Cefuroxime


Thông tin thuốc gốc
Chỉ định và Liều dùng
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.
Cách dùng
Oral Susp: Should be taken with food.
Tab: May be taken with or without food.
Hướng dẫn pha thuốc
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.
Tương kỵ
Aminoglycosides. Y-site: Azithromycin, filgrastim, fluconazole, midazolam, pantoprazole, vinorelbine.
Chống chỉ định
Hypersensitivity to cefuroxime or to other cephalosporins.
Thận trọng
History of hypersensitivity to penicillin, and GI disease (particularly colitis). Renal impairment. Pregnancy and lactation.
Phản ứng phụ
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.
Quá liều
Symptoms: Encephalopathy, convulsions and coma. Management: Haemodialysis or peritoneal dialysis may reduce serum levels.
Tương tác
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.
Tác dụng
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.
Đặc tính

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)

Bảo quản
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.
Phân loại MIMS
Phân loại ATC
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.

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