Cefuroxime


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Susceptible infections 250 or 500 mg 12 hourly for 7-10 days. Uncomplicated UTI 250 mg 12 hourly for 7-10 days. Resp tract infections 250 - 500 mg 12 hourly for 7-10 days. Lyme disease 500 mg bid for 20 days. Uncomplicated gonorrhoea 1 g as a single dose. May be given w/ oral probenecid 1 g. IM/IV Susceptible infections 0.75 g 8 hrly, may increase up to 1.5 g 6-8 hrly in more severe infections. Pneumonia 1.5 g bid, followed by an oral dose of 0.5 g bid. Acute exacerbations of chronic bronchitis 750 mg bid, followed by an oral dose 500 mg bid. Prophylaxis of surgical infections  1 or 2 g may be given 0.5 to 2 hours prior to surgery via deep IM inj or slow IV inj over at least 2-4 minutes. IV Meningitis 3 g 8 hrly. IM Gonorrhoea 1.5 g as a single dose divided between 2 inj sites. May be given w/ oral probenecid 1 g.
Dosage Details
Intramuscular
Gonorrhoea
Adult: As cefuroxime Na: 1.5 g as a single dose divided between 2 inj sites. May be given w/ oral probenecid 1 g.

Intravenous
Meningitis
Adult: As cefuroxime Na: 3 g 8 hrly.
Child: ≤3 wk 30-100 mg/kg daily by IV inj given as 2 or 3 divided doses; >3 wk <40 kg: 30-100 mg/kg daily by IV inj given as 3 or 4 divided doses; 60 mg/kg daily to most infections.

Oral
Susceptible infections
Adult: As cefuroxime axetil: 250 or 500 mg 12 hourly for 7-10 days.
Child: >3 months weighing <40 kg: 15 mg/kg 12 hourly for 7-10 days. Max: 250 mg 12 hourly.

Oral
Uncomplicated urinary tract infections
Adult: 250 mg 12 hourly for 7-10 days.
Child: >3 mth to 2 yr 10 mg/kg bid. Max 125 mg bid; >2 yr 15 mg/kg bid. Max: 250 mg bid.

Oral
Respiratory tract infections
Adult: 250 - 500 mg 12 hourly for 7-10 days.
Child: >3 months 10 mg/kg 12 hourly. Max: 125 mg 12 houry for 7-10 days

Oral
Uncomplicated gonorrhoea
Adult: As cefuroxime axetil: 1 g as a single dose. May be given w/ oral probenecid 1 g.

Oral
Lyme disease
Adult: As cefuroxime axetil: 500 mg bid for 20 days.
Child: >3 mth to 2 yr 10 mg/kg bid. Max 125 mg bid; >2 yr 15 mg/kg bid. Max: 250 mg bid.

Parenteral
Prophylaxis of surgical infections
Adult: 1.5 g IV before the procedure followed by 750 mg IM 8 hrly for up to 24-48 hr depending on the procedure. For total joint replacement: 1.5 g, may be mixed w/ methylmethacrylate cement.

Parenteral
Susceptible infections
Adult: As cefuroxime Na: 0.75 g 8 hrly, by deep IM or slow IV inj over 3-5 min or IV infusion, may increase up to 1.5 g 6-8 hrly in more severe infections.
Child: ≤3 wk 30-100 mg/kg daily by IV inj given as 2 or 3 divided doses; >3 wk <40 kg: 30-100 mg/kg daily by IV inj given as 3 or 4 divided doses; 60 mg/kg daily to most infections.

Parenteral
Pneumonia
Adult: 1.5 g bid by deep IM or slow IV inj over 3-5 min or IV infusion, followed by an oral dose 0.5 g bid.
Child: ≤3 wk 30-100 mg/kg daily by IV inj given as 2 or 3 divided doses; >3 wk <40 kg: 30-100 mg/kg daily by IV inj given as 3 or 4 divided doses; 60 mg/kg daily to most infections.

Parenteral
Acute exacerbations of chronic bronchitis
Adult: 750 mg bid by deep IM or slow IV inj over 3-5 min or IV infusion, followed by an oral dose 500 mg bid.
Child: ≤3 wk 30-100 mg/kg daily by IV inj given as 2 or 3 divided doses; >3 wk <40 kg: 30-100 mg/kg daily by IV inj given as 3 or 4 divided doses; 60 mg/kg daily to most infections.
Renal Impairment
Patients on haemodialysis should receive an additional 750-mg dose after each dialysis. Patients on continuous peritoneal dialysis may be given 750 mg bid.
CrCl (mL/min)
Dosage
<10 750 mg once daily.
10-20 750 mg bid.
Administration
Oral Susp: Should be taken with food.
Tab: May be taken with or without food.
Reconstitution
Powd for oral susp: Tap the bottle thoroughly to loosen the powd. Add the amount of water specified on the bottle to provide a susp containing 125 mg or 250 mg per 5 mL. Shake the bottle after addition. Powd for inj: Add 8 mL or 16 mL of sterile water for inj to a vial labelled as 0.75 g or 1.5 g, respectively, to provide a soln containing approx 90 mg/mL. For IV infusion: Reconstitute 50 mL or 100 mL of dextrose 5% inj, NaCl 0.9% inj or NaCl 0.45% inj to a vial labelled as 0.75 g or 1.5 g to a suitable container.
Incompatibility
Aminoglycosides. Y-site: Azithromycin, filgrastim, fluconazole, midazolam, pantoprazole, vinorelbine.
Contraindications
Hypersensitivity to cefuroxime or to other cephalosporins.
Special Precautions
History of hypersensitivity to penicillin, and GI disease (particularly colitis). Renal impairment. Pregnancy and lactation.
Adverse Reactions
Rash, fever, pruritus, erythema, urticaria, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, serum sickness-like reactions, angioedema; mild to moderate hearing loss (childn); nausea, vomiting, gagging, epigastric burning, GI bleeding and infection, abdominal pain, flatulence, ptyalism, indigestion, mouth ulcers, swollen tongue, anorexia, thirst, dyspepsia, stomach cramps, diarrhoea; decreased Hb and haematocrit, thrombocytosis, lymphocytosis, haemolytic anaemia, increased prothrombin time; transient increase in serum AST (SGOT), ALT (SGPT), alkaline phosphatase, LDH and bilirubin levels; transient increase in BUN and/or serum creatinine concentration, decreased CrCl, bilateral renal cortical necrosis; UTI, kidney pain, urethral pain or bleeding, dysuria, vaginitis, vag candidiasis, vulvovaginal pruritus, vag discharge or irritation; Jarisch-Herxheimer reaction; neck muscle spasm, muscle cramps or stiffness, chest pain or tightness, shortness of breath, tachycardia, chills, lockjaw-type reaction, viral illness, upper resp infection, sinusitis, cough, joint swelling, arthralgia; pain at inj site, thrombophlebitis (IV). Rarely, transient eosinophilia and neutropenia, pancytopenia, leucopenia, thrombocytopenia; headache, somnolence or sleepiness, dizziness, hyperactivity, irritable behaviour, myoclonic jerks, seizures, generalised hyperexcitability; jaundice; acute renal failure, interstitial nephritis.
Potentially Fatal: Anaphylaxis, pseudomembranous colitis.
IM/IV/Parenteral/PO: B
MonitoringParameters
Monitor renal, hepatic and haematologic function periodically. Monitor prothrombin time in patients at risk of prolongation. Observe for signs and symptoms of anaphylaxis during 1st dose.
Overdosage
Symptoms: Encephalopathy, convulsions and coma. Management: Haemodialysis or peritoneal dialysis may reduce serum levels.
Drug Interactions
May enhance the nephrotoxic effect of strong-acting diuretics (e.g. furosemide) and aminoglycosides. May enhance the effect of oral anticoagulants. May reduce the efficacy of OCs. Probenecid prolongs the excretion of cefuroxime and elevated peak serum level.
Food Interaction
May enhance absorption w/ food.
Lab Interference
Positive direct antiglobulin (Coombs') test. Slight interference w/ copper reduction methods (Benedict's, Fehling's, Clinitest®). False-negative result in ferricyanide test.
Action
Description: Cefuroxime inhibits bacterial cell wall synthesis by binding to one 1 or more of the penicillin-binding proteins (PBPs) which in turn inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
Pharmacokinetics:
Absorption: Absorbed from the GI tract. Enhanced by the presence of food. Time to peak plasma concentration: Approx 2-3 hr (oral); 45 min (IM).
Distribution: Widely distributed into the body (including pleural fluid, synovial fluid, aqueous humour, sputum, bone), CSF even on inflamed meninges. Crosses the placenta and enters breast milk. Plasma protein binding: Up to 50%.
Excretion: Via urine (66-100% as unchanged drug); bile (small amounts). Plasma half-life: Approx 70 min.
Chemical Structure

Chemical Structure Image
Cefuroxime

Source: National Center for Biotechnology Information. PubChem Database. Cefuroxime, CID=41375, https://pubchem.ncbi.nlm.nih.gov/compound/Cefuroxime (accessed on Jan. 21, 2020)

Storage
Tab: Store between 15-30°C. Powd for oral susp: Store between 2-30°C. After reconstitution: Store between 2-8°C. Powd for inj: Store between 15-30°C. After reconstitution: Store between 2-8°C. Protect from light.
MIMS Class
ATC Classification
J01DC02 - cefuroxime ; Belongs to the class of second-generation cephalosporins. Used in the systemic treatment of infections.
S01AA27 - cefuroxime ; Belongs to the class of second-generation cephalosporins. Used in the treatment of eye infections.
References
Anon. Cefuroxime. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 14/10/2014.

Buckingham R (ed). Cefuroxime. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 13/10/2014.

Ceftin Powder for suspension, Tablet, Film Coated (GlaxoSmithKline LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 13/10/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Cefuroxime Axetil, Cefuroxime Sodium . AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 13/10/2014.

Disclaimer: This information is independently developed by MIMS based on Cefuroxime from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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