chest pain, chills, cough, dizziness, drowsiness, dyspepsia, dyspnea, dysuria, fever, flatulence, headache, itching, loss of appetite, muscle cramps, nausea, restlessness, seizure, skin rash, vomiting, serum sickness, sinus tachycardia, skin erythema, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria, vaginal discharge, vasculitis
Uncommon < 1%
•
↑ serum TBIL
Unknown frequency
•
Acute generalized exanthematous pustulosis, agranulocytosis, aplastic anemia, ↑ BUN, ischemic heart disease, Jarisch-Herxheimer reaction, myocardial infarction, pseudomembranous colitis
Interactions
Drug(s)
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