cefuroxime (Rx)Brand and Other Names:Ceftin, Zinacef

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

oral suspension

  • 125mg/5mL
  • 250mg/5mL

powder for injection

  • 750mg
  • 1.5g
  • 7.5g
  • 75g
  • 225g

tablet

  • 250mg
  • 500mg
more...

Pharyngitis/Tonsillitis

250 mg PO q12hr for 10 days

Acute Bacterial Maxillary Sinusitis

250 mg PO q12hr for 10 days

Acute Bacterial Exacerbations of Chronic Bronchitis

250-500 mg PO q12hr for 10 days

500-750 mg IV q8hr; switch to oral therapy as soon as clinically possible

Secondary Bacterial Infections of Acute Bronchitis

250-500 mg PO q12hr for 5-10 days

Uncomplicated Pneumonia

750 mg IV/IM q8hr

Uncomplicated Skin/Skin Structure Infections

250-500 mg PO q12hr for 10 days

750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Uncomplicated Urinary Tract Infections

125-250 mg PO q12hr for 7-10 days

750 mg IV/IM q8hr; switch to oral therapy as soon as clinically possible

Gonorrhea

Uncomplicated: 1 g PO once or 1.5 g IM once at 2 different sites with 1 g probenecid PO

Disseminated: 750 mg IV/IM q8hr

Early Lyme Disease

500 mg PO q12hr for 20 days

Severe or Complicated Infections

1.5 g IV/IM q8hr; may be administered q6hr in life-threatening situations

Dosing Modifications

Renal impairment

  • CrCl >30 mL/min: No adjustment necessary
  • CrCl 10-30 mL/min: Administer dose q24hr
  • CrCl <10 mL/min: Administer dose q48hr

Dosing Considerations

Susceptible organisms

  • Borrelia burgdorferi, Escherichia coli, Haemophilus influenzae, Klebsiella spp, Moraxella catarrhalis, Neisseria gonorrhoeae, Proteus mirabilis, Streptococcus pneumoniae, Streptococcus pyogenes

Dosage Forms & Strengths

oral suspension

  • 125mg/5mL
  • 250mg/5mL

powder for injection

  • 750mg
  • 1.5g
  • 7.5g
  • 75g
  • 225g

tablet

  • 250mg
  • 500mg
more...

Acute Bacterial Maxillary Sinusitis

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

>12 years: 250 mg tablet PO q12hr for 10 days

Acute Otitis Media

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day; alternatively, 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

Alternativley: 125-250 mg PO q12hr for 10 days

>12 years: 250-500 mg tablet PO q12hr for 10 days

Impetigo

<3 months: Safety and efficacy not established

3 months-12 years: 30 mg/kg/day suspension PO divided q12hr for 10 days; not to exceed 1000 mg/day or 75-100mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

Alternativley: 125-250 mg PO q12hr for 10 days

>12 years: 250-500 mg tablet PO q12hr for 10 days

Pharyngitis/Tonsillitis

<3 months: Safety and efficacy not established

3 months-12 years: 20 mg/kg/day PO divided q12hr for 10 days; not to exceed 500 mg/day or 75-150 mg/kg/day IV/IM divided q8hr; not to exceed 6 g/day 

Alternativley: 125-250 mg PO q12hr for 10 days

>12 years: 250 mg PO q12hr for 10 days

Severe or Serious Infections (Off-label)

<6 days, <2 kg: 100 mg/kg/day IV/IM divided q12hr  

<6 days, >2 kg: 150 mg/kg/day IV/IM divided q8hr

>7 days: 150 mg/kg/day IV/IM divided q8hr

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Interactions

Interaction Checker

cefuroxime and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            Sort by :  
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            Adverse Effects

            >10%

            Diarrhea (4-11%; depends on duration)

            1-10%

            Decreased hemoglobin or hematocrit (10%)

            Eosinophilia (7%)

            Nausea or vomiting (3-7%)

            Vaginitis (<5%)

            Transient rise in hepatic transaminases (2-4%)

            Diaper rash (3%)

            Increase in alkaline phosphatase (2%)

            Thrombophlebitis (2%)

            Increase in lactate dehydrogenase (1%)

            <1%

            Anemia

            Cholestasis

            Colitis

            Dyspnea

            Epidermal necrolysis

            Increase in blood urea nitrogen (BUN) and creatinine

            Jaundice

            Nephritis

            Prolonged prothrombin time (PT)/international normalized ratio (INR)

            Rash

            Stevens-Johnson syndrome

            Stomach cramps

            Transient neutropenia and leukopenia

            Urticaria

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            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            Do not crush tablet

            Prolonged INR in nutritionally deficient patients, prolonged treatment, and hepatic and renal disease reported

            Film-coated tablet and oral solution are not bioequivalent; tablets should not be crushed

            Use caution in patients with history of colitis, renal impairment, or with a history of seizure disorders

            Use with caution in patients with history of penicillin allergy

            Reduce dosage by 50% if CrCl is 10-30 mL/min and by 75% if CrCl <10 mL/min (high doses may cause CNS toxicity)

            Some products may contain phenylalanine

            Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Drug excreted in breast milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Binds to penicillin-binding proteins and inhibits final transpeptidation step of peptidoglycan synthesis, resulting in cell-wall death; resists degradation by beta-lactamase; proper dosing and appropriate route of administration are determined by condition of patient, severity of infection, and susceptibility of microorganism

            Absorption

            Bioavailability: Fasting, 37%; postprandial, 52%

            Peak serum time: 2-3 hr (PO); 15-60 min (IM); 2-3 min (IV)

            Distribution

            Widely distributed to body tissues and fluids, including cerebrospinal fluid (CSF)

            Protein bound: 33-50%

            Metabolism

            Partially metabolized in liver

            Elimination

            Half-life: 1-2 hr (prolonged with renal impairment)

            Excretion: Urine (66-100% as unchanged drug)

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            Administration

            IV Incompatibilities

            Additive: Aminoglycosides, ciprofloxacin, ranitidine, sodium bicarbonate

            Syringe: Doxapram

            Y-site: Azithromycin, cisatracurium (potentially; compatible at low concentration [0.1 mg/mL]), clarithromycin, filgrastim, fluconazole, midazolam, vancomycin, vinorelbine

            IV Compatibilities

            Solution: D5W, NS

            Additive: Clindamycin, floxacillin, furosemide, gentamicin (incompatible in total parenteral nutrition [TPN]), metronidazole, midazolam, netilmicin

            Y-site (partial list): Acyclovir, allopurinol, amiodarone, diltiazem, linezolid, milrinone, morphine sulfate, ondansetron, propofol, tacrolimus

            IV Preparation

            Direct injection: reconstitute in 8 mL (for 750-mg vial) or 16 mL (for 1.5-g vial) to obtain ~90 mg/mL solution

            Infusion: Reconstitute in 100 mL SWI, D5W or NS to obtain 7.5 mg/mL (750-mg vial) or 15 mg/mL (1.5-g vial) solution

            7.5 g bulk package not to be used for direct injection

            IM Preparation

            Reconstitute 750 mg in 3 mL SWI to obtain ~220 mg/mL solution

            IV Administration

            Direct injection: Inject directly into vein over 3-5 minutes or slowly into tubing of free-flowing compatible IV solution

            Infusion: Infuse intermittently over 15-60 minutes

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • View the formulary and any restrictions for each plan.
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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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