CEFUROXIME
Generic Name: cefuroxime, cefuroxime axetil, cefuroxime sodium
Brand Name: Ceftin , Zinacef
Classification: Antibiotic, Cephalosporin (second generation)
Cefuroxime is a semisynthetic cephalosporin antibiotic that is administered parenterally in the form of its
sodium salt C16H15N4NaO8S or orally as an ester derivative C20H22N4O10S.
Therapeutic actions
Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final
transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis
and arresting cell wall assembly resulting in bacterial cell death.
Absorption: Absorbed from the GI tract with peak plasma concentrations after 2-3 hr (oral); may be
enhanced by the presence of food.
Distribution: Pleural and synovial fluid, sputum, bone and aqueous fluids; CSF (therapeutic
concentrations). Crosses the placenta and enters breast milk. Protein-binding: Up to 50%.
Metabolism: Rapidly hydrolysed (intestinal mucosa and blood).
Excretion: Via the urine by glomerular filtration and renal tubular secretion (as unchanged); via bile
(small amounts); 70 min (elimination half-life); prolonged in neonates and renal impairment.
Indications
Oral (cefuroxime axetil)
Pharyngitis, tonsillitis caused by Streptococcus pyogenes
Otitis media caused by Streptococcus pneumoniae, S. pyogenes, Haemophilus influenzae,
Moraxella catarrhalis
Lower respiratory infections caused by S. pneumoniae, Haemophilus parainfluenzae, H. influenzae
UTIs caused by Escherichia coli, Klebsiella pneumoniae
Uncomplicated gonorrhea (urethral and endocervical)
Dermatologic infections, including impetigo caused by Streptococcus aureus, S. pyogenes
Treatment of early Lyme disease
Parenteral (cefuroxime sodium)
Lower respiratory infections caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae,
S. pyogenes
Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, Klebsiella, Enterobacter
UTIs caused by E. coli, Klebsiella
Uncomplicated and disseminated gonorrhea caused by N. gonorrhoeae
Septicemia caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae
Meningitis caused by S. pneumoniae, H. influenzae, S. aureus, N. meningitidis
Bone and joint infections caused by S. aureus
Perioperative prophylaxis
Treatment of acute bacterial maxillary sinusitis in patients 3 mo–12 yr
Adverse effects
Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhea, GI
disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis.
Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.
Contraindications
Hypersensitivity to cephalosporins.
Nursing considerations
Assessment
History: Hepatic and renal impairment, lactation, pregnancy
Physical: Skin status, LFTs, renal function tests, culture of affected area, sensitivity tests
Interventions
Culture infection, and arrange for sensitivity tests before and during therapy if expected response is
not seen.
Give oral drug with food to decrease GI upset and enhance absorption.
Give oral drug to children who can swallow tablets; crushing the drug results in a bitter, unpleasant
taste.
Have vitamin K available in case hypoprothrombinemia occurs.
Discontinue if hypersensitivity reaction occurs.
Teaching points
Oral drug
Take full course of therapy even if you are feeling better.
This drug is specific for this infection and should not be used to self-treat other problems.
Swallow tablets whole; do not crush them. Take the drug with food.
You may experience these side effects: Stomach upset or diarrhea.
Report severe diarrhea with blood, pus, or mucus; rash; difficulty breathing; unusual tiredness,
fatigue; unusual bleeding or bruising; unusual itching or irritation.
Parenteral drug
Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur.
You may experience these side effects: Stomach upset or diarrhea. Report severe diarrhea, difficulty
breathing, unusual tiredness or fatigue, pain at injection site.
