Cefuroxime (Oral)

Cefuroxime is part of the cephalosporin family of antibiotics that are bactericides, functioning in the body in similar fashion to penicillin-based drugs.

Overview

Cefuroxime is part of a family of antibiotics known as cephalosporins. It is marketed under these brand names: Ceftin, Kefurox, and Zinacef. Cephalosporins were first available for use in treatment of bacterial infection in 1964. First isolated in Sardinia in 1948, cephalosporins are derived from anaerobic mold and have evolved over time to combat different forms of bacteria. All of these antibiotics work by killing bacterial cells in the body that are creating the infection. The bactericidal properties stem from the drug's ability to disrupt the formation of the bacterial cell wall. Once the integrity of the cell has been lost, then the cell dies. In this respect, it acts similarly to antibiotics derived from penicillin.

Cefuroxime is generally prescribed to treat a wide spectrum of infection, from rather insignificant to serious and life-threatening. It can be delivered to the patient in tablet form and oral suspension for the treatment of infections like ear infections, sinusitis, tonsillitis or urinary tract infections. It can also be given to the patient in injection form by a medical practitioner, either intravenously or by intramuscular injection (IV or IM) for treatment of more significant infections such as pneumonia, appendicitis, or septicemia. It can also be delivered in IV form for prevention of infection in surgery, particularly open heart surgery. Cefuroxime is also indicated for treatment of gonorrhea in the form of a single injection. It is also the first line of antibiotics in the treatment of Lyme Disease.

While cefuroxime is generally well tolerated, it does carry the risk of side effects. Some of those can be life threatening including anaphylaxis in the case of hypersensitivity to the components of cephalosporin. Use of cefuroxime is contraindicated when the patient also takes probenecid or suffers from significant renal impairment. The range of side effects caused by cefuroxime tends to be exacerbated in elderly patients. Cefuroxime is also directly linked to the development of a condition called CDAD - Clostridium difficile-associated diarrhea. This condition can be quite serious, even fatal, in elderly patients with compromised health. In the event this condition develops, patients should discontinue use of cefuroxime immediately. It should not be taken concomitantly with a medication called probenecid. Probenecid is used to treat gout and can amplify the antibiotic in the body to unsafe levels. In the rare event that a patient takes too much cefuroxime, the overdose can lead to seizures. This is especially true in patients with kidney damage who do not take an adjusted dose of cefuroxime. In these cases, the patient can suffer seizures and further kidney damage. Cefuroxime can lead to edema and fluid retention in patients with congestive heart failure or other heart problems because of the sodium content in cefuroxime.

Cefuroxime is an antibiotic and is only effective in the treatment of bacterial infections. It is not recommended, nor effective in the treatment of viruses, viral infections or other maladies. Taking antibiotics in the absence of bacterial infection creates risk for the patient in that there is a possibility that the antibiotic will be less effective for that patient at a later date when he or she is being treated for a bacterial infection. This can be very dangerous if the infection is life-threatening and there are limited options for treatment. Over-prescription of antibiotics also creates risk for the greater public health as it has led to antibiotic resistance in strains of bacteria that are more difficult to treat with currently available antibiotics.

Conditions treated

Type of medication

  • Cephalosporin-based antibiotic

Side Effects

This family of antibiotics often causes side effects in the digestive system, including:

  • Upset stomach
  • Vomiting
  • Persistent nausea
  • Diarrhea
  • Indigestion

Other mild side effects are:

These side effects are common and not usually severe enough to discontinue use.

Cefuroxime can also cause allergic reactions and other more dangerous side effects. If patients experience any of the following, they should contact the doctor or seek emergency medical treatment.

  • Stomach cramps accompanied by fever
  • Trouble swallowing
  • Difficulty breathing
  • Hives
  • Facial swelling, including tongue, lips and/or eyes
  • Wheezing
  • Itching
  • Recurrence of fever, even after treatment has stopped
  • Rash
  • Bloody or watery stool
  • Chills
  • Sore throat
  • Seizure (in case of overdose)

Dosage

In pediatric patients when treating a mild to moderate infection such as an infection of the middle ear or sinusitis, the usual dose is 250mg - 500mg twice daily for 7 to 14 days. Cefuroxime is also available in an oral suspension which would be taken at a dosing level of 10 to 15 mg/kg twice a day.

In more serious infections (pneumonia, wound infections, etc), the dosing level adjusts to 50 to 100 mg/kg every twelve hours.

For any patient, if the infection is severe enough, cefuroxime can also be delivered through IV.

For adult patients being treated for standard infections the recommended dosing level is 250-500 mg tablets taken every 12 hours.

In the treatment of Lyme Disease, the recommended dosage is 500mg every 12 hours for 20 days.

In the treatment of severe infection, particularly pneumonia, meningitis or septicemia, the patient should receive the antibiotic via IV delivery at a dosage of 1.5g every 6-8 hours.

If Cefuroxime is being administered prophylactically before and during surgery, the recommended protocol is 1.5g IV delivered 30-60 minutes before surgery begins. If the procedure is especially long, another 750mg can be given to the patient every 8 hours.

In the case of open heart surgery, the patient should receive a 1.5g IV with initial anesthesia and then every 12 hours up to 6g total.

Patients with renal or liver impairment should take a lower dose of cefuroxime based on the severity of their infection and the level of function of the kidneys or liver.

Cefuroxime tablets can be taken with or without food, although taking it with food may reduce the risk of some of the digestive side effects associated with this medication. Cefuroxime suspension must be taken with food.

Drug Interactions

Cefuroxime does not interact negatively with many drugs. The major drug interaction that should be avoided is with the live cholera vaccine. It has moderate interaction with the following medications:

  • Acetaminophen
  • Aluminum hydroxide
  • Aspirin
  • Amoxicillin
  • Simethicone
  • Magnesium carbonate
  • Famotidine
  • Bumetanide
  • Sodium phosphate
  • Omeprazole
  • Clarithromycin
  • Balsalazide
  • Lidocaine
  • Ferrous fumarate
  • Citric acid
  • Caffeine
  • Probenecid
  • Codeine
  • Vitamin D
  • Psyllium
  • Desogestrel
  • Disulfiram
  • Ibuprofen
  • Gentamicin
  • indium oxyquinoline in-111
  • Naproxen
  • Lansoprazole
  • Mycophenolic acid
  • Neomycin
  • Quinapril
  • Ranitidine bismuth citrate
  • Streptomycin
  • Live typhoid vaccine
  • Torsemide

Some delivery mechanisms for Cefuroxime contain sodium in the solution. Patients being treated for hypertension or congestive heart failure should avoid ingesting sodium while taking cefuroxime to avoid swelling and further complications related to blood pressure.

Warnings

Cefuroxime may reduce the effectiveness and reliability of oral contraceptives. Patients who are taking cefuroxime and oral birth control will need to use other forms of contraception while they completing their course of antibiotics.

Medications containing magnesium and/or aluminum can impact the effectiveness of cefuroxime, so it should be taken at least an hour before taking the antibiotic.

Cefuroxime use, particularly in elderly patients, has been shown to cause the overgrowth of microbial flora leading to a condition called CDAD (Clostridium difficile-associated diarrhea). While it can be managed with fluids and electrolytes, immediate discontinuation of cefuroxime is indicated. The development of CDAD can increase mortality and morbidity rates in affected patients.

Cefuroxime is indicated only for the treatment of infection caused by bacteria. When prescribed in the absence of bacterial infection, it will not provide help to the patient and can lead to the development of antibiotic-resistant strains of bacteria and can lower the efficacy and effectiveness of the antibiotic for the patient in the treatment of later infections.

When cefuroxime is prescribed in suspension form, it contains a substance called phenylalanine. In this form, cefuroxime is contraindicated for patients with a condition called phenylketonuria.

Cefuroxime can interact with glucose tests for patients with diabetes, resulting in a false positive result for the presence of glucose in urine.

There have not been adequate studies of cefuroxime in pregnant women. While there have not been direct links of harm to the fetus, use of this antibiotic for women who are pregnant should be prescribed with great caution.

Nursing mothers should exercise caution when taking cefuroxime as it does pass through breast milk from mother to child.

Patients with decreased renal function should take a lower dosage of cefuroxime as it passes through kidneys and can result in further damage. This is especially true in elderly patients.

Cefuroxime has been known to cause anaphylaxis, rarely fatally, in patients who are allergic to elements of the medication.

The use of cephalosporin medications has been linked to the onset of hepatitis and other liver impairment. They have also been known to trigger seizures, particularly in those patients who also suffer from renal impairment.

For patients who suffer from congestive heart failure, edema, hypertension or other conditions related to fluid retention, the use of cefuroxime should be closely monitored as the sodium content of the medication may cause further complications.

Cefuroxime can exacerbate symptoms related to colitis. Patients with this condition should be closely monitored while taking this medication. The same is true for patients who suffer from renal impairment. If they are going to require a long course of antibiotic treatment, doctors should test the patient's kidney function during the course of treatment.

Taking probenecid and cefuroxime at the same time is contraindicated.

Storage

Cefuroxime is supplied in tablet form in several strengths (125mg, 250mg, and 500mg). The tablets are either white or blue and coated with a film. They are shaped as capsules and come in bottles of 20 tablets or bottles of 60 tablets.

The tablets should be stored between 68 and 77 degrees Fahrenheit (20-25 degrees Celsius). Medication should be stored in the original container with the lid secured tightly.

Cefuroxime is also supplied in suspension form. It should be stored in the refrigerator. Any unused suspension should be disposed of after ten days.

Cefuroxime can be given intravenously in a hospital or other medical facility. The powder used to create the solution is a strength of 750mg. The powder should be stored at room temperature and has a shelf life of 24 months. Once the powder has been used to create the solution, the solution should be dispensed to the patient within 24 hours. After that time, it should be discarded.

In any form, cefuroxime should be kept away from children and pets. It should be discarded according to the advice of pharmacists or other medical service providers. Medication return programs are the best option for disposal. In the absence of access to a take back program or other disposal options, patients should consult the FDA website for safe disposal of medications.

Summary

Cefuroxime is a well tolerated, effective antibiotic that is part of the standard protocol of antibiotic treatment for bacterial infections. It is a second-generation cephalosporin, which makes it one of the older versions of this particular derivations. It is most effective on gram-negative infections, while the original iteration of cephalosporin was more effective against gram-positive infections.

While it does carry the risk of side effects, most are minor and would not indicate discontinuation of the medication. The most common side effects are nausea, rash, diarrhea and yeast infections. A small number of patients do experience serious side effects, including allergic reaction type symptoms like wheezing, hives, and anaphylaxis. Elderly patients taking cefuroxime run the risk of developing serious diarrhea that can become CDAD. This is a dangerous condition that can be fatal. It can also have an impact on renal function and liver function. While rare, these are possible reactions. Cefuroxime is not recommended for patients taking a medication called probenecid which is used to treat gout. It is also not recommended for mothers who are nursing. Patients with heart disease or other fluid retention issues should be monitored closely as the sodium contained in cefuroxime can cause further edema and other complications related to this condition.

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Last Reviewed:
December 23, 2017
Last Updated:
April 02, 2018
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