Classifications: antibiotic; second-generation cephalosporin; Therapeutic: antibiotic; cephalosporin
Pregnancy Category: B
125 mg, 250 mg, 500 mg tablets; 125 mg/5 mL, 250 mg/5 mL suspension; 750 mg, 1.5 g injection
Semisynthetic second-generation cephalosporin beta-lactam antibiotic. Preferentially binds to one or more of the penicillin-binding
proteins (PBP) located on cell walls of susceptible organisms. This inhibits third and final stage of bacterial cell wall
synthesis, thus killing the bacterium.
Resistance against beta-lactamaseproducing strains exceeds that of first-generation cephalosporins. Similar to other
second-generation cephalosporins, cefuroxime is more active against gram-negative bacteria than are the first-generation
cephalosporins but not as active as the third-generation cephalosporins.
Infections caused by susceptible organisms in the lower respiratory tract, urinary tract, skin, and skin structures; also
used for treatment of meningitis, gonorrhea, and otitis media and for perioperative prophylaxis (e.g., open-heart surgery),
early Lyme disease.
Hypersensitivity to cephalosporins and related antibiotics; viral infections.
History of allergy, particularly to drugs; penicillin sensitivity; renal insufficiency; history of colitis or other GI disease;
potent diuretics; pregnancy (category B), lactation.
Route & Dosage
|Moderate to Severe Infections
Adult: PO 250500 mg q12h IV/IM 750 mg1.5 g q68h
Child (3 mo12 y): PO 1015 mg/kg (125250 mg) q12h IV/IM 50100 mg/kg/d divided q8h (max: 6 g/d)
Adult: IV/IM 1.53 g q8h
Child/Infant (>3 mo): IV/IM 200240 mg/kg/d divided q68h; reduced to 100 mg/kg/d upon improvement
Adult/Adolescent: IV/IM 1.5 g 3060 min before surgery, then 750 mg q8h for 24 h
Clcr 1020 mL/min: give q12h; <10 mL/min: give q24h
Hemodialysis: Give supplemental dose
- Cefuroxime tablets and oral suspension are not substitutable on a mg-for-mg basis.
- The oral suspension is for infants and children 3 mo to 12 y. Each teaspoon (5 mL) contains the equivalent of 125 mg cefuroxime.
Shake oral suspension well before each use.
- Shake IM suspension gently before administration. IM injections should be made deeply into large muscle mass. Rotate injection
- IV administration to neonates, infants and children: Verify correct IV concentration and rate of infusion/injection with
PREPARE: Direct: Dilute each 750 mg with 8 mL sterile water, D5W, or NS. Intermittent: Further dilute in 50100 mL of compatible solution. Continuous: May be added to 1000 mL of IV compatible solution.
ADMINISTER: Direct: Give slowly over 35 min. Intermittent: Give over 30 min. Continuous: Give over 624 h.
INCOMPATIBILITIES Solution/additive: aminoglycosides, ciprofloxacin, ranitidine. Y-site: aminoglycosides, azithromycin, cisatracurium, clarithromycin, filgrastim, fluconazole, midazolam, vancomycin, vinorelbine.
- Cefuroxime powder and solutions of the drug may range in color from light yellow to amber without adversely affecting product
- Store powder protected from light unless otherwise directed. After reconstitution, store suspension at 2°30°
C (36°86° F). Discard after 10 d.
Adverse Effects (≥1%) Body as a Whole:
Thrombophlebitis (IV site); pain, burning, cellulitis (IM site); superinfections, positive Coombs' test. GI: Diarrhea,
nausea, antibiotic-associated colitis
Rash, pruritus, urticaria. Urogenital:
Increased serum creatinine and BUN, decreased creatinine clearance.
Diagnostic Test Interference
Cefuroxime causes false-positive (black-brown or green-brown color) urine glucose reaction with copper reduction reagents (e.g., Benedict's or Clinitest). but not with enzymatic glucose oxidase reagents (e.g., Clinistix, TesTape). False-positive direct Coombs' test (may interfere with cross-matching procedures and hematologic studies) has been reported.
elimination of cefuroxime, thus prolonging its action.
Well absorbed from GI tract; hydrolyzed to active drug in GI mucosa. Peak:
PO 2 h; IM 30 min. Distribution:
Widely distributed in body tissues and fluids; adequate CNS penetration with inflamed meninges; crosses placenta. Elimination:
66100% in 24 h; in breast milk. Half-Life:
Assessment & Drug Effects
- Determine history of hypersensitivity reactions to cephalosporins, penicillins, and history of allergies, particularly to
drugs, before therapy is initiated.
- Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy if indicated.
Therapy may be instituted pending test results. Monitor periodically BUN and creatinine clearance.
- Inspect IM and IV injection sites frequently for signs of phlebitis.
- Report onset of loose stools or diarrhea. Although pseudomembranous colitis (see Signs & Symptoms, Appendix F) rarely occurs,
this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic
- Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report their appearance promptly.
- Monitor I&O rates and pattern: Especially important in severely ill patients receiving high doses. Report any significant
Patient & Family Education
- Report loose stools or diarrhea promptly.
- Report any signs or symptoms of hypersensitivity (see Appendix F).