Cefuroxime

ADMINISTRATION ROUTES:

PO, IV or IM

ALTERNATIVE NAMES:

Zinacef, Zinnat

ICU INDICATIONS:

1. Treatment of infections caused by susceptible organisms

PRESENTATION AND ADMINISTRATION:

IV:

750 mg and 1.5 gm vials of powder

Add at least 6 mL of water to 750 mg vial or 15 mL water to 1.5 gm vial. Shake gently until all powder is dissolved. Inject slowly over 3-5 minutes

If dose does not equal vial size, prepare as follows to obtain desired dose:

Store at room temperature

Compatible with: Normal saline, glucose and sodium chloride, 5% dextrose, Hartmanns

Do NOT mix with sodium bicarbonate; however, if required, can be given into the tubing of a sodium bicarbonate infusion

IM:

Reconstitute with 3 mL of 1% lignocaine or 3 mL water to make an opaque suspension. Inject into a large muscle mass. Single doses of more than 750 mg must not be given at one site.

PO:

Zinnat 250 mg tablets (white)

DOSAGE:

IV:

750 mg-1.5 gm TDS

PO:

Pneumonia: 500 mg PO BD (not appropriate initial therapy in Intensive Care)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose in renal impairment

Dose in renal replacement therapy

Note: oral cefuroxime should be dosed as in normal renal function

DOSAGE IN PAEDIATRICS:

IV:

Severe infection: 50 mg/kg (max 2 gm) BD (1st week of life), TDS (2nd week of life), QID (> 2nd week of life)

PO:

10-15 mg/kg BD

CLINICAL PHARMACOLOGY:

Cefuroxime is a second generation cephalosporin with in vitro activity against a wide range of gram-positive and gram-negative organisms. The bactericidal action of cefuroxime results from inhibition of cell-wall synthesis.

Cefuroxime is usually active against the following organisms in vitro:

Aerobes, Gram-Positive:

• Staphylococcus aureus
• Staphylococcus epidermidis
• Streptococcus pneumoniae
• Streptococcus pyogenes
• other Streptococci

Note: most strains of enterococci including Enterococcus faecalis (formerly Streptococcus faecalis) are resistant to cefuroxime. Methicillin-resistant staphylococci and Listeria monocytogenes are resistant to cefuroxime

Aerobes, Gram-Negative:

• Citrobacter spp.
• Enterobacter spp.
• Escherichia coli
• Haemophilus influenzae (including ampicillin-resistant strains)
• Haemophilus parainfluenzae
• Klebsiella spp. (including Klebsiella pneumoniae)
• Moraxella (Branhamella) catarrhalis (including ampicillin- and cephalothin-resistant strains)
• Morganella morganii (formerly Proteus morganii)
• Neisseria gonorrhoeae (including penicillinase- and non-penicillinase-producing strains)
• Neisseria meningitidis
• Proteus mirabilis
• Providencia rettgeri (formerly Proteus rettgeri)
• Salmonella spp.
• Shigella spp.

Note: some strains of Morganella morganii, Enterobacter cloacae, and Citrobacter spp. have been shown by in vitro tests to be resistant to cefuroxime and other cephalosporins. Pseudomonas and Campylobacter spp., Acinetobacter calcoaceticus, and most strains of Serratia spp. and Proteus vulgaris are resistant to most first- and second-generation cephalosporins.

Anaerobes:

• Gram-positive and gram-negative cocci (including Peptococcus and Peptostreptococcus spp.)
• Gram-positive bacilli (including Clostridium spp.)
• Gram-negative bacilli (including Bacteroides and Fusobacterium spp.)

Note: Clostridium difficile and most strains of Bacteroides fragilis are resistant to cefuroxime

CONTRAINDICATIONS:

1. Hypersensitivity to cephalosporins

WARNINGS:

Anaphylaxis

Cephalosporins are a common cause of anaphylactic reactions and cross reactivity with penicillins may occur

Pseudomembranous colitis

Pseudomembranous colitis has been reported with nearly all antibacterial agents, including cefotaxime, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents

PRECAUTIONS:

General:

Prescribing Cefuroxime in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Positive direct Coombs' tests have been reported during treatment with the cephalosporin antibiotics. It should be recognised that a positive Coombs' test may be due to the drug.

Laboratory Tests:

No tests additional to usual ICU tests are required

Drug/Laboratory Test Interactions:

A false-positive reaction for glucose in the urine may occur with copper reduction tests (Benedict's or Fehling's solution or with CLINITEST tablets) but not with enzyme-based tests for glycosuria. As a false-negative result may occur in the ferricyanide test, it is recommended that either the glucose oxidase or hexokinase method be used to determine blood plasma glucose levels in patients receiving Cefuroxime

IMPORTANT DRUG INTERACTIONS IN ICU:

None of note

ADVERSE REACTIONS:

Body as a Whole:

Drug fever

Haematological System:

Positive Coombs' test, thrombocytopaenia

Urogenital System:

Interstitial nephritis

Digestive System:

Diarrhoea, nausea, hepatitis, cholestasis

Nervous System:

Seizure

Skin:

Thrombophlebitis, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis

Cephalosporin-Class Adverse Reactions:

In addition to the adverse reactions listed above that have been observed in patients treated with cefaclor, the following reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics: fever, abdominal pain, superinfection, renal dysfunction, toxic nephropathy, haemorrhage, false positive test for urinary glucose, elevated bilirubin, elevated LDH, and pancytopaenia.

Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced. If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated