Cefuzonam

General

• Type: 2nd generation Cephalosporin
• Dosage Forms: powder for injection
• Dosage Strengths: 250mg, 500mg, 1g
• Routes of Administration: IV, IM
• Common Trade Names: Cosmosin

Adult Dosing

General

• 1-2g/day IM/IV divided q12h

Severe Infections

• Up to 4g/day IM/IV divided q12h

Pediatric Dosing

General

• 40-80mg/kg/day IM/IV divided q6-8h
• Max: 150mg/kg/day for severe infections (do not exceed 4g/day)

Special Populations

• Pregnancy: Safety not established (Use only if clearly needed)
• Lactation: Excreted in breast milk (Caution advised)
• Renal
  • Adult
    • CrCl 30-50: 500mg q12h
    • CrCl 10-29: 500mg q24h
    • CrCl <10: 500mg q48h
    • Hemodialysis: Give dose after dialysis
  • Pediatric
    • Renal impairment: Reduce dose or extend interval
• Hepatic
  • No specific adjustment defined

Contraindications

• Allergy to class/drug
• Previous shock to Cefuzonam

Adverse Reactions

Serious

• Anaphylaxis / Shock
• Stevens-Johnson Syndrome
• Toxic Epidermal Necrolysis
• Pancytopenia / Agranulocytosis
• Interstitial Pneumonia (PIE syndrome)
• Pseudomembranous colitis (Clostridium difficile)
• Acute Renal Failure

Common

• Diarrhea
• Rash
• Nausea and Vomiting
• Elevated LFTs (AST/ALT)
• Eosinophilia
• Injection site pain/phlebitis

Pharmacology

• Half-life: ~1 hour (extended in renal failure)
• Metabolism: Not significantly metabolized
• Excretion: Urine (largely 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	S
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	S
	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	I
	Serratia marcescens	R
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	I
	Citrobacter diversus	I
	Citrobacter sp.	I
	Aeromonas sp	I
	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	I
	Clostridium difficile	R
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	I
	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)