Cefuroxime

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 PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumX1
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisI
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeI
N. meningitidisS
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negI
Enterobacter sp, AmpC posR
Serratia spR
Serratia marcescensX1
Salmonella spX1
Shigella spX1
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.R
Morganella sp.I
Citrobacter freundiiR
Citrobacter diversusI
Citrobacter sp.I
Aeromonas spS
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaI
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaS
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisR
Prevotella melaninogenicaS
Clostridium difficileX1
Clostridium (not difficile)S
Fusobacterium necrophorumX1
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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