CEFUROXIME SODIUM

CEFUROXIME SODIUM (se-fyoor-ox'eem) Zinacef CEFUROXIME AXETIL Ceftin Classifications: antibiotic; second-generation cephalosporin; Therapeutic: antibiotic; cephalosporin Prototype: Cefaclor 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

Action

Semisynthetic second-generation cephalosporin beta-lactam antibiotic. 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.

Therapeutic Effect

Resistance against beta-lactamase–producing strains exceeds that of first-generation cephalosporins. Similar to other second-generation cephalosporins, cefuroxime is more active against gram-negative bacteria than are the first-generation cephalosporins but not as active as the third-generation cephalosporins.

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; viral infections.

Cautious Use

History of allergy, particularly to drugs; penicillin sensitivity; renal insufficiency; history of colitis or other GI disease; potent diuretics; pregnancy (category B), lactation.

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 50–100 mg/kg/d divided q8h (max: 6 g/d) Bacterial Meningitis Adult: IV/IM 1.5–3 g q8h Child/Infant (>3 mo): IV/IM 200–240 mg/kg/d divided q6–8h; reduced to 100 mg/kg/d upon improvement Surgical Prophylaxis Adult/Adolescent: IV/IM 1.5 g 30–60 min before surgery, then 750 mg q8h for 24 h Renal Impairment Clcr 10–20 mL/min: give q12h; <10 mL/min: give q24h Hemodialysis: Give supplemental dose

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 8 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, ciprofloxacin, ranitidine. Y-site: aminoglycosides, azithromycin, cisatracurium, clarithromycin, filgrastim, fluconazole, midazolam, 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: 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% in 24 h; 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).

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