Indication
Cefuroxime is indicated in the treatment of
1. Upper respiratory tract
infections: For example, ear, nose and throat infections such as otitis media,
sinusitis, tonsillitis and pharyngitis.
2. Lower respiratory tract
infections: For example, acute bronchitis, acute exacerbations of chronic bronchitis
and pneumonia.
3. Skin and sft tissue
infections: Such as furunculosis, pyoderma and impetigo.
4. Genilo-urinary tract
infections: Such as pyelonephritis, urethritis and cystitis.
5. Gonorrhoea: Acute
uncomplicated gonococcal urethritis and cervicitis.
6. Early lyme disease and
subsequent prevention of late Lyme disease.
Pharmacology
Cefuroxime is a well-characterized and effective antibacterial
agent, which has broad-spectrum bactericidal activity against a wide range of common
pathogens, including β-lactamase producing strains. Cefuroxime has good stability
to bacterial β-lactamase and consequently, is active against many
ampicillin-resistant and amoxycillin-resistant strains.
Composition
Cefuroxime 125 mg tablet: Each film coated tablet
contains Cefuroxime 125 mg as Cefuroxime axetil BP.
Cefuroxime 250 mg tablet: Each film coated tablet
contains Cefuroxime 250 mg as Cefuroxime axetil BP.
Cefuroxime 500 mg tablet: Each film coated tablet
contains Cefuroxime 500 mg as Cefuroxime axetil BP.
Cefuroxime powder for suspension (70 ml): Each 5 ml
reconstituted suspension contains 125 mg Cefuroxime, as Cefuroxime axetil BP.
Cefuroxime 750 mg IM/IV injection: Each vial contains Cefuroxime
750 mg, as Cefuroxime sodium BP.
Cefuroxime 1.5 gm IV injection: Each vial contains
Cefuroxime 1.5 gm, as Cefuroxime sodium BP.
Dosage and Administration
Adults: Most
infections well respond to 250 mg b.i.d. In mild to moderate lower respiratory tract
infections e.g bronchitis 250 mg b.i.d. should be given. For more severe lower
respiratory tract infections or if pneumonia is suspected then 500 mg b.i.d.
should be given.
For urinary tract infections
a dose of 125 mg b.i.d. is usually adequate, in pyelonephritis the recommended dose
is 250 mg b.i.d. A single dose of one gram is recommended for the treatment of uncomplicated
gonorrhea.
Lyme disease in adults and
children over the age of 12 years: The recommended dose is 500 mg b.i.d. for 20
days.
Children:
The usual dose is 125 mg b.i.d. or 10 mg/kg b.i.d. to a maximum of 250 mg
daily.
For otitis media, in
children less than two years of age the usual dosage is 125 mg b.i.d. or 10
mg/kg b.i.d. to a maximum of 250 mg daily and in children over two years of age
250 mg b.i.d. or 15 mg/kg b.i.d. to a maximum of 500 mg daily.
There is no experience in
children under three months of age. The usual course of therapy in seven days. Cefuroxime
should be taken after food for optimum absorption.
Parental Dosage
Adults: Cefuroxime
750 mg to 1.5 g IM or IV every 8 hourly, usually 50 to 10 days.
Preoperative
prophylaxis: For clean contaminated or potentially contaminated surgical procedures,
administer 1.5 g IV prior to surgery ( half to one hour before ). Thereafter,
give 750 mg iV or IM every 8 hours when the procedure is prolonged.
Infants
and Children (>3 months): 50 to100 mg/kg/day in
equally divided doses every 6 to 8 hours. Use 100 mg/kg/day (not to exceed the
maximum adult dose) for more severe or serious infections.
Bone
and Joint Infections: 150 mg/kg/day (not to exceed the maximum
adult dose) in equally divided doses every 8 hours.
Bacterial
meningitis: Initially 200 to 240 mg/kg/day IV in divided
doses every 8 hours.
Direction for Reconstitution
Cefuroxime 750 mg intramuscular Injection: Add 3 ml water
for injection BP and shake gently for dispersion
For 750 mg intravenous
injection: Add 6 ml water for injection BP and shake gently for dispersion.
For 1.5 mg intravenous
injection: Add 16 ml water for injection BP and shake gently for dispersion.
For Suspension: shake the
bottle well before adding water. Then add 35 ml of boiled and cooled water
(with the help of the provided cup from different company) to the bottle. Then
continue shaking the bottle until the powder is dissolved property.
Contraindication
Cefuroxime is
contraindicated in patients with known allergy to Cephalosporins.
Side Effect
Cefuroxime has been
associated with nausea and vomiting in a small number of patients.
Acute Over dosage
Excessively large dosage of
all cephalosporins can cause cerebral irritation and may cause convulsions.
This complication is unlikely to occur in routine practice unless the patient
is in renal failure hemodialysis or peritoneal dialysis can remove Cefuroxime.
Precaution
As with antibiotics,
prolonged use of Cefuroxime may result in the over growth of non-susceptible organisms
(e.g. Canada enterococci, Clostridium difficult), which may require
interruption of treatment.
Use in Pregnancy and Lactation
While all antibiotics should
be avoided in the first trimester if possible. Cefuroxime has been safety used
in later pregnancy to treat urinary and other infections. The placental
transfer of Cefuroxime into the fetus was studied in 20 women and
therapeutically active concentrations were found in the serum of infants for up
to 6 hours after delivery. Cefuroxime is excreted in human milk and
consequently caution should be exercised when Cefuroxime is administered to a
nursing mother.
Drug Interaction
No potentially hazardous
interactions have been reported.
Storage Condition
Tablet:
Store below 30 degree C, protected from light and moisture.
Suspension:
Store below 25 degree C, protected from light and moisture.
Injection:
Store below 25 degree C, protected from light and moisture. Use reconstituted
solution immediately. The reconstituted solution is stable for 2 hours at room
temperature and for 12 hours when refrigerated at 2 degree to 8 degree Celsius.
How Supplied from different companies
Cefuroxime 125 mg tablet: Box containing 20 tablets in blister pack.
Cefuroxime 250 mg tablet: Box containing 20 tablets in blister pack.
Cefuroxime 500 mg tablet: Box containing 20 tablets in blister pack.
Cefuroxime powder for suspension (70 ml): Bottle containing 70 ml suspension (after
reconstitution).
Cefuroxime 750 mg IM/IV injection: Pack of 1 vial containing Cefuroxime 750 mg as
Cefuroxime sodium BP accompanied by a solvent ampoule of 10 ml water for
injection. It also contains a complementary pouch comprised of disposable
syringe (10 ml) needle, alcohol pad and first aid bandage.
Cefuroxime 1.5 gm IV
injection: Pack of 1 vial containing Cefuroxime 1.5 gm as
Cefuroxime sodium BP accompanied by two solvent ampoule of 10 ml water for
injection in each. It also contains a complementary pouch comprised of
disposable syringe (20 ml) needle alcohol pad and first aid bandage.
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