Formulary
Cefuroxime: Indications, Dosing, Side Effects and Interactions
Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.
MedNext Academy | 8 min read
Cefuroxime: Indications, Dosing, Side Effects and Interactions
Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.
Drug action
Cephalosporins are antibacterials that attach to penicillin binding proteins to interrupt cell wall biosynthesis, leading to bacterial cell lysis and death.
Indications and dose
**Susceptible infections due to Gram-positive and Gram-negative bacteria**
- **Child** (By Mouth): 12-17 years 250 mg twice daily, dose may be doubled in severe lower respiratory-tract infections or if pneumonia is suspected.
- **Adult** (By Mouth): 250 mg twice daily, dose may be doubled in severe lower respiratory-tract infections or if pneumonia is suspected.
- **Child** (By Intravenous Infusion, Or By Intravenous Injection, Or By Intramuscular Injection): 20 mg/kg every 8 hours (max. per dose 750 mg); increased to 50-60 mg/kg every 6-8 hours (max. per dose 1.5 g), increased dose used for severe infection and cystic fibrosis.
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection, Or By Intramuscular Injection): 750 mg every 6-8 hours; increased if necessary up to 1.5 g every 6-8 hours, increased dose used for severe infections.
**Hospital-acquired pneumonia**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 750 mg every 8 hours; increased if necessary to 750 mg every 6 hours, increased dose used for severe infections, alternatively 1.5 g every 6-8 hours, increased dose used for severe infections.
**Cellulitis,Erysipelas**
- **Child** (By Intravenous Injection, Or By Intravenous Infusion): 20 mg/kg every 8 hours (max. per dose 750 mg); increased if necessary up to 50-60 mg/kg every 6-8 hours (max. per dose 1.5 g).
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 750 mg every 6-8 hours; increased if necessary up to 1.5 g every 6-8 hours.
**Prophylaxis of infection from human bites [in combination with other drugs],Prophylaxis of infection from animal bites [in combination with other drugs],Treatment of infection from human bites [in combination with other drugs] ,Treatment of infection from animal bites [in combination with other drugs]**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): Prophylaxis of infection from human bites [in combination with other drugs], Prophylaxis of infection from animal bites [in combination with other drugs], Treatment of infection from human bites [in combination with other drugs] , Treatment of infection from animal bites [in combination with other drugs] 750 mg every 8 hours; increased if necessary to 750 mg every 6 hours, increased dose used for severe infections, alternatively 1.5 g every 6-8 hours, increased dose used for severe infections.
**Acute diverticulitis [in combination with metronidazole]**
- **Adult** (By Intravenous Injection, Or By Intravenous Infusion): 750 mg every 6-8 hours; increased if necessary up to 1.5 g every 6-8 hours, use increased dose in severe infection.
**Lyme disease**
- **Child** (By Mouth): 12-17 years 500 mg twice daily for 14-21 days (for 28 days in Lyme arthritis).
- **Adult** (By Mouth): 500 mg twice daily for 14-21 days (for 28 days in Lyme arthritis).
**Open fractures, prophylaxis**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 1.5 g every 8 hours until soft tissue closure (maximum duration 72 hours).
**Acute prostatitis**
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 1.5 g every 6-8 hours.
**Urinary-tract infection (lower)**
- **Child** (By Mouth): (body-weight 40 kg and above) 250 mg twice daily.
- **Adult** (By Mouth): 250 mg twice daily.
**Urinary tract infection (catheter-associated)**
- **Child** (By Intravenous Infusion, Or By Intravenous Injection): 16-17 years 0.75-1.5 g every 6-8 hours.
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 0.75-1.5 g every 6-8 hours.
**Acute pyelonephritis**
- **Child** (By Mouth): (body-weight 40 kg and above) 250 mg twice daily.
- **Adult** (By Mouth): 250 mg twice daily.
- **Child** (By Intravenous Infusion, Or By Intravenous Injection): 16-17 years 0.75-1.5 g every 6-8 hours.
- **Adult** (By Intravenous Infusion, Or By Intravenous Injection): 0.75-1.5 g every 6-8 hours.
**Gonococcal conjunctivitis [adjunctive treatment, using 5% eye drops]**
- **Adult** (To The Eye): Apply every 1 hour day and night for 48 hours, then apply every 1 hour daytime only for 5 days, then apply 4 times a day until complete resolution.
**Susceptible infections due to Gram-positive and Gram-negative bacteria for cefuroxime**
- **Child 3 months-1 year** (By mouth): 10 mg/kg twice daily (max. per dose 125 mg).
- **Child 2-11 years** (By mouth): 15 mg/kg twice daily (max. per dose 250 mg).
- **Child 12-17 years** (By mouth): 250 mg twice daily, dose may be doubled in severe lower respiratory-tract infections or if pneumonia is suspected.
- **Neonate up to 7 days** (By intravenous infusion, or by intravenous injection): 25 mg/kg every 12 hours, increased if necessary to 50 mg/kg every 12 hours, increased dose used in severe infection.
- **Neonate 7 days to 20 days** (By intravenous infusion, or by intravenous injection): 25 mg/kg every 8 hours, increased if necessary to 50 mg/kg every 8 hours, increased dose used in severe infection.
- **Neonate 21 days to 28 days** (By intravenous infusion, or by intravenous injection): 25 mg/kg every 6 hours, increased if necessary to 50 mg/kg every 6 hours, increased dose used in severe infection.
- **Child** (By intravenous infusion, or by intravenous injection, or by intramuscular injection): 20 mg/kg every 8 hours (max. per dose 750 mg); increased to 50-60 mg/kg every 6-8 hours (max. per dose 1.5 g), increased dose used for severe infection and cystic fibrosis.
**Cellulitis, Erysipelas for cefuroxime**
- **Child** (By intravenous injection, or by intravenous infusion): 20 mg/kg every 8 hours (max. per dose 750 mg); increased if necessary up to 50-60 mg/kg every 6-8 hours (max. per dose 1.5 g).
**Prophylaxis of infection from human bites [in combination with other drugs], Prophylaxis of infection from animal bites [in combination with other drugs], Treatment of infection from human bites [in combination with other drugs] , Treatment of infection from animal bites [in combination with other drugs] for cefuroxime**
- **Child** (By intravenous infusion, or by intravenous injection): 20 mg/kg every 8 hours (max. per dose 750 mg); increased if necessary to 50-60 mg/kg every 6-8 hours (max. per dose 1.5 g), increased dose used for severe infections.
**Lyme disease for cefuroxime**
- **Child 3 months-11 years** (By mouth): 15 mg/kg twice daily (max. per dose 500 mg) for 14-21 days (for 28 days in Lyme arthritis).
- **Child 12-17 years** (By mouth): 500 mg twice daily for 14-21 days (for 28 days in Lyme arthritis).
**Surgical prophylaxis for cefuroxime**
- **Child** (Initially by intravenous injection): 50 mg/kg for 1 dose (max. per dose 1.5 g), to be administered up to 30 minutes before the procedure, then (by intravenous injection or by intramuscular injection) 30 mg/kg every 8 hours (max. per dose 750 mg) if required for up to 3 doses (for high-risk procedures).
**Urinary-tract infection (lower) for cefuroxime**
- **Child (body-weight up to 40 kg)** (By mouth): 15 mg/kg twice daily (max. per dose 250 mg).
- **Child (body-weight 40 kg and above)** (By mouth): 250 mg twice daily.
**Urinary tract infection (catheter-associated) for cefuroxime**
- **Child 3 months-15 years** (By intravenous infusion, or by intravenous injection): 20 mg/kg every 8 hours (max. per dose 750 mg); increased to 50-60 mg/kg every 6-8 hours (max. per dose 1.5 g), increased dose used for severe infection.
- **Child 16-17 years** (By intravenous infusion, or by intravenous injection): 0.75-1.5 g every 6-8 hours.
**Acute pyelonephritis for cefuroxime**
- **Child (body-weight up to 40 kg)** (By mouth): 15 mg/kg twice daily (max. per dose 250 mg).
- **Child (body-weight 40 kg and above)** (By mouth): 250 mg twice daily.
- **Child 3 months-15 years** (By intravenous infusion, or by intravenous injection): 20 mg/kg every 8 hours (max. per dose 750 mg); increased to 50-60 mg/kg every 6-8 hours (max. per dose 1.5 g), increased dose used for severe infection.
- **Child 16-17 years** (By intravenous infusion, or by intravenous injection): 0.75-1.5 g every 6-8 hours.
**Gonococcal conjunctivitis [adjunctive treatment, using 5% eye drops] for cefuroxime**
- **Child 12-17 years (body-weight 45 kg and above)** (To the eye): Apply every 1 hour day and night for 48 hours, then apply every 1 hour daytime only for 5 days, then apply 4 times a day until complete resolution.
Cautions
For Aprokam intracameral injection With intracameral use Combined operations with cataract surgery (in adults); complicated cataracts (in adults); reduced corneal endothelial cells (less than 2000) (in adults); severe risk of infection (in adults); severe thyroid disease (in adults)
Side effects
Common or very common Abdominal pain; diarrhoea; dizziness; eosinophilia; headache; leucopenia; nausea; neutropenia; pseudomembranous enterocolitis; skin reactions; thrombocytopenia; vomiting Uncommon Anaphylactic reaction; angioedema Rare or very rare Agranulocytosis; haemolytic anaemia; nephritis tubulointerstitial (reversible); severe cutaneous adverse reactions (SCARs) Side-effects For cefuroxime Common or very common With oral use Increased risk of infection Uncommon With parenteral use Gastrointestinal disorder Frequency not known With oral use Drug fever; hepatic disorders; Jarisch-Herxheimer reaction; serum sickness With parenteral use Cutaneous vasculitis; drug fever; increased risk of infection
Pregnancy
Not known to be harmful.
Breast feeding
Present in milk in low concentration, but appropriate to use.
Renal impairment
Dose adjustments With intravenous use in adults: Use parenteral dose of 750 mg twice daily if eGFR 10-20 mL/minute/1.73 m 2 . Use parenteral dose of 750 mg once daily if eGFR less than 10 mL/minute/1.73 m 2 . In children: Reduce parenteral dose if estimated glomerular filtration rate less than 20 mL/minute/1.73 m 2 .
Medicinal forms
Solution,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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