Diferencia entre revisiones de «Cefuroxime»

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==General==
==General==
*Type: [[Is Generation::2nd generation]] [[Is DrugClass::cephalosporin]]
*Type: [[Is Generation::3rd generation]] [[Is DrugClass::cephalosporin]]
*Dosage Forms: tablet, powder for injection
*Dosage Forms: tablet  
*Dosage Strength: tablet: 250mg, 500mg; powder for injection: 750mg, 1.5g, 7.5g, 75g, 225g
*Dosage Strengths: 200, 400mg
*Routes of Administration: PO, IV, IM
*Routes of Administration: PO
*Common Trade Names: Ceftin, Zinacef, Kefurox
*Common Trade Names: Spectracef


==Adult Dosing==
==Adult Dosing==
===Chronic [[Bronchitis]], Acute bacterial exacerbation===
*400 mg PO bid x10 days
===[[Pneumonia]], community-acquired===
*400 mg PO bid for at least 5 days
**May D/C after five days if afebrile x48-72 hours
===[[Pharyngitis]]/Tonsillitis, streptococcal===
*200mg PO bid x10 days
===Skin infection===
*200 mg PO bid x10 days
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Cefuroxime]] [[Has Population::Adult]]
{{#ask: [[Has DrugName::Cefuroxime]] [[Has Population::Adult]]
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|?Treats disease=Disease
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|?Has Dose=Dose
|?Has Context=Context
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|mainlabel=-
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}}


==Pediatric Dosing==
==Pediatric Dosing==
===12+ yo, Chronic [[Bronchitis]], Acute bacterial exacerbation===
*400 mg PO bid x10 days
===12+ yo, [[Pneumonia]], community-acquired===
*400 mg PO bid x14 days
===12+ yo, [[Pharyngitis]]/Tonsillitis, streptococcal===
*200mg PO bid x10 days
===12+ yo, Skin infection===
*200 mg PO bid x10 days
===Indications by Disease===
===Indications by Disease===
{{#ask: [[Has DrugName::Cefuroxime]] [[Has Population::Pediatric]]
{{#ask: [[Has DrugName::Cefuroxime]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Dose=Dose
|?Has Context=Context
|?Has Context=Context
|format=table
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|mainlabel=-
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==Special Populations==
==Special Populations==
*Pregnancy: B
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: B; May use during pregnancy
*Lactation: Probably Safe
*Lactation: May use while breastfeeding
*Renal Dosing
*Renal Dosing
**Adult: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
**Adult
**Pediatric: 3 mo-12 yo: CrCl <10: 15mg/kg susp q24h; HD: give dose after dialysis, no supplement; PD: no supplement; >13 yo: renal impairment: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
***CrCl 30-49: Max 200mg bid
***CrCl <30:   Max 200mg qd
***ESRD/HD:   Not defined
**Pediatric
***CrCl 30-49: Max 200mg bid
***CrCl <30:   Max 200mg qd
***ESRD/HD:   Not defined
*Hepatic Dosing
*Hepatic Dosing
**Adult: Not defined
**Adult
**Pediatric: Not defined
***Child-Pugh Class A or B: No adjusment
***Child-Pugh Class C: Not defined
**Pediatric
***Child-Pugh Class A or B: No adjusment
***Child-Pugh Class C: Not defined


==Contraindications==
==Contraindications==
*Allergy to class/drug (See [[Cephalosporin Cross-reactivity]])
*Allergy to class/drug
*Caution if hypersensitive to [[PCN]]
*Hypersensitivity to milk proteins
*Caution if renal impairment
*Carnitine deficiency
*Caution if hepatic impairment
*Caution:
*Caution if seizure disorder
**Hypersensitivity to PCN
*Caution if malnutrition
**Renal impairment
*Caution if recent antibiotic-associated colitis history
**Decreased muscle mass
**Recent abx-associated colitis


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===Serious===
*[[Anaphylaxis]]
*[[Anaphylaxis]]
*[[Angioedema]]
*Serum-sickness like reaction
*[[TEN|Toxic epidermal necrolysis]]
*[[Stevens-Johnson syndrome]]
*[[Stevens-Johnson Syndrome|Stevens-Johnson syndrome]]
*[[Erythema multiforme]]
*Interstitial nephritis
*[[Toxic epidermal necrolysis]]
*Pancytopenia
*[[Leukopenia]]
*[[Neutropenia]]
*[[Thrombocytopenia]]
*[[Thrombocytopenia]]
*Agranulocytosis
*[[Anemia]], hemolytic
*Leukopenia
*[[Seizure]]
*Neutropenia
*Nephrotoxicity
*Hemolytic Anemia
*Cholestatic [[jaundice]]
*[[Seizures]]
*C. difficle-associated diarrhea
*[[Clostridium difficile]] associated diarrhea
*Super infection
*Carnitine deficiency (long-term use)
 
===Common===
===Common===
*[[Diarrhea]]
*[[Diarrhea]]
*Nausea/Vomiting
*[[Nausea]]
*Jarisch-Herxheimer reaction
*[[Headache]]
*[[Vaginitis]]
*[[Abdominal pain]]
*Diaper Rash
*Candidiasis, vulvovaginal
*ALT, AST elevated
*Dyspepsia
*Renal Impairment
*Anemia


==Pharmacology==
==Pharmacology==
*Half-life: 1.4 hours, 3.5 hours (CrCl 35),
*Half-life: 1.6h; 4.7h in severe renal impairment
*Metabolism: Minimal; CYP 450: unknown
*Metabolism: Minimal
*Excretion: Urinary primarily (Up to 100% unchanged)
*Excretion: Urine primarily
*Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis
*Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis


Línea 108: Línea 141:
| ||[[Staph. Epidermidis]]||I
| ||[[Staph. Epidermidis]]||I
|-
|-
| ||[[C. jeikeium]]||R
| ||[[C. jeikeium]]||X1
|-
|-
| ||[[L. monocytogenes]]||R
| ||[[L. monocytogenes]]||R
|-
|-
| Gram Negatives||[[N. gonorrhoeae]]||I
| Gram Negatives||[[N. gonorrhoeae]]||'''S'''
|-
|-
| ||[[N. meningitidis]]||'''S'''
| ||[[N. meningitidis]]||X1
|-
|-
| ||[[Moraxella catarrhalis]]||'''S'''
| ||[[Moraxella catarrhalis]]||'''S'''
Línea 128: Línea 161:
| ||E coli/Klebsiella KPC+||R
| ||E coli/Klebsiella KPC+||R
|-
|-
| ||[[Enterobacter]] sp, AmpC neg||I
| ||[[Enterobacter]] sp, AmpC neg||R
|-
|-
| ||[[Enterobacter]] sp, AmpC pos||R
| ||[[Enterobacter]] sp, AmpC pos||R
Línea 136: Línea 169:
| ||Serratia marcescens||X1
| ||Serratia marcescens||X1
|-
|-
| ||[[Salmonella]] sp||X1
| ||[[Salmonella]] sp||'''S'''
|-
|-
| ||[[Shigella]] sp||X1
| ||[[Shigella]] sp||'''S'''
|-
|-
| ||[[Proteus mirabilis]]||'''S'''
| ||[[Proteus mirabilis]]||'''S'''
|-
|-
| ||[[Proteus vulgaris]]||'''S'''
| ||[[Proteus vulgaris]]||I
|-
|-
| ||[[Providencia sp.]]||R
| ||[[Providencia sp.]]||X1
|-
|-
| ||[[Morganella sp.]]||I
| ||[[Morganella sp.]]||R
|-
|-
| ||[[Citrobacter freundii]]||R
| ||[[Citrobacter freundii]]||R
|-
|-
| ||[[Citrobacter diversus]]||I
| ||[[Citrobacter diversus]]||X1
|-
|-
| ||[[Citrobacter sp.]]||I
| ||[[Citrobacter sp.]]||'''S'''
|-
|-
| ||[[Aeromonas sp]]||'''S'''
| ||[[Aeromonas sp]]||X1
|-
|-
| ||[[Acinetobacter sp.]]||R
| ||[[Acinetobacter sp.]]||X1
|-
|-
| ||[[Pseudomonas aeruginosa]]||R
| ||[[Pseudomonas aeruginosa]]||R
|-
|-
| ||[[Burkholderia cepacia]]||R
| ||[[Burkholderia cepacia]]||X1
|-
|-
| ||[[Stenotrophomonas maltophilia]]||R
| ||[[Stenotrophomonas maltophilia]]||X1
|-
|-
| ||[[Yersinia enterocolitica]]||I
| ||[[Yersinia enterocolitica]]||X1
|-
|-
| ||[[Francisella tularensis]]||X1
| ||[[Francisella tularensis]]||X1
Línea 188: Línea 221:
| Anaerobes||[[Actinomyces]]||X1
| Anaerobes||[[Actinomyces]]||X1
|-
|-
| ||[[Bacteroides fragilis]]||R
| ||[[Bacteroides fragilis]]||X1
|-
|-
| ||[[Prevotella melaninogenica]]||'''S'''
| ||[[Prevotella melaninogenica]]||X1
|-
|-
| ||[[Clostridium difficile]]||X1
| ||[[Clostridium difficile]]||X1
|-
|-
| ||[[Clostridium (not difficile)]]||'''S'''
| ||[[Clostridium (not difficile)]]||X1
|-
|-
| ||[[Fusobacterium necrophorum]]||X1
| ||[[Fusobacterium necrophorum]]||X1
|-
|-
| ||[[Peptostreptococcus sp.]]||'''S'''
| ||[[Peptostreptococcus sp.]]||X1
|}
|}


Línea 210: Línea 243:
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[[Category:Pharmacology]]
[[Category:Pharmacology]] [[Category:ID]]
[[Category:ID]]

Revisión del 02:39 20 mar 2026

General

  • Type: 3rd generation cephalosporin
  • Dosage Forms: tablet
  • Dosage Strengths: 200, 400mg
  • Routes of Administration: PO
  • Common Trade Names: Spectracef

Adult Dosing

Chronic Bronchitis, Acute bacterial exacerbation

  • 400 mg PO bid x10 days

Pneumonia, community-acquired

  • 400 mg PO bid for at least 5 days
    • May D/C after five days if afebrile x48-72 hours

Pharyngitis/Tonsillitis, streptococcal

  • 200mg PO bid x10 days

Skin infection

  • 200 mg PO bid x10 days


Indications by Disease

DiseaseDoseContext
Lyme disease500mg PO BID x 20 daysEarly Lyme disease, alternative
Neisseria gonorrhoeae1000mg PO x 1Uncomplicated urethral/cervical/rectal infection, alternative regimen
Pharyngitis250mg PO bid x10 daysPharyngitis/Tonsillitis, streptococcal
Pneumonia (main)500 mg BIDOutpatient, Unhealthy
Sinusitis250mg PO BID x 10 daysAlternative, not recommended per IDSA guidelines

Pediatric Dosing

12+ yo, Chronic Bronchitis, Acute bacterial exacerbation

  • 400 mg PO bid x10 days

12+ yo, Pneumonia, community-acquired

  • 400 mg PO bid x14 days

12+ yo, Pharyngitis/Tonsillitis, streptococcal

  • 200mg PO bid x10 days

12+ yo, Skin infection

  • 200 mg PO bid x10 days


Indications by Disease

DiseaseDoseContext
Acute otitis media15mg/kg PO BID x7-10 daysPrior Month Treatment
Lyme disease30mg/kg/day PO divided BID x 20 days (max 500mg/dose)Early Lyme disease, alternative, >13yo
Pharyngitis250mg PO bid x10 days12+ yo, Pharyngitis/Tonsillitis, streptococcal
Sinusitis30mg/kg/day PO divided BID x 10 days (max 500mg/dose)Alternative, not recommended per IDSA guidelines

Special Populations

  • Pregnancy Rating: B; May use during pregnancy
  • Lactation: May use while breastfeeding
  • Renal Dosing
    • Adult
      • CrCl 30-49: Max 200mg bid
      • CrCl <30: Max 200mg qd
      • ESRD/HD: Not defined
    • Pediatric
      • CrCl 30-49: Max 200mg bid
      • CrCl <30: Max 200mg qd
      • ESRD/HD: Not defined
  • Hepatic Dosing
    • Adult
      • Child-Pugh Class A or B: No adjusment
      • Child-Pugh Class C: Not defined
    • Pediatric
      • Child-Pugh Class A or B: No adjusment
      • Child-Pugh Class C: Not defined

Contraindications

  • Allergy to class/drug
  • Hypersensitivity to milk proteins
  • Carnitine deficiency
  • Caution:
    • Hypersensitivity to PCN
    • Renal impairment
    • Decreased muscle mass
    • Recent abx-associated colitis

Adverse Reactions

Serious

Common

Pharmacology

  • Half-life: 1.6h; 4.7h in severe renal impairment
  • Metabolism: Minimal
  • Excretion: Urine primarily
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep S
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium X1
MSSA S
MRSA R
CA-MRSA R
Staph. Epidermidis I
C. jeikeium X1
L. monocytogenes R
Gram Negatives N. gonorrhoeae S
N. meningitidis X1
Moraxella catarrhalis S
H. influenzae S
E. coli S
Klebsiella sp S
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp R
Serratia marcescens X1
Salmonella sp S
Shigella sp S
Proteus mirabilis S
Proteus vulgaris I
Providencia sp. X1
Morganella sp. R
Citrobacter freundii R
Citrobacter diversus X1
Citrobacter sp. S
Aeromonas sp X1
Acinetobacter sp. X1
Pseudomonas aeruginosa R
Burkholderia cepacia X1
Stenotrophomonas maltophilia X1
Yersinia enterocolitica X1
Francisella tularensis X1
Brucella sp. X1
Legionella sp. R
Pasteurella multocida S
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp X1
Mycoplasm pneumoniae X1
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces X1
Bacteroides fragilis X1
Prevotella melaninogenica X1
Clostridium difficile X1
Clostridium (not difficile) X1
Fusobacterium necrophorum X1
Peptostreptococcus sp. X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ Sanford Guide to Antimicrobial Therapy 2014
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