Names and pronunciation
(sef-yoor-ox′eem)
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Individual generic drug information
Extracted information for cefuroxime only.
(sef-yoor-ox′eem)
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Func. class.: Antiinfective
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Chem. class.: Cephalosporin (second generation)
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Do not confuse: cefaclor/cephalexin Cefotan/Ceftin cefprozil/ceFAZolin/cefuroxime
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ACTION: Inhibits bacterial cell wall synthesis, renders cell wall osmotically unstable, leads to cell death by binding to cell wall membrane
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USES: cefaclor: gram-negative bacilli: Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella; gram-positive organisms: Streptococcus pneumoniae, Streptococcus pyogenes, aureus; respiratory Staphylococcus tract, urinary tract, skin, infections; otitis media cefoTEtan: gram-negative organisms: Haemophilus influenzae, Escherichia coli, Enterobacter aerogenes, Proteus mirabilis, Klebsiella, Citrobacter, Salmonella, Shigella, Acinetobacter, Bacteroides fragilis, Neisseria, Ser- ratia; gram-positive organisms: Strep- tococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus; lower, serious respiratory tract, uri- nary tract, skin, bone, joint, gyneco- logic, gonococcal, intraabdominal infections cefOXitin: gram-negative bacilli: Hae- mophilus influenzae, Escherichia coli, Proteus, Klebsiella, Bacteroides fragilis, Neisseria gonorrhoeae; gram-positive organisms: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococ- cus aureus; anaerobes including Clos- tridium; lower respiratory tract, urinary tract, skin, bone, gynecologic, gonococ- cal infections; septicemia, peritonitis cefprozil: pharyngitis/tonsillitis; otitis media; secondary bacterial infection of acute bronchitis; acute bacterial exacer- bation of chronic bronchitis; uncompli- cated skin and skin structure infections; acute sinusitis cefuroxime: gram-negative bacilli: Haemophilus influenzae, Escherichia coli, Neisseria, Proteus mirabilis, Kleb- siella; gram-positive organisms: Strepto- coccus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus; seri- ous lower respiratory tract, urinary tract, skin, bone, joint, gonococcal infections; septicemia, meningitis, surgery prophylaxis
Source pages 254, 255
Extracted information for cefuroxime only.
CONTRAINDICATIONS: Hyper- sensitivity to cephalosporins or related antibiotics; seizures Precautions: Pregnancy, breastfeeding, children, GI/renal disease, diabetes mel- litus, coagulopathy, pseudomembranous colitis
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SIDE EFFECTS CNS: Dizziness, headache, seizures GI: Diarrhea, nausea, vomiting, anorexia, CDAD HEMA: Leukopenia, thrombocytopenia, agranulocytosis, neutropenia, eosino- philia, hemolytic anemia INTEG: Rash, urticaria, dermatitis, Stevens-Johnson syndrome, IV site reactions SYST: Anaphylaxis, serum sickness, superinfection
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INTERACTIONS Increase: effect/toxicity—aminoglyco- sides, probenecid Increase: bleeding risk (cefoTEtan)— anticoagulants, thrombolytics, NSAIDs, antiplatelets Decrease: absorption of cephalosporin— antacids Drug/Lab Test False increase: creatinine (serum urine), urinary 17-KS False positive: urinary protein, direct Coombs’ test, urine glucose testing (Clinitest) Interference: cross-matching
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Extracted information for cefuroxime only.
DOSAGE AND ROUTES cefaclor • Adult: PO 250-500 mg q8hr, extended release 500 mg q12hr; max 1.5 g/day (capsule, oral suspension); 1 g/day C (extended release) • Child >1 mo: PO 20-40 mg/kg/day in divided doses q8hr or total daily dose may be divided and given q12hr, max 1 g/day
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Available forms: Capsules 250, 500 mg; oral suspension 125, 250, 375 mg/5 mL; extended-release tablet 375, 500 mg cefoTEtan • Adult: IM/IV 1-3 g q12hr × 5-10 days Renal dose • Adult: IM/IV CCr 30-50 mL/min 1-2 g, then 1-2 g q8-12hr; CCr 10-29 mL/ min 1-2 g, then 1-2 g q12-24hr; CCr 5-9 mL/min 1-2 g, then 0.5-1 g q12- 24hr; CCr<5 mL/min 1-2 g, then 0.5-1 g q24-48hr Perioperative prophylaxis • Adult: IV 1-2 g ½-1 hr before surgery Available forms: Injection 1, 2, 10 g; premixed 1 g/50 mL D5W, 2 g/50 mL D5W cefOXitin Perioperative prophylaxis • Adult: IV 2 g 30-60 min prior to sur- gery, then 2g q6hr × 24 hr • Child/infant >3 mo: IV/30-40 mg/kg 30-60 min prior to surgery then 30-40 mg/kg q6hr × 24 hr Renal dose • Adult: IM/IV after loading dose, CCr 30-50 mL/min, 1-2 g q8-12hr; CCr 10-29 mL/min, 1-2 g q12-24hr; CCr <10 mL/min, 0.5-1 g q12-24hr Severe infections • Adult: IM/IV 2 g q4hr • Child ≥3 mo: IM/IV 80-160 mg/kg/ day divided q4-6hr; max 12 g/day Available forms: Powder for injection 1, 2 g; premixed 1 g/50 mL D5W, 2 g/50 mL D5W cefprozil Upper respiratory infections • Adult: PO 500 mg q24hr × 10 days Otitis media • Child 6 mo-12 yr: PO 15 mg/kg q12hr × 10 days Lower respiratory infections • Adult: PO 500 mg q12hr × 10 days Skin/skin structure infections • Adult/child ≥13 yr: PO 250-500 mg q12hr × 10 days Child 2-12 yr: PO 20 mg/kg q24hr × 10 days, max adult dose Renal dose • Adult: PO CCr <30 mL/min, 50% of dose Available forms: Tablets 250, 500 mg; suspension 125, 250 mg/5 mL cefuroxime • Adult/child: PO 250 mg q12hr; may increase to 500 mg q12hr for serious infections • Adult: IM/IV 750 mg-1.5 g q8hr for 5-10 days Urinary tract infections • Adult: PO 250 mg q12hr × 7-10 days Otitis media • Child >3 mo-12 yr: PO 250 mg q12hr × 10 days Surgical prophylaxis • Adult: IV 1.5 g ½-1 hr before surgery Severe infections • Adult: IM/IV 1.5 g q6hr; may give up to 3 g q8hr for bacterial meningitis • Child >3 mo: IM/IV 50-100 mg/kg/ day or IM in divided doses q6-8hr Uncomplicated gonorrhea • Adult: IM 1 g as single dose in 2 separate sites with oral probenecid Early Lyme disease Adult/child ≥13 yr: PO 500 mg q12hr × 20 days Renal dose • Dosage reduction indicated with se- vere renal impairment (CCr <20 mL/min) Available forms: Tablets 125, 250, 500 mg; solution for injection 1.5 g/50 mL, 750 mg/50 mL; suspension 125, 250 mg/5 mL
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Administer: • Do not break, crush, or chew extended- release tablets or capsules • On an empty stomach 1 hr before or 2 hr after a meal cefaclor • Identify allergies before use • Obtain C&S specimen before use • Shake suspension, refrigerate, discard after 2 wk • For 10-14 days to ensure organism death, prevent superinfection • With food if needed for GI symptoms • After C&S completed • Swallow extended release whole cefoTEtan • Identify allergies before use • Obtain C&S specimen before use Direct IV route • IV direct after diluting 1 g/10 mL sterile water for injection, give over 3-5 min Intermittent IV infusion route • May be diluted further with 50-100 mL NS or D5W; shake; run over ½-1 hr by Y-tube or 3-way stopcock; discon- tinue primary infusion during adminis- tration • May be stored 96 hr refrigerated or 24 hr at room temperature Y-site compatibilities: Allopurinol, ami- fostine, aztreonam, diltiazem, famotidine, filgrastim, fluconazole, fludarabine, hepa- rin, insulin (regular), melphalan, meperi- dine, morphine, PACLitaxel, remifentanil, sargramostim, tacrolimus, teniposide, the- ophylline, thiotepa cefOXitin IV route Direct IV route • After diluting 1 g/10 mL or more D5W, NS, give over 3-5 min Intermittent IV infusion route may be di- luted further with 50-100 mL NS or D5W; run over ½-1 hr by Y-tube or 3-way stopcock; discontinue primary infusion during administration Continuous infusion route give by con- tinuous infusion at prescribed rate; may store 96 hr refrigerated or 24 hr at room temperature • After C&S completed Y-site compatibilities: Acyclovir, ami fostine, amphotericin B cholesteryl sul- fate complex, aztreonam, cyclophos phamide, diltiazem, DOXOrubicin liposome, famotidine, fluconazole, foscar net, HYDROmorphone, magnesium sul- fate, meperidine, morphine, ondansetron, perphenazine, remifentanil, teniposide, thiotepa cefprozil PO route • Without regard to meals • Identify allergies before use • Obtain C&S specimen before use, may start product before results are received • Refrigerate/shake suspension before use; discard after 14 days cefuroxime PO route • Identify allergies before use • Obtain C&S specimen before use, may start product before results are received • With food if needed for GI symptoms Y-site compatibilities: Acyclovir, allopuri- nol, amifostine, atracurium, aztreonam, cyclophosphamide, diltiazem, famotidine, fludarabine, foscarnet, HYDROmorphone, melphalan, meperidine, morphine, on- dansetron, pancuronium, perphenazine, remifentanil, sargramostim, tacrolimus, teniposide, thiotepa, vecuronium
Source pages 256, 257
Extracted information for cefuroxime only.
Assess: • I&O ratio • Blood studies: AST, ALT, CBC, Hct, biliru- bin, LDH, alkaline phosphatase, Coombs’ test monthly if patient is on long-term therapy • Electrolytes: potassium, sodium, chlorine monthly if patient is on long-term therapy • Clostridium difficile–associated diarrhea (CDAD): bowel pattern daily; if severe diarrhea occurs, product should be discontinued • Anaphylaxis: rash, flushing, urticaria, pruritus, dyspnea; discontinue product, no- tify prescriber, have emergency equipment available; cross-sensitivity may occur with penicillins or other beta-lactam antibiotics • Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac daily • Overgrowth of infection: perineal itching, fever, malaise, redness, pain, swelling, drain- age, rash, diarrhea, change in cough, sputum
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Evaluate: • Therapeutic response: negative C&S, decreased symptoms of infections
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To complete full course of product therapy; to take missed dose as soon as remembered unless close to next dose, do not double dose; to use calibrated device for syrup, liquid suspension • To report diarrhea with mucus, blood CDAD; symptoms of hypersensitivity, stools may change to red color TREATMENT OF ANAPHY- LAXIS: EPINEPHrine, antihistamines; resuscitate if needed CEPHALOSPORINS— THIRD/FOURTH GENERATION
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Extracted information for cefuroxime only.
PHARMACOKINETICS cefaclor PO: Peak ½-1 hr, half-life 36-54 min, 25% bound by plasma proteins, 60%- 85% eliminated unchanged in urine, crosses placenta, excreted in breast milk (low concentrations) cefoTEtan IM/IV: Peak 1½-3 hr, half-life hr, 75%- 90% protein binding, 50%-80% elimi- nated unchanged in urine, crosses pla- centa, excreted in breast milk cefOXitin Half-life ½-1 hr; 65%-80% protein binding 90%-100%; eliminated unchanged in urine; crosses placenta, blood-brain barrier; elimi- nated in breast milk; not metabolized IM: Peak 15-30 min IV: Peak infusion’s end, duration 6-8 hr cefprozil C PO: Peak 1.5 hr, protein binding 36%, half- life 1.3 hr (normal renal function), 2 hr (hepatic disease), 5½-6 hr (end-stage re- nal disease), extensively metabolized to an active metabolite, eliminated in urine 60% cefuroxime Peak PO 2 hr, IM 45 min, IV 2-3 min, 66% excreted unchanged in urine, half- life 1-2 hr in normal renal function
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Filter the extracted dose blocks for this individual drug.
cefaclor
• Adult: PO 250-500 mg q8hr, extended release 500 mg q12hr; max 1.5 g/day (capsule, oral suspension); 1 g/day C (extended release)
Candidate age grouping · source page 255
cefaclor
• Child >1 mo: PO 20-40 mg/kg/day in divided doses q8hr or total daily dose may be divided and given q12hr, max 1 g/day
Candidate age grouping · source page 255