cefuroxime (Zinacef, Ceftin)
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Introduction
Tradename: Zinacef, Ceftin. 2nd generation cephalosporin.
Indications
- treatment of moderate bacterial infections due to susceptible organisms
- penetrates into CSF & may be used for the treatment of meningitis with susceptible organisms
- prophylaxis for perioperative infection
- empiric therapy for fever of unknown origin[7]
Contraindications
- Enterococcus, MRSA & Pseudomonas aeruginosa
- anaerobic coverage
Dosage
- adults
- children:
- neonates
Tabs: 125, 250, 500 mg, Suspension: 125 mg/5 mL.
Injection: 750 mg, 1.5 g.
Dosage adjustment in renal failure
Table
| creatinine clearance | dosage |
|---|---|
| 10-30 mL/min | every 12 hours |
| < 10 mL/min | every 24 hours |
| dose after hemodialysis |
Pharmacokinetics
- oral absorption increased 40-50% when taken with food
- widely distributed to body tissues
- therapeutic concentrations achieved in CSF even when meninges are not inflammed
- crosses placenta
- appears in breast milk
- peak serum concentration within 15-60 minutes after IM injection
- protein binding 33-50%
- 1/2life 1-2 hours (17 hours ESRD)
- eliminated unchanged in the urine by both glomerular filtration & tubular excretion
- dose adjustment is necessary with renal insufficiency
elimination via kidney
1/2life = 1-2 hours
protein binding = 33-50 %
Antimicrobial activity
- Streptococcus
- Streptococcus pneumonia
- Streptococcus viridans, milleri
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis (+/-)
- Neisseria gonorrhoeae
- Neisseria meningitidis
- Moraxella catarrhalis
- Haemophilus influenzae
- Haemophilus parainfluenzae[7]
- Escherichia coli
- Klebsiella species
- Enterobacter species (+/-)
- Salmonella species
- Shigella species
- Proteus mirabilis
- Providencia species
- Morganella species (+/-)
- Citrobacter species (+/-)
- Aeromonas species (+/-)
- Yersinia enterocolitica (+/-)
- Haemophilus ducreyi
Adverse effects
- not common (1-10%)
- uncommon (< 1%)
- dizziness, fever, headache, rash, nausea/vomiting, diarrhea, epigastric pain, GI bleeding, colitis, neutropenia (transient), pain at site of injection, vaginitis, transient increase in serum transaminases & alkaline phosphatase, increase in serum creatinine &/or BUN
- cross-reactivity with penicillin 2-5%
Drug interactions
- probenecid increases & prolongs 1/2life of cefuroxime
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Mechanism of action
inhibition of bacterial cell wall synthesis
More general terms
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 162
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Sanford Guide to antimicrobial therapy 1997
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 7.0 7.1 7.2 7.3 Deprecated Reference
Database
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=41375
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=41816
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=47419
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2658
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=167440
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2669
- PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2659