Cefuroxime

 

1. Generic & Brand Names

• Generic: Cefuroxime

• Brands:

  • Oral: Ceftin® (global), Zinnat® (EU/Asia)

  • IV/IM: Zinacef® (global), Kefurox®

• Formulations:

  • Tablets (125mg, 250mg, 500mg)

  • Oral suspension (125mg/5mL)

  • Powder for injection (250mg, 750mg, 1.5g vials)

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2. Drug Class & Mechanism

• Class: 2nd-generation cephalosporin

• Mechanism: Inhibits bacterial cell wall synthesis → bactericidal

• Spectrum:

  • Gram-positive: S. aureus (MSSA), S. pneumoniae, S. pyogenes

  • Gram-negative: H. influenzae, E. coli, Klebsiella, Moraxella catarrhalis

  • NOT for: MRSA, Pseudomonas, Enterococci

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3. FDA-Approved Uses

Infection Type	Key Pathogens	Formulation
Acute Otitis Media (AOM)	S. pneumoniae, H. influenzae	Oral/IV
Acute Bacterial Sinusitis	S. pneumoniae, H. influenzae	Oral/IV
Pharyngitis/Tonsillitis	S. pyogenes (Group A Strep)	Oral
Skin/Soft Tissue Infections	S. aureus, S. pyogenes	Oral/IV
Lyme Disease (Early)	B. burgdorferi	Oral

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4. Dosing Regimens

Infection Type	Adult Dose	Pediatric Dose (≥3 mo)
AOM/Sinusitis	250 mg PO q12h	15 mg/kg PO q12h (max 500mg/day)
Strep Throat	250 mg PO q12h x 10 days	15 mg/kg PO q12h x 10 days
Uncomplicated Skin	250-500 mg PO q12h	15 mg/kg PO q12h
Severe Infections (IV)	750 mg-1.5g IV q8h	50-100 mg/kg/day IV divided q6-8h
Renal Adjustment:

• CrCl 10-20 mL/min: ↓ dose by 50%

• CrCl <10 mL/min: ↓ dose by 75%

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5. Resistance Concerns (2024)

Pathogen	Resistance Rate	Clinical Implication
S. pneumoniae	20-35%	Avoid if penicillin-resistant
H. influenzae	15-25% (β-lactamase+)	Combine with β-lactamase inhibitor?
S. aureus (MSSA)	<5%	First-line for non-purulent cellulitis

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6. Side Effects

Common (≥10%)	Serious (<1%)
Diarrhea	Anaphylaxis (cross-reacts with penicillin)
Nausea/vomiting	C. difficile colitis
Rash	Stevens-Johnson Syndrome
Elevated LFTs	Hemolytic Anemia
Vaginal candidiasis	Seizures (high IV doses)

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7. Contraindications & Warnings

• 🚫 Absolute Contraindications:

  • Anaphylaxis to penicillins/cephalosporins (5-10% cross-reactivity)

  • Carnitine deficiency (suspension contains aspartate)

• High-Risk Groups:

  • Penicillin-allergic: Use only if non-IgE-mediated reaction

  • Renal impairment: Adjust dose + monitor levels

  • Pregnancy (Category B): Safe but avoid high doses

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8. Drug Interactions

Medication	Effect	Action
Probenecid	↑ Cefuroxime levels	Avoid combo
Oral Contraceptives	↓ Efficacy (use backup)	Counsel patient
Aminoglycosides	↑ Nephrotoxicity	Monitor creatinine

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9. Clinical Use Cases

Scenario	Recommendation
Strep throat (penicillin-allergic)	250 mg PO q12h x 10d
Non-purulent cellulitis	500 mg PO q12h x 5-7d
AOM with amoxicillin failure	250 mg PO q12h x 10d
Early Lyme disease	500 mg PO q12h x 14-21d

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10. IV-to-PO Transition Criteria

• Clinically stable

• Afebrile ≥24h

• WBC normalizing

• Tolerating oral intake

• Equivalent dosing: 750mg IV ≈ 500mg PO

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11. Storage & Administration

Formulation	Instructions
Oral Tablets	Swallow whole; with/without food
Suspension	Reconstitute with water → refrigerate (discard after 10 days)
IV Solution	Reconstitute → stable 24h at RT, 7d refrigerated
IM Injection	Reconstitute with lidocaine (pain reduction)

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Key Advantages & Limitations

Diagram

Code

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Alternatives When Ineffective

Infection	Preferred Agents
Penicillin-resistant AOM	Amoxicillin-clavulanate
MRSA Skin Infection	TMP-SMX, Doxycycline, Clindamycin
Severe Sinusitis	Ceftriaxone IV → Levofloxacin PO

Stewardship Tip: Reserve for confirmed β-lactam-susceptible infections. Avoid for viral URIs.

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Patient Counseling

1. "Take with food to reduce nausea."

2. Suspension: "Shake well; use dosing syringe."

3. Diarrhea: "Stop if >3 watery stools/day or blood in stool."

4. Allergy: "Seek ER for rash/swelling/difficulty breathing."

💡 Clinical Pearl: For penicillin-allergic patients with mild non-IgE reactions, cefuroxime cross-reactivity is <5% (IDSA 2023).

Prescribing Status: Widely available; no restrictions but monitor local resistance patterns.