Dosing and uses of Ceftin, Zinacef (cefuroxime)
Adult dosage forms and strengths
oral suspension
- 125mg/5mL
- 250mg/5mL
powder for injection
- 750mg
- 1.5g
- 7.5g
- 75g
- 225g
tablet
- 250mg
- 500mg
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
Pediatric dosage forms and strengths
oral suspension
- 125mg/5mL
- 250mg/5mL
powder for injection
- 750mg
- 1.5g
- 7.5g
- 75g
- 225g
tablet
- 250mg
- 500mg
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
Ceftin, Zinacef (cefuroxime) adverse (side) 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
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
Pregnancy and 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.
Pharmacology of Ceftin, Zinacef (cefuroxime)
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)
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
