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Drugs, Supplies and Delivery
Cefuroxime
Cefuroxime is a second-generation cephalosporin antibiotic widely used for treating a variety of bacterial infections. It is valued for its broad-spectrum activity against both Gram-positive and Gram-negative bacteria, as well as its availability in oral and parenteral formulations. This article references the British National Formulary (BNF), Lippincott Textbook of Pharmacology, and Lange Basic & Clinical Pharmacology to provide a detailed overview of cefuroxime, including its mechanism of action, clinical uses, dosing guidelines, side effects, precautions, drug interactions, and generic names.
Cefuroxime exerts its bactericidal effect by inhibiting bacterial cell wall synthesis. According to the Lippincott Textbook of Pharmacology, cefuroxime binds to penicillin-binding proteins (PBPs) on the bacterial cell wall, disrupting peptidoglycan cross-linking. This weakens the cell wall, leading to osmotic instability and cell lysis.
The Lange Basic & Clinical Pharmacology highlights cefuroxime’s resistance to many beta-lactamases, making it effective against beta-lactamase-producing organisms like Haemophilus influenzae and Moraxella catarrhalis. However, it is less stable against extended-spectrum beta-lactamases (ESBLs).
Cefuroxime is indicated for:
- Respiratory Tract Infections:
- Community-acquired pneumonia.
- Acute exacerbations of chronic bronchitis.
- Sinusitis, pharyngitis, and tonsillitis.
- Urinary Tract Infections (UTIs):
- Uncomplicated cystitis and pyelonephritis.
- Skin and Soft Tissue Infections:
- Cellulitis, impetigo, and wound infections.
- Surgical Prophylaxis: Prevention of postoperative infections.
- Lyme Disease: Early stages (off-label use).
The BNF emphasizes its role as a first-line agent for community-acquired infections and its use in surgical prophylaxis.
Dosing varies by infection severity, patient age, and formulation:
Oral (Tablets/Suspension):
- Adults: 250–500 mg twice daily for 5–10 days.
- Children: 10–15 mg/kg twice daily (max 500 mg/day).
Parenteral (IV/IM):
- Adults: 750 mg–1.5 g every 8 hours.
- Children: 30–100 mg/kg/day in divided doses every 6–8 hours (max 6 g/day).
Renal Impairment:
- Creatinine Clearance (CrCl) 10–20 mL/min: Reduce dose by 50%.
- CrCl <10 mL/min: Reduce dose by 75%.
Administration Tips:
- Oral: Take with food to enhance absorption.
- IV Infusion: Dilute in 50–100 mL of compatible fluid (e.g., 0.9% saline) and infuse over 30 minutes.
- IM Injection: Reconstitute with sterile water to reduce discomfort.
Cefuroxime is generally well-tolerated, but potential side effects include:
- Common:
- Gastrointestinal disturbances (nausea, diarrhea).
- Injection site reactions (pain, inflammation).
- Rash or pruritus.
- Serious (Rare):
- Hypersensitivity reactions (anaphylaxis, Stevens-Johnson syndrome).
- Clostridioides difficile-associated diarrhea (CDAD).
- Hematologic effects (neutropenia, thrombocytopenia).
- Contraindications: Hypersensitivity to cephalosporins or severe beta-lactam allergy.
- Renal Impairment: Dose adjustment is critical to avoid toxicity.
- Pregnancy and Lactation: Generally safe but use only if benefits outweigh risks.
- Cross-Reactivity: Low risk of cross-reactivity with penicillins (<1%), but caution is advised.
Key interactions per the BNF and Lange Basic & Clinical Pharmacology:
- Probenecid: Reduces renal excretion, increasing cefuroxime levels (avoid concurrent use).
- Oral Anticoagulants (e.g., warfarin): Enhanced anticoagulant effect (monitor INR).
- Aminoglycosides: Synergistic against Gram-negative bacteria but may increase nephrotoxicity.
- Generic: Cefuroxime axetil (oral), cefuroxime sodium (parenteral).
- Brand Names: Zinnat® (oral), Zinacef® (parenteral).
