Cefuroxime

# Cefuroxime ## Overview - **Classification**: Second-generation cephalosporin antibiotic. - **Mechanism**: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to bacterial cell lysis. ## Primary Indications 1. **Community-Acquired Infections** - Respiratory tract infections (e.g., pharyngitis, tonsillitis, otitis media, sinusitis, bronchitis, pneumonia). 2. **Skin and Soft Tissue Infections** - Uncomplicated skin infections. 3. **Urinary Tract Infections** - Uncomplicated UTIs. 4. **Early Lyme Disease** - Treatment of early manifestations. 5. **Surgical Prophylaxis** - Prevention of surgical site infections. ## Adult Dosing ### Standard Dosing **Acute Bacterial Exacerbation of Chronic Bronchitis / Community-Acquired Pneumonia (Oral)** - **Dose**: **250 mg** or **500 mg** - **Frequency**: Twice daily (BID) - **Route**: Oral (PO) - **Duration**: 5-10 days **Pharyngitis / Tonsillitis (Oral)** - **Dose**: **250 mg** - **Frequency**: Twice daily (BID) - **Route**: Oral (PO) - **Duration**: 10 days **Uncomplicated Urinary Tract Infection (Oral)** - **Dose**: **250 mg** - **Frequency**: Twice daily (BID) - **Route**: Oral (PO) - **Duration**: 7-10 days **Early Lyme Disease (Oral)** - **Dose**: **500 mg** - **Frequency**: Twice daily (BID) - **Route**: Oral (PO) - **Duration**: 20 days **Surgical Prophylaxis (IV)** - **Dose**: **1.5 g** - **Frequency**: 30-60 min pre-op; may repeat 8h post-op - **Route**: Intravenous (IV) - **Special considerations**: Often combined with metronidazole for colorectal surgery. ### Dose Adjustments - **Renal Impairment**: - CrCl > 20 mL/min: No adjustment needed. - CrCl 10-20 mL/min: Standard dose every **24 hours**. - CrCl < 10 mL/min: Standard dose every **48 hours**. - Hemodialysis: Administer dose after dialysis. - **Hepatic Impairment**: No specific adjustment needed. - **Elderly Patients**: Adjust based on renal function, as age can decrease CrCl. ## Pediatric Dosing ### Neonates (0-28 days) - **Note**: Not routinely recommended due to potential for bilirubin displacement in jaundiced neonates. Consult infectious disease specialist if considered for severe infections. ### Infants (1-12 months) - **Indication**: Otitis Media, Pharyngitis, Other mild-moderate infections - **Dose**: **15 mg/kg** (oral) - **Frequency**: Twice daily (BID) - **Maximum**: **250 mg/dose** or **500 mg/day** (oral) - **Special Notes**: Administer oral suspension with food to enhance absorption. ### Children (1-12 years) - **Indication**: Otitis Media, Sinusitis (oral) - **Dose**: **15 mg/kg** (oral) - **Frequency**: Twice daily (BID) - **Maximum**: **250 mg/dose** (Max **500 mg/day**) - **Indication**: Pharyngitis/Tonsillitis (oral) - **Dose**: **125 mg** (oral) - **Frequency**: Twice daily (BID) - **Maximum**: **250 mg/day** - **Indication**: Early Lyme Disease (oral) - **Dose**: **15-20 mg/kg** (oral) - **Frequency**: Twice daily (BID) - **Maximum**: **500 mg/dose** - **Duration**: 20 days ### Adolescents (13-18 years) - **Dose**: Generally follow **adult dosing** recommendations. - **Maximum**: **Adult maximum doses**. - **Special Notes**: Administer with food. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to cefuroxime or other cephalosporins. - **Absolute**: History of severe hypersensitivity (e.g., anaphylaxis) to any beta-lactam antibiotic (e.g., penicillins). ### Common Adverse Effects - **Common (1-10%)**: Diarrhea, nausea, vomiting, abdominal pain. - **Common (1-10%)**: Headache, dizziness. - **Common (1-10%)**: Rash, candidiasis (oral/vaginal). - **Serious but Rare**: *Clostridioides difficile*-associated diarrhea (CDAD). - **Serious but Rare**: Severe hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis). - **Serious but Rare**: Seizures (especially with high doses or renal impairment). - **Serious but Rare**: Hemolytic anemia, neutropenia, thrombocytopenia. ### Key Drug Interactions - **Oral Contraceptives**: May decrease efficacy (advise backup method, although risk is low). - **Antacids/H2 blockers/PPIs**: May decrease absorption of oral cefuroxime axetil; administer cefuroxime at least 1 hour before or 2 hours after. - **Probenecid**: Increases and prolongs cefuroxime serum concentrations. - **Warfarin**: May enhance anticoagulant effect; monitor INR closely. - **Live Bacterial Vaccines (e.g., Typhoid)**: May decrease vaccine efficacy; avoid concurrent use. ## Monitoring & Follow-up - **Before Treatment**: Assess renal function (CrCl) if risk factors for impairment. - **During Treatment**: Monitor for signs of hypersensitivity reactions (e.g., rash, itching, swelling). - **During Treatment**: Monitor for diarrhea, especially if severe or persistent, for potential CDAD. - **Clinical Signs**: Resolution of infection symptoms (e.g., fever, pain, inflammation, discharge). ## Clinical Pearls - 💡 **Tip 1**: Oral cefuroxime axetil **must be administered with food** to maximize absorption and reduce gastrointestinal upset. - 💡 **Tip 2**: Cefuroxime is generally stable against many common bacterial beta-lactamases, making it effective against a broader spectrum than first-gen cephalosporins. - 💡 **Tip 3**: Counsel patients to complete the entire prescribed course of treatment, even if symptoms improve earlier. - 💡 **Tip 4**: For patients with a history of mild penicillin allergy (e.g., rash), cefuroxime may be cautiously used after risk assessment. Avoid in severe penicillin allergy. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.