Cefuroxime

General

• Type: 2nd generation cephalosporin
• Dosage Forms: tablet, powder for injection
• Dosage Strength: tablet: 250mg, 500mg; powder for injection: 750mg, 1.5g, 7.5g, 75g, 225g
• Routes of Administration: PO, IV, IM
• Common Trade Names: Ceftin, Zinacef, Kefurox

Adult Dosing

Mild-Moderate Bacterial infections

• 250-500mg PO BID x5-10 days

Renal Dosing

• no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement

Hepatic Dosing

• not defined

Indications by Disease

Disease	Dose	Context
Lyme disease	500mg PO BID x 20 days	Early Lyme disease, alternative
Neisseria gonorrhoeae	1000mg PO x 1	Uncomplicated urethral/cervical/rectal infection, alternative regimen
Pharyngitis	250mg PO bid x10 days	Pharyngitis/Tonsillitis, streptococcal
Pneumonia (main)	500 mg BID	Outpatient, Unhealthy
Sinusitis	250mg PO BID x 10 days	Alternative, not recommended per IDSA guidelines

Pediatric Dosing

Mild-Moderate Bacterial Infections

• 3 mo-12 yo: Dose: 30mg/kg/day susp PO divided q12h x10 days; Max: 1000mg/day; Alt: 250mg tab PO BID x10 days; Info: give susp with food
• >13 yo: Dose: 250-500mg tab PO BID x5-10 days; Info: dose, duration varies by infection type, severity

Renal Dosing

• 3 mo-12 yo: CrCl <10: 15mg/kg PO 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

Hepatic Dosing

• not defined

Indications by Disease

Disease	Dose	Context
Acute otitis media	15mg/kg PO BID x7-10 days	Prior Month Treatment
Lyme disease	30mg/kg/day PO divided BID x 20 days (max 500mg/dose)	Early Lyme disease, alternative, >13yo
Pharyngitis	250mg PO bid x10 days	12+ yo, Pharyngitis/Tonsillitis, streptococcal
Sinusitis	30mg/kg/day PO divided BID x 10 days (max 500mg/dose)	Alternative, not recommended per IDSA guidelines

Special Populations

• Pregnancy: B
• Lactation: Probably Safe
• Renal Dosing
  • Adult: no adjustment; HD: give dose after dialysis, no supplement; PD: no supplement
  • 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
• Hepatic Dosing
  • Adult: Not defined
  • Pediatric: Not defined

Contraindications

• Allergy to class/drug (See Cephalosporin Cross-reactivity)
• Caution if hypersensitive to PCN
• Caution if renal impairment
• Caution if hepatic impairment
• Caution if seizure disorder
• Caution if malnutrition
• Caution if recent antibiotic-associated colitis history

Adverse Reactions

Serious

• Anaphylaxis
• Angioedema
• Toxic epidermal necrolysis
• Stevens-Johnson syndrome
• Interstitial nephritis
• Pancytopenia
• Thrombocytopenia
• Agranulocytosis
• Leukopenia
• Neutropenia
• Hemolytic Anemia
• Seizures
• Clostridium difficile associated diarrhea

Common

• Diarrhea
• Nausea/Vomiting
• Jarisch-Herxheimer reaction
• Vaginitis
• Diaper Rash
• ALT, AST elevated
• Renal Impairment
• Anemia

Pharmacology

• Half-life: 1.4 hours, 3.5 hours (CrCl 35),
• Metabolism: Minimal; CYP 450: unknown
• Excretion: Urinary primarily (Up to 100% unchanged)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

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	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	S
	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	I
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	X1
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	R
	Morganella sp.	I
	Citrobacter freundii	R
	Citrobacter diversus	I
	Citrobacter sp.	I
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	I
	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	R
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	S
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

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

• Antibiotics (Main)