Cefuroxime is an oral (cefuroxime axetil) and parenteral (cefuroxime sodium) second-generation cephalosporin. Although the dosage forms differ, the bacterial spectrum and mechanism of action are the same. Similar to other second-generation cephalosporins, cefuroxime is more active against gram-negative bacteria than the first-generation cephalosporins, but not as active as the third-generation cephalosporins. Except for ceftriaxone, cefuroxime is more active against Haemophilus influenzae, including beta-lactamase-producing strains, than other cephalosporins. Common clinical uses of cefuroxime include respiratory tract infections, otitis media, urinary tract infections, skin infections, and surgical prophylaxis. The oral tablets and suspension are not bioequivalent and are not substitutable on a milligram-per-milligram basis.
General Administration Information
For storage information, see the specific product information within the How Supplied section.
Route-Specific Administration
Oral Administration
-NOTE: Tablets and suspension are NOT bioequivalent and can not be substituted on a mg-per-mg basis.
Oral Solid Formulations
-Administer the tablets without regard to meals.
-Swallow whole. The crushed tablet has a strong, persistent bitter taste when crushed.
Oral Liquid Formulations
-Administer the oral suspension with food.
-Shake well prior to each use.
-For accurate dosage, use a calibrated device, such as an oral syringe, calibrated spoon, or dosage cup.
-Taste and palatability of the suspension have been reported to be unpleasant, particularly compared with other oral cephalosporins.
Reconstitution
-Review the reconstitution instructions for the individual product and package size, as the amount of water required for reconstitution may vary between manufacturers.
-Prior to reconstitution, tap the bottle several times to loosen the powder.
-Add the total amount of water, invert the bottle and vigorously rock the bottle from side to side, so that water rises through the powder.
-Once the sound of the powder against the bottle disappears, turn the bottle upright and vigorously shake it in a diagonal direction.
-Some manufacturers recommend waiting 1 hour after reconstitution before administering to the patient. Check the manufacturer's instructions prior to administration.
-Storage: Store the mixed suspension in a refrigerator between 2 and 8 degrees C (36 and 46 degrees F). Discard any unused suspension after 10 days.
Injectable Administration
-Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.
Intravenous Administration
Reconstitution
-Reconstitute 750-mg or 1.5-g vial with 8.3 or 16 mL, respectively, of Sterile Water for Injection to yield an approximate concentration of 90 mg/mL.
-Storage: Store for up to 24 hours at room temperature or 48 hours refrigerated (5 degrees C).
Dilution
-Further dilute in a compatible solution to a usual concentration of 1 to 30 mg/mL.
-Compatible solutions include 0.9% Sodium Chloride Injection, 5% Dextrose Injection, 5% Dextrose and 0.9% Sodium Chloride Injection, 5% Dextrose and 0.45% Sodium Chloride Injection, 5% Dextrose and 0.225% Sodium Chloride Injection, 10% Dextrose Injection, 10% Invert Sugar in Water for Injection, 1/6 M Sodium Lactate Injection, Ringer's Injection, and Lactated Ringer's Injection.
-To prepare solution for freezing, immediately withdraw the contents of the reconstituted vial and add to a compatible container containing 50 or 100 mL of 0.9% Sodium Chloride Injection or 5% Dextrose Injection and freeze. Thaw frozen solutions at room temperature and do not refreeze. Do not force thaw by immersion in water baths or by microwave.
-Storage: Store for up to 24 hours at room temperature or 7 days refrigerated. Frozen solutions are stable for 6 months when stored at -20 degrees C. Store thawed solutions for up to 24 hours at room temperature or 7 days refrigerated.
Intermittent IV Push
-Inject directly into a vein over 3 to 5 minutes or slowly into the tubing of a freely-flowing compatible IV solution.
Intermittent IV Infusion
-Infuse over 15 to 60 minutes.
-Temporarily discontinue the administration of other solutions at the same site.
Continuous IV Infusion
-Add to an IV infusion pack containing 0.9% Sodium Chloride Injection, 5% Dextrose Injection, 10% Dextrose Injection, 5% Dextrose and 0.9% Sodium Chloride Injection, 5% Dextrose and 0.45% Sodium Chloride Injection, or 1/6 M Sodium Lactate Injection.
Intramuscular Administration
Reconstitution
-Reconstitute the 750-mg vial with 3 mL of Sterile Water for Injection to yield an approximate concentration of 225 mg/mL.
-Shake gently prior to administration and withdraw the appropriate dose for injection.
-Storage: Store for up to 24 hours at room temperature or 48 hours refrigerated (5 degrees C).
Intramuscular Injection
-Inject deeply into a large muscle mass (e.g., anterolateral thigh or deltoid [children and adolescents only]).
-In general, IM administration of drugs in very low birth weight premature neonates is not practical due to small muscle mass, and absorption is unreliable due to hemodynamic instability that is relatively common in this population.
A decrease in hemoglobin and hematocrit (anemia) and eosinophilia have been reported in 10% and 1% to 7% of patients, respectively, after IV administration of cefuroxime. Transient neutropenia (less than 1%) and leukopenia (0.1%) were less common. A similar pattern and incidence has been seen with other cephalosporins used in controlled studies. As with other cephalosporins, there have been rare reports of thrombocytopenia. A positive Coombs' test has been reported in less than 1% of pediatric patients receiving oral cefuroxime. Hemolytic anemia, pancytopenia, and increased prothrombin time (hypoprothrombinemia) have been reported with postmarketing use. Aplastic anemia, hemorrhage (bleeding), and agranulocytosis have been reported with the cephalosporin class.
Gastrointestinal infection, viral illness, upper respiratory tract infection, sinusitis, and urinary tract infection have been reported in less than 1% of patients receiving cefuroxime during clinical trials.
Diarrhea (4% to 10.6%) and nausea or vomiting (3% to 7%) were reported in patients receiving oral cefuroxime during clinical trials. Dislike of taste was reported in 5% of pediatric patients. Abdominal pain, flatulence, ptyalism (hypersalivation), dyspepsia, abdominal cramps, indigestion, oral ulceration, anorexia, and thirst were reported in less than 1% of patients receiving oral cefuroxime. Diarrhea (0.5%) and nausea (0.2%) have also been reported with parenteral use.
Headache, dizziness, drowsiness, and somnolence were reported in less than 1% of adults treated with cefuroxime during clinical trials, while hyperactivity and irritability have been reported in less than 1% of pediatric patients. Seizures and encephalopathy are a rare but a serious complication of cephalosporin therapy, and have been reported in postmarketing experience with cefuroxime. If seizures occur, discontinue treatment and administer appropriate anticonvulsant therapy as indicated. More commonly associated with penicillins, the epileptogenic properties of both penicillins and cephalosporins are thought to be related to their beta-lactam ring. Renal impairment and lack of needed dosage adjustment are associated with an increased risk of seizures.
The injection site reaction thrombophlebitis/phlebitis (1.7%) has been reported with IV administration of cefuroxime during clinical trials.
Dysuria, urethral pain/bleeding, and kidney pain have been reported in less than 1% of patients during clinical trials. Interstitial nephritis, a hypersensitivity reaction, has rarely been reported in patients treated with cefuroxime. Elevations in serum creatinine and/or blood urea nitrogen (azotemia) and a decreased creatinine clearance have been observed with cefuroxime use; however, causality has not been established. Toxic nephropathy has been reported with cephalosporin use.
Transient elevated hepatic enzymes (specifically AST, ALT, LDH, alkaline phosphatase) were reported in 4% or less of patients treated with cefuroxime during clinical trials. Hyperbilirubinemia was noted in 0.2% of patients. Hepatic impairment, including hepatitis, cholestasis, and jaundice have been reported with postmarketing use.
Cough, fever, chills, and shortness of breath (dyspnea) were reported in less than 1% of patients during clinical trials.
Serious and sometimes fatal anaphylactoid reactions have been reported in patients receiving beta-lactam antibiotics, including cefuroxime. If an allergic reaction occurs, discontinue cefuroxime and institute appropriate therapy. Rash, hives, swollen tongue, erythema, pruritus, and urticaria have been reported in less than 1% of adult patients during clinical trials. Diaper dermatitis (3%) and rash (less than 1%) were reported in pediatric patients. Rarely, anaphylaxis, drug fever, erythema multiforme, toxic epidermal necrolysis, and Stevens-Johnson syndrome have occurred. Angioedema, cutaneous vasculitis, and serum sickness-like reaction have been reported with postmarketing use.
Joint swelling, arthralgia, muscle cramps, muscle stiffness, muscle spasm of the neck, and lockjaw-type reaction were reported in less than 1% of patients receiving cefuroxime during clinical trials.
Chest pain (unspecified)/chest tightness and sinus tachycardia were reported in less than 1% of adults receiving cefuroxime during clinical trials. Acute myocardial ischemia with or without myocardial infarction may occur as part of an allergic reaction.
Jarish-Herxheimer reaction was reported in 5.6% of patients treated for early Lyme disease with a 20-day cefuroxime regimen. The Jarisch-Herxheimer reaction is a self-limiting systemic reaction that has been reported in the setting of spirochete infections, such as Lyme disease, syphilis, relapsing fever, and leptospirosis, after the initiation of antimicrobial therapy. It is characterized by fever, chills, myalgias, headache, exacerbation of cutaneous lesions, tachycardia, hyperventilation, vasodilation with flushing, and mild hypotension. Less commonly, symptoms may include meningitis, pulmonary failure, hepatic and renal dysfunction, myocardial injury, premature uterine contractions in pregnant patients, and worsening cerebral function as well as strokes and seizures. The reaction has been noted in up to 30% of patients with early Lyme disease. The timing of the reaction varies by underlying infection but typically presents within a few hours after the initiation of antibiotics. For Lyme disease, the reaction usually begins within 1 to 2 hours after starting therapy and disappears within 12 to 24 hours. The reaction after treatment in syphilis usually starts at 4 hours, peaks at 8 hours, and subsides by 16 hours whereas it starts at about 1 to 2 hours, peaks at 4 hours, and subsides by 8 hours after treatment in relapsing fever. The pathogenesis of this reaction is unknown but may be due to the release of spirochetal heat-stable pyrogen. Fluids and antipyretics can be used to alleviate symptoms and duration of the reaction if severe.
Microbial overgrowth and superinfection can occur with antibiotic use. C. difficile-associated diarrhea (CDAD) or pseudomembranous colitis has been reported with cefuroxime. If pseudomembranous colitis is suspected or confirmed, ongoing antibacterial therapy not directed against C. difficile may need to be discontinued. Institute appropriate fluid and electrolyte management, protein supplementation, C. difficile-directed antibacterial therapy, and surgical evaluation as clinically appropriate. During clinical trials, vaginitis was reported in up to 5.4% of patients. Vaginal pruritus, candidiasis, vaginal discharge (leukorrhea), and vaginal irritation were reported in less than 1% of patients.
Cefuroxime does not treat viral infection (e.g., common cold). Prescribing in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria (antimicrobial resistance). Patients should be told to complete the full course of treatment, even if they feel better earlier.
Cefuroxime is contraindicated in patients with cephalosporin hypersensitivity. Use cefuroxime with caution in patients with carbapenem hypersensitivity or penicillin hypersensitivity due to the risk of cross-reactivity. In patients with a documented penicillin hypersensitivity, cross-reactivity to cephalosporins is approximately 3% to 7%. Serious and potentially fatal reactions and serious skin reactions have occurred with beta-lactam use. If an allergic reaction occurs, discontinue cefuroxime and institute appropriate treatment and supportive measures.
Use cefuroxime with caution in patients with renal impairment, including renal failure, because the drug is eliminated via renal mechanisms. Dosage adjustment is recommended. Neurological reactions, including seizures, have been reported in patients with renal impairment who did not receive appropriate dosage adjustment. If seizures occur, discontinue cefuroxime.
Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. Careful medical history is necessary as pseudomembranous colitis has been reported to occur over 2 months after the administration of antibacterial agents. Almost all antibacterial agents, including cefuroxime, have been associated with pseudomembranous colitis or C. difficile-associated diarrhea (CDAD) which may range in severity from mild to life-threatening. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
Available data over several decades with cephalosporin use, including cefuroxime, during pregnancy have not established drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes. In animal studies during organogenesis with oral cefuroxime at 14 and 9 times the maximum recommended human dose (MRHD) based on body surface area, there were no adverse developmental outcomes.
Cefuroxime is excreted in human breast milk. The highest maternal milk concentration occurred in lactating women 8 hours after intramuscular administration of cefuroxime 750 mg. Allowing for infant milk consumption of 150 mL/kg/day, the estimated breast-fed infant dose would be less than 1% of the adult dose. No data are available on the effects of cefuroxime on the breast-fed infant or the effects of the drug on milk production. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for cefuroxime and any potential adverse effects on the breast-fed infant from cefuroxime or the underlying maternal condition. Rare potential complications in the nursing infant include alterations of gut flora that might result in diarrhea or related complications (e.g., dehydration). Because the risk of serious reactions is relatively rare, the use of many cephalosporins is considered compatible with breast-feeding. Although the use of cefuroxime during breast-feeding has not been evaluated, previous American Academy of Pediatrics (AAP) recommendations and other experts consider other cephalosporins, such as cefazolin, cefprozil, and cefadroxil, as generally compatible with breast-feeding.
Cefuroxime use may result in laboratory test interference. A false-positive result for glucose in the urine may occur with copper reduction tests (Benedict's or Fehling's solution or with CLINITEST tablets) but not with enzyme-based tests for glycosuria. A false-negative result for blood plasma glucose may occur with the ferricyanide test; the glucose oxidase or hexokinase method is recommended to determine blood plasma glucose levels in patients receiving cefuroxime.
Use cefuroxime oral suspension with caution in patients with phenylketonuria. The 125 mg/5 mL suspension contains 11.8 mg of phenylalanine per 5 mL. The 250 mg/5 mL suspension contains 25.2 mg of phenylalanine per 5 mL.
No overall differences in cefuroxime safety or effectiveness were observed between geriatric and younger adult subjects during clinical trials or in subsequent clinical experience. However, because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function. Cefuroxime is eliminated renally, and dosages should be adjusted if renal dysfunction is present. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents of long-term care facilities. According to OBRA, use of antibiotics should be limited to confirmed or suspected bacterial infections. Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions.
All cephalosporins may be associated with a fall in prothrombin activity (hypoprothrombinemia). Those that contain the NMTT side chain (e.g., cefotetan) have been associated with an increased risk of hypoprothrombinemia and PT prolongation. Patients at risk include those with renal or hepatic disease, malnutrition, those receiving a prolonged course of antimicrobial therapy, and those previously stabilized on anticoagulant therapy. Patients with a preexisting coagulopathy (e.g., vitamin K deficiency) may be at higher risk of bleeding. Monitor prothrombin time in patients at risk and administer exogenous vitamin K as indicated.
General dosing information:
-The tablets and suspension are NOT bioequivalent and can not be substituted on a mg for mg basis.
Per the manufacturer, this drug has been shown to be active against most strains of the following microorganisms either in vitro and/or in clinical infections: Citrobacter sp., Enterobacter sp., Escherichia coli, Haemophilus influenzae (beta-lactamase negative), Haemophilus influenzae (beta-lactamase positive), Haemophilus parainfluenzae, Klebsiella sp., Moraxella catarrhalis, Morganella morganii, Neisseria gonorrhoeae, Neisseria meningitidis, Proteus mirabilis, Providencia rettgeri, Salmonella sp., Shigella sp., Staphylococcus aureus (MSSA), Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes (group A beta-hemolytic streptococci)
NOTE: The safety and effectiveness in treating clinical infections due to organisms with in vitro data only have not been established in adequate and well-controlled clinical trials.
This drug may also have activity against the following microorganisms: Borrelia burgdorferi
NOTE: Some organisms may not have been adequately studied during clinical trials; therefore, exclusion from this list does not necessarily negate the drug's activity against the organism.
For the treatment of mild-to-moderate acute bacterial exacerbations of chronic bronchitis caused by susceptible strains, including epdisodes due to chronic obstructive pulmonary disease (COPD)* (emphysema* or chronic bronchitis):
Oral dosage (tablets):
Adults: 250 to 500 mg PO every 12 hours for 5 to 7 days. The FDA-approved treatment duration is 10 days.
Adolescents: 250 to 500 mg PO every 12 hours for 10 days.
For the treatment of skin and skin structure infections, including impetigo, cellulitis, erysipelas, animal bite wounds, and diabetic foot ulcer*:
-for the treatment of impetigo:
Oral dosage (suspension):
Adolescents*: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 5 to 7 days.
Infants and Children 3 months to 12 years: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 5 to 7 days. The FDA-approved duration is 10 days.
Infants 1 to 2 months*: 15 mg/kg/dose PO every 12 hours for 5 to 7 days.
-for the treatment of cellulitis and erysipelas:
Oral dosage (tablets and suspension*):
Adults: 250 to 500 mg PO every 12 hours for 5 to 14 days.
Adolescents: 250 to 500 mg PO every 12 hours for 5 to 14 days.
Infants* and Children*: 10 to 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 5 to 14 days.
Intravenous or Intramuscular dosage:
Adults: 0.75 to 1.5 g IV or IM every 6 to 8 hours for 5 to 14 days.
Infants, Children, and Adolescents 3 months to 17 years: 100 to 150 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 6 g/day) for 5 to 14 days.
Infants 1 to 2 months*: 100 to 150 mg/kg/day IV or IM divided every 8 hours for 5 to 14 days.
Neonates 32 weeks gestation and older and 8 days and older*: 50 mg/kg/dose IV or IM every 8 hours for 5 to 14 days.
Neonates 32 weeks gestation and older and 0 to 7 days*: 50 mg/kg/dose IV or IM every 12 hours for 5 to 14 days.
Neonates younger than 32 weeks gestation and 7 days and older*: 50 mg/kg/dose IV or IM every 8 hours for 5 to 14 days.
Neonates younger than 32 weeks gestation and 0 to 6 days*: 50 mg/kg/dose IV or IM every 12 hours for 5 to 14 days.
-for the treatment of animal bite wounds:
Oral dosage (tablets and suspension*):
Adults: 500 mg PO every 12 hours plus an anaerobic agent. In setting of a cat or dog bite, preemptive early antimicrobial therapy for 3 to 5 days is recommended for patients who are immunocompromised, asplenic, have advanced liver disease, have edema of the bite area, have moderate to severe injuries, particularly of the hand or face, or have penetrating injuries to the periosteum or joint capsule.
Intravenous or Intramuscular dosage:
Adults: 1 g IV every 12 hours plus an anaerobic agent. In setting of a cat or dog bite, preemptive early antimicrobial therapy for 3 to 5 days is recommended for patients who are immunocompromised, asplenic, have advanced liver disease, have edema of the bite area, have moderate to severe injuries, particularly of the hand or face, or have penetrating injuries to the periosteum or joint capsule. The FDA-approved dose is 0.75 to 1.5 g IV or IM every 8 hours for 5 to 10 days.
-for the treatment of diabetic foot ulcer*:
Intravenous dosage:
Adults: 1.5 g IV every 6 to 8 hours for 7 to 14 days for moderate or severe infections with no complicating features or infections with ischemic limb/necrosis/gas forming plus clindamycin or metronidazole. Continue treatment for up to 28 days if infection is improving but is extensive and resolving slower than expected or if patient has severe peripheral artery disease.
For the treatment of urinary tract infection (UTI), including pyelonephritis and catheter-associated urinary tract infection:
-for the treatment of nonspecific uncomplicated UTI:
Oral dosage (tablets):
Adults: 250 mg PO every 12 hours for 7 to 10 days.
Adolescents: 250 mg PO every 12 hours for 7 to 10 days. Shorter courses of therapy (i.e., 3 to 5 days) may be adequate for uncomplicated UTI.
Oral dosage (suspension)*:
Infants, Children, and Adolescents 2 months to 17 years: 10 to 15 mg/kg/dose (Max: 250 mg/dose) PO every 12 hours for 3 to 5 days.
Intravenous or Intramuscular dosage:
Adults: 750 mg IV or IM every 8 hours.
Infants, Children, and Adolescents 3 months to 17 years: 50 to 100 mg/kg/day (Max: 2.25 g/day) IV or IM divided every 6 to 8 hours.
-for the treatment of severe UTI, including pyelonephritis:
Oral dosage (tablet or suspension)*:
Infants, Children, and Adolescents 2 months to 17 years: 10 to 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 7 to 14 days.
Infants younger than 2 months: 10 to 15 mg/kg/dose PO every 12 hours. Infants younger than 2 to 3 months are at risk for systemic infection and rapid change in their clinical condition. Treat UTIs as presumed pyelonephritis in these patients.
Intravenous or Intramuscular dosage:
Adults: 1.5 g IV or IM every 8 hours for 7 to 14 days with or without an aminoglycoside.
Infants, Children, and Adolescents 3 months to 17 years: 100 to 150 mg/kg/day (Max: 4.5 g/day) IV or IM divided every 8 hours for 24 to 48 hours or until patient is clinically stable and afebrile, followed by oral antibiotics for a total duration of 7 to 14 days.
Infants 1 to 2 months*: 100 to 150 mg/kg/day IV or IM divided every 8 hours. Infants younger than 2 to 3 months are at risk for systemic infection and rapid change in their clinical condition. Treat UTIs as presumed pyelonephritis in these patients.
Neonates 32 weeks gestation and older and 8 days and older*: 50 mg/kg/dose IV or IM every 8 hours. Neonates are at risk for systemic infection and rapid change in their clinical condition. Treat UTIs as presumed pyelonephritis in these patients.
Neonates 32 weeks gestation and older and 0 to 7 days*: 50 mg/kg/dose IV or IM every 12 hours. Neonates are at risk for systemic infection and rapid change in their clinical condition. Treat UTIs as presumed pyelonephritis in these patients.
Neonates younger than 32 weeks gestation and 7 days and older*: 50 mg/kg/dose IV or IM every 8 hours. Neonates are at risk for systemic infection and rapid change in their clinical condition. Treat UTIs as presumed pyelonephritis in these patients.
Neonates younger than 32 weeks gestation and 0 to 6 days*: 50 mg/kg/dose IV or IM every 12 hours. Neonates are at risk for systemic infection and rapid change in their clinical condition. Treat UTIs as presumed pyelonephritis in these patients.
-for the treatment of catheter-associated UTI:
Intravenous or Intramuscular dosage:
Adults: 750 mg or 1.5 g IV or IM every 8 hours for 7 to 14 days.
Infants, Children, and Adolescents 3 months to 17 years: 100 to 150 mg/kg/day (Max: 4.5 g/day) IV or IM divided every 8 hours for 7 to 14 days.
Infants 1 to 2 months*: 100 to 150 mg/kg/day IV or IM divided every 8 hours for 7 to 14 days.
For the treatment of bone and joint infections, including osteomyelitis and infectious arthritis:
-for the treatment of osteomyelitis:
Intravenous dosage:
Adults: 1.5 g IV every 8 hours for 4 to 6 weeks. For life-threatening infections or infections due to less susceptible organisms, 1.5 g IV every 6 hours may be required.
Infants, Children, and Adolescents 3 months to 17 years: 150 mg/kg/day (Max: 6 g/day) IV divided every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 3 to 4 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for severe or complicated infections.
Infants 1 to 2 months*: 150 mg/kg/day IV divided every 6 to 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates 32 weeks gestation and older and 8 days and older*: 50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates 32 weeks gestation and older and 0 to 7 days*: 50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates younger than 32 weeks gestation and 7 days and older*: 50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates younger than 32 weeks gestation and 0 to 6 days*: 50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Oral dosage*:
Infants, Children, and Adolescents 3 months to 17 years: 60 to 100 mg/kg/day (Max: 3 g/day) PO divided every 8 hours as step-down therapy after initial parenteral therapy. Treat for a total duration of 3 to 4 weeks (parenteral plus oral) for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for severe or complicated infections.
Infants 1 to 2 months: 60 to 100 mg/kg/day PO divided every 8 hours as step-down therapy after initial parenteral therapy. Treat for a total duration of 4 to 6 weeks (parenteral plus oral). A longer course (several months) may be needed for severe or complicated infections.
-for the treatment of infectious arthritis:
Intravenous dosage:
Adults: 1.5 g IV every 8 hours. For life-threatening infections or infections due to less susceptible organisms, 1.5 g IV every 6 hours may be required. Treat for 1 to 2 weeks or until clinically improved, followed by oral step-down therapy for 2 to 4 weeks.
Infants, Children, and Adolescents 3 months to 17 years: 150 mg/kg/day (Max: 6 g/day) IV divided every 6 to 8 hours. Treat for 2 to 4 days or until clinically improved, followed by oral step-down therapy for a total duration of 2 to 3 weeks for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for septic hip arthritis or severe or complicated infections.
Infants 1 to 2 months*: 150 mg/kg/day IV divided every 6 to 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates 32 weeks gestation and older and 8 days and older*: 50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates 32 weeks gestation and older and 0 to 7 days*: 50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates younger than 32 weeks gestation and 7 days and older*: 50 mg/kg/dose IV every 8 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Neonates younger than 32 weeks gestation and 0 to 6 days*: 50 mg/kg/dose IV every 12 hours. Treat for 14 to 21 days or until clinically improved, followed by oral step-down therapy for a total duration of 4 to 6 weeks. A longer course (several months) may be needed for severe or complicated infections.
Oral dosage*:
Infants, Children, and Adolescents 3 months to 17 years: 60 to 100 mg/kg/day (Max: 3 g/day) PO divided every 8 hours as step-down therapy after initial parenteral therapy. Treat for a total duration of 2 to 3 weeks (parenteral plus oral) for uncomplicated cases. A longer course (i.e., 4 to 6 weeks or longer) may be needed for septic hip arthritis or severe or complicated infections.
Infants 1 to 2 months: 60 to 100 mg/kg/day PO divided every 8 hours as step-down therapy after initial parenteral therapy. Treat for a total duration of 4 to 6 weeks (parenteral plus oral). A longer course (several months) may be needed for severe or complicated infections.
For the treatment of pharyngitis:
Oral dosage (tablets):
Adults: 250 mg PO every 12 hours for 10 days. Guidelines do not recommended cefuroxime for routine therapy for Group A Streptococcal pharyngitis therapy to prevent rheumatic fever.
Adolescents: 250 mg PO every 12 hours for 10 days. Guidelines do not recommended cefuroxime for routine therapy for Group A Streptococcal pharyngitis therapy to prevent rheumatic fever.
Oral dosage (suspension):
Infants, Children, and Adolescents 3 months to 17 years: 10 mg/kg/dose (Max: 250 mg/dose) PO every 12 hours for 10 days. Guidelines do not recommended cefuroxime for routine therapy for Group A Streptococcal pharyngitis therapy to prevent rheumatic fever.
Infants 1 to 2 months*: 10 mg/kg/dose PO every 12 hours for 10 days. Guidelines do not recommended cefuroxime for routine therapy for Group A Streptococcal pharyngitis therapy to prevent rheumatic fever.
For the treatment of gonorrhea:
-for the treatment of uncomplicated gonorrhea, including rectal infections in females, cervicitis, and urethritis:
Oral dosage (tablets):
Adults: Not recommended by guidelines. The FDA-approved dosage is 1 g PO as a single dose.
Adolescents: Not recommended by guidelines. The FDA-approved dosage is 1 g PO as a single dose.
Intramuscular dosage:
Adults: Not recommended by guidelines. The FDA-approved dosage is 1.5 g IM as a single dose plus probenecid.
Adolescents: Not recommended by guidelines. The FDA-approved dosage is 1.5 g IM as a single dose plus probenecid.
-for the treatment of disseminated gonorrhea:
Intravenous or Intramuscular dosage:
Adults: Not recommended by guidelines. The FDA-approved dosage is 750 mg IV or IM every 8 hours for 5 to 10 days.
Adolescents: Not recommended by guidelines. The FDA-approved dosage is 750 mg IV or IM every 8 hours for 5 to 10 days.
For the treatment of Lyme disease, including erythema migrans, Lyme arthritis*, Lyme carditis*, borrelial lymphocytoma*, and acrodermatitis chronica atrophicans*:
-for the treatment of early Lyme disease (erythema migrans), including solitary and multiple erythema migrans:
Oral dosage (tablets and suspension*):
Adults: 500 mg PO every 12 hours for 14 days.
Adolescents: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 14 days.
Infants* and Children*: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 14 days.
-for the initial treatment of Lyme arthritis*:
Oral dosage:
Adults: 500 mg PO every 12 hours for 28 days.
Infants, Children, and Adolescents: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 28 days.
-for the treatment of recurrent or refractory Lyme arthritis*:
Oral dosage:
Adults: 500 mg PO every 12 hours for 28 days. A second course of oral antibiotics may be a reasonable alternative for patients in whom synovial proliferation is modest compared to joint swelling and for those who prefer repeating a course of oral antibiotics before considering IV therapy.
Infants, Children, and Adolescents: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 28 days. A second course of oral antibiotics may be a reasonable alternative for patients in whom synovial proliferation is modest compared to joint swelling and for those who prefer repeating a course of oral antibiotics before considering IV therapy.
-for the treatment of Lyme carditis*:
Oral dosage:
Adults: 500 mg PO every 12 hours for 14 to 21 days for patients with mild disease not requiring hospitalization (i.e., first degree AV block with PR interval less than 300 milliseconds) or as appropriate oral stepdown treatment after IV therapy in hospitalized patients with severe disease (i.e., symptomatic, first degree AV block with PR interval 300 milliseconds or greater, second or third degree AV block).
Infants, Children, and Adolescents: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 14 to 21 days for patients with mild disease not requiring hospitalization (i.e., first degree AV block with PR interval less than 300 milliseconds) or as appropriate oral stepdown treatment after IV therapy in hospitalized patients with severe disease (i.e., symptomatic, first degree AV block with PR interval 300 milliseconds or greater, second or third degree AV block).
-for the treatment of borrelial lymphocytoma*:
Oral dosage:
Adults: 500 mg PO every 12 hours for 14 days.
Infants, Children, and Adolescents: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 14 days.
-for the treatment of acrodermatitis chronica atrophicans*:
Oral dosage:
Adults: 500 mg PO every 12 hours for 21 to 28 days.
Infants, Children, and Adolescents: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 21 to 28 days.
For the treatment of acute otitis media:
Oral dosage (tablets):
Children 6 years and older (who can swallow whole tablets): 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 5 to 7 days for mild to moderate disease and 10 days for severe disease. The FDA-approved dose is 250 mg PO every 12 hours for 10 days. Guidelines recommend cefuroxime as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.
Oral dosage (suspension):
Children 6 years and older: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 5 to 7 days for mild to moderate disease and 10 days for severe disease. Guidelines recommend cefuroxime as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.
Children 2 to 5 years: 15 mg/kg/dose PO every 12 hours for 7 days for mild to moderate disease and 10 days for severe disease. Guidelines recommend cefuroxime as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.
Infants and Children 3 to 23 months: 15 mg/kg/dose PO every 12 hours for 10 days. Guidelines recommend cefuroxime as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.
Infants 1 to 2 months*: 15 mg/kg/dose PO every 12 hours for 10 days. Guidelines recommend cefuroxime as an alternative to high-dose amoxicillin or high-dose amoxicillin; clavulanate in penicillin allergic patients.
For the treatment of bacteremia:
Intravenous or Intramuscular dosage:
Adults: 1.5 g IV or IM every 8 hours. For life-threatening infections or infections due to less susceptible organisms, 1.5 g IV or IM every 6 hours may be required.
Infants, Children, and Adolescents 3 months to 17 years: 100 to 150 mg/kg/day (Max: 6 g/day) IV or IM divided every 6 to 8 hours.
Infants 1 to 2 months*: 100 to 150 mg/kg/day IV or IM divided every 8 hours.
Neonates 32 weeks gestation and older and 8 days and older*: 50 mg/kg/dose IV or IM every 8 hours.
Neonates 32 weeks gestation and older and 0 to 7 days*: 50 mg/kg/dose IV or IM every 12 hours.
Neonates younger than 32 weeks gestation and 7 days and older*: 50 mg/kg/dose IV or IM every 8 hours.
Neonates younger than 32 weeks gestation and 0 to 6 days*: 50 mg/kg/dose IV or IM every 12 hours.
For the treatment of meningitis:
Intravenous or Intramuscular dosage:
Adults: 1.5 g IV or IM every 6 hours or 3 g IV or IM every 8 hours (Max: 9 g/day) is the FDA-approved dosage. However, guidelines recommend a third-generation cephalosporin for meningitis.
Infants 3 to 11 months, Children, and Adolescents: 200 to 240 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 9 g/day) is the FDA-approved dosage. However, guidelines recommend a third-generation cephalosporin for meningitis.
For surgical infection prophylaxis:
Intravenous or Intramuscular dosage:
Adults: 1.5 g IV or IM within 30 to 60 minutes prior to the surgical incision. For lengthy operations, additional doses of 750 mg IV or IM may be given during the procedure and postoperatively every 8 hours. For open heart surgery, 1.5 g IV every 12 hours for 6 g total dose. Intraoperative redosing 4 hours from the first preoperative dose and a duration of prophylaxis less than 24 hours for most procedures are recommended by clinical practice guidelines. A longer prophylaxis duration of 48 hours for certain cardiothoracic procedures is controversial. Cefuroxime is FDA-approved for clean-contaminated or potentially contaminated procedures. Clinical practice guidelines recommend cefuroxime for cardiac or clean head and neck (with prosthesis) procedures and as an alternate therapy for urogynecology procedures. Cefuroxime is also recommended in combination with metronidazole for clean-contaminated head and neck procedures.
Infants*, Children*, and Adolescents*: 50 mg/kg (Max: 1.5 g/dose) IV or IM as a single dose within 60 minutes prior to the surgical incision. Intraoperative redosing 4 hours from the first preoperative dose and a duration of prophylaxis less than 24 hours for most procedures are recommended by clinical practice guidelines. A longer prophylaxis duration of 48 hours for certain cardiothoracic procedures is controversial. Clinical practice guidelines recommend cefuroxime for cardiac or clean head and neck (with prosthesis) procedures. Cefuroxime is also recommended in combination with metronidazole for clean-contaminated head and neck procedures.
-for ophthalmic surgical infection prophylaxis*:
Intraocular dosage:
Adults: 1 mg by intracameral injection is optional at the end of the procedure. Perioperative antisepsis with povidone-iodine is recommended. The necessity of continuing topical antimicrobials postoperatively has not been established.
For the treatment of intraabdominal infections*, including peritonitis*, appendicitis*, intraabdominal abscess*, and biliary tract infections* (cholecystitis):
-for the treatment of complicated community-acquired intraabdominal infections with adequate source control:
Intravenous dosage:
Adults: 1.5 g IV every 8 hours as part of combination therapy for 3 to 7 days. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess.
Infants, Children, and Adolescents: 100 to 150 mg/kg/day (Max: 4.5 g/day) IV divided every 8 hours as part of combination therapy for 3 to 7 days. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess.
Neonates 32 weeks gestation and older and 8 days and older: 50 mg/kg/dose IV every 8 hours as part of combination therapy for 7 to 10 days.
Neonates 32 weeks gestation and older and 0 to 7 days: 50 mg/kg/dose IV every 12 hours as part of combination therapy for 7 to 10 days.
Neonates younger than 32 weeks gestation and 7 days and older: 50 mg/kg/dose IV every 8 hours as part of combination therapy for 7 to 10 days.
Neonates younger than 32 weeks gestation and 0 to 6 days: 50 mg/kg/dose IV every 12 hours as part of combination therapy for 7 to 10 days.
-for the treatment of uncomplicated intraabdominal infections with adequate source control:
Intravenous dosage:
Adults: 1.5 g IV every 8 hours as part of combination therapy. Antibiotics should be discontinued within 24 hours. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.
Infants, Children, and Adolescents: 100 to 150 mg/kg/day (Max: 4.5 g/day) IV divided every 8 hours as part of combination therapy. Antibiotics should be discontinued within 24 hours. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.
-for the treatment of uncomplicated intraabdominal infections without definitive source control:
Intravenous dosage:
Adults: 1.5 g IV every 8 hours for at least 48 hours, followed by oral step-down therapy for a total treatment duration of 5 to 10 days as part of combination therapy. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.
Infants, Children, and Adolescents: 100 to 150 mg/kg/day (Max: 4.5 g/day) IV divided every 8 hours for at least 48 hours, followed by oral step-down therapy for a total treatment duration of 5 to 10 days as part of combination therapy. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.
Oral dosage:
Adults: 250 mg PO every 12 hours for a total treatment duration of 5 to 10 days as step-down therapy after initial parenteral therapy as part of combination therapy. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.
Infants, Children, and Adolescents: 10 to 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for a total treatment duration of 5 to 10 days as step-down therapy after initial parenteral therapy as part of combination therapy. Uncomplicated infections include acute appendicitis without perforation, abscess, or local peritonitis; traumatic bowel perforations repaired within 12 hours; acute cholecystitis without perforation; and ischemic, non-perforated bowel.
For the treatment of tonsillitis:
Oral dosage (tablets):
Adults: 250 mg PO every 12 hours for 10 days.
Adolescents: 250 mg PO every 12 hours for 10 days.
Oral dosage (suspension):
Infants, Children, and Adolescents 3 months to 17 years: 10 mg/kg/dose (Max: 250 mg/dose) PO every 12 hours for 10 days.
Infants 1 to 2 months*: 10 mg/kg/dose PO every 12 hours for 10 days.
For the treatment of sinusitis:
Oral dosage (tablets):
Adults: 250 mg PO every 12 hours for 10 days. The Infectious Diseases Society of America (IDSA) does not recommend cefuroxime for empiric use.
Children (who can swallow tablets whole) and Adolescents: 250 mg PO every 12 hours for 10 days. The Infectious Diseases Society of America (IDSA) does not recommend cefuroxime for empiric use.
Oral dosage (suspension):
Infants, Children, and Adolescents 3 months to 17 years: 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 10 days. The Infectious Diseases Society of America (IDSA) does not recommend cefuroxime for empiric use.
Infants 1 to 2 months*: 15 mg/kg/dose PO every 12 hours for 10 days. The Infectious Diseases Society of America (IDSA) does not recommend cefuroxime for empiric use.
For the treatment of lower respiratory tract infections (LRTIs), including pneumonia, community-acquired pneumonia (CAP), and pleural empyema*:
-for the treatment of nonspecific lower respiratory tract infections (LRTIs), pneumonia, and pleural empyema*:
Intravenous or Intramuscular dosage:
Adults: 0.75 to 1.5 g IV or IM every 8 hours. For life-threatening infections or infections due to less susceptible organisms, 1.5 g IV or IM every 6 hours may be required. For community-acquired empyema, guidelines recommend cefuroxime in combination with metronidazole for at least 2 weeks after drainage and defervescence.
Adolescents: 100 to 150 mg/kg/day (Max: 4.5 g/day) IV or IM divided every 8 hours. Higher doses (i.e., 150 mg/kg/day) are generally recommended for pneumonia.
Infants and Children 3 months to 12 years: 100 to 150 mg/kg/day (Max: 4.5 g/day) IV or IM divided every 8 hours. Higher doses (i.e., 150 mg/kg/day) are generally recommended for pneumonia. Guidelines recommend cefuroxime as an alternative for bacterial pneumonia in HIV-infected patients.
Infants 1 to 2 months*: 100 to 150 mg/kg/day IV or IM divided every 8 hours. Higher doses (i.e., 150 mg/kg/day) are generally recommended for pneumonia. Guidelines recommend cefuroxime as an alternative for bacterial pneumonia in HIV-infected patients.
Neonates 32 weeks gestation and older and 8 days and older*: 50 mg/kg/dose IV or IM every 8 hours.
Neonates 32 weeks gestation and older and 0 to 7 days*: 50 mg/kg/dose IV or IM every 12 hours.
Neonates younger than 32 weeks gestation and 7 days and older*: 50 mg/kg/dose IV or IM every 8 hours.
Neonates younger than 32 weeks gestation and 0 to 6 days*: 50 mg/kg/dose IV or IM every 12 hours.
-for the treatment of community-acquired pneumonia (CAP):
Oral dosage*:
Adults: 500 mg PO every 12 hours for at least 5 days as part of combination therapy for outpatients with comorbidities. Guide treatment duration by clinical stability.
Adolescents: 10 to 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 5 to 7 days. Guidelines recommend cefuroxime as an alternative oral step-down therapy for patients with S. pneumoniae and penicillin allergy and as part of combination therapy for HIV-infected outpatients.
Infants and Children: 10 to 15 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 5 to 7 days. Guidelines recommend cefuroxime as an alternative oral step-down therapy for infants and children 3 months of age and older with S. pneumoniae and penicillin allergy.
For the treatment of chorioamnionitis* or intraamniotic infection*:
Intravenous dosage:
Adults: 750 mg IV every 8 hours during the intrapartum period as alternative combination therapy. Give 1 additional dose after cesarean delivery; an additional dose is generally not needed after vaginal delivery. Other risk factors such as bacteremia or persistent postpartum fever may require additional therapy.
Adolescents: 750 mg IV every 8 hours during the intrapartum period as alternative combination therapy. Give 1 additional dose after cesarean delivery; an additional dose is generally not needed after vaginal delivery. Other risk factors such as bacteremia or persistent postpartum fever may require additional therapy.
Maximum Dosage Limits:
-Adults
9 g/day IV/IM; 1,000 mg/day PO.
-Geriatric
9 g/day IV/IM; 1,000 mg/day PO.
-Adolescents
240 mg/kg/day (Max: 9 g/day) IV/IM; 30 mg/kg/day (Max: 1,000 mg/day) PO is FDA-approved maximum; however, doses up to 100 mg/kg/day (Max: 3,000 mg/day) PO have been used off-label.
-Children
240 mg/kg/day (Max: 9 g/day) IV/IM; 30 mg/kg/day (Max: 1,000 mg/day) PO is FDA-approved maximum; however, doses up to 100 mg/kg/day (Max: 3,000 mg/day) PO have been used off-label.
-Infants
3 to 11 months: 240 mg/kg/day IV/IM; 30 mg/kg/day PO is FDA-approved maximum; however, doses up to 100 mg/kg/day PO have been used off-label.
1 to 2 months: Safety and efficacy have not been established; however, doses up to 150 mg/kg/day IV/IM and 100 mg/kg/day PO have been used off-label.
-Neonates
32 weeks gestation and older and 8 days and older: Safety and efficacy have not been established; however, doses up to 150 mg/kg/day IV/IM have been used off-label.
32 weeks gestation and older and 0 to 7 days: Safety and efficacy have not been established; however, doses up to 100 mg/kg/day IV/IM have been used off-label.
younger than 32 weeks gestation and 7 days and older: Safety and efficacy have not been established; however, doses up to 150 mg/kg/day IV/IM have been used off-label.
younger than 32 weeks gestation and 0 to 6 days: Safety and efficacy have not been established; however, doses up to 100 mg/kg/day IV/IM have been used off-label.
Patients with Hepatic Impairment Dosing
Specific guidelines for dosage adjustments in hepatic impairment are not available; however, it appears no dosage adjustment is necessary.
Patients with Renal Impairment Dosing
Adults
Oral
The following are FDA-approved dose adjustments; however, some recommend the full dose regardless of the degree of renal impairment.
CrCl 30 mL/minute or more: No dosage adjustment needed.
CrCl 10 to 29 mL/minute: Reduce frequency to once every 24 hours.
CrCl less than 10 mL/minute: Reduce frequency to once every 48 hours.
Parenteral
CrCl more than 20 mL/minute: No dosage adjustment needed.
CrCl 10 to 20 mL/minute: Give a loading dose of 0.75 to 1.5 g IV/IM, followed by 750 mg IV/IM every 12 hours.
CrCl less than 10 mL/minute: Give a loading dose of 0.75 to 1.5 g IV/IM, followed by 750 mg IV/IM every 24 hours.
Pediatrics
Oral
For oral therapy, renal dosage adjustment for pediatric patients is not provided in FDA-approved labeling. However, some experts have recommended the following, based on a usual pediatric dose of 30 mg/kg/day PO divided every 12 hours.
CrCl 10 mL/minute/1.73 m2 or more: No dosage adjustment needed.
CrCl less than 10 mL/minute/1.73 m2: 15 mg/kg/dose PO every 24 hours.
Parenteral
For parenteral therapy, FDA-approved labeling recommends similar adjustments to those provided for adults, based on a usual adult dose of 750 to 1,500 mg IV or IM every 8 hours (see above). Additionally, some experts have recommended the following, based on a usual pediatric dose of 75 to 150 mg/kg/day IV or IM divided every 8 hours.
CrCl 30 mL/minute/1.73 m2 or more: No dosage adjustment needed.
CrCl 10 to 29 mL/minute/1.73 m2: 25 to 50 mg/kg/dose IV or IM every 12 hours.
CrCl less than 10 mL/minute/1.73 m2: 25 to 50 mg/kg/dose IV or IM every 24 hours.
Intermittent hemodialysis
Adults: Cefuroxime is significantly removed during a standard hemodialysis session. A supplemental dose should be given after each dialysis, or the dosing regimen should be timed so that the dose of cefuroxime is scheduled at the end of the dialysis session.
Pediatrics: 15 mg/kg/dose PO every 24 hours OR 25 to 50 mg/kg/dose IV or IM every 24 hours. Administer after dialysis on dialysis days.
Peritoneal dialysis
Adults: Give a loading dose of 0.75 to 1.5 g IV/IM, followed by 750 mg IV or IM every 24 hours; oral dose adjustments not necessary.
Pediatrics: 15 mg/kg/dose PO every 24 hours OR 25 to 50 mg/kg/dose IV or IM every 24 hours.
Continuous renal replacement therapy
Adults: 1 g IV or IM every 12 hours.
Pediatrics: 25 to 50 mg/kg/dose IV or IM every 8 hours.
*non-FDA-approved indication
Aluminum Hydroxide: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Aluminum Hydroxide; Magnesium Carbonate: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Aluminum Hydroxide; Magnesium Hydroxide: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Aluminum Hydroxide; Magnesium Trisilicate: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Amikacin: (Minor) Cefuroxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Aminoglycosides: (Minor) Cefuroxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Amoxicillin; Clarithromycin; Omeprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Antacids: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Aspirin, ASA; Omeprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Bumetanide: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Clinicians should be aware that this may occur even in patients with minor or transient renal impairment.
Calcium Carbonate: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Calcium Carbonate; Magnesium Hydroxide: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Calcium Carbonate; Simethicone: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Calcium; Vitamin D: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Cimetidine: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Desogestrel; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Dexlansoprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Dienogest; Estradiol valerate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Estetrol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Drospirenone; Ethinyl Estradiol; Levomefolate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Elagolix; Estradiol; Norethindrone acetate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Esomeprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Estradiol; Levonorgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Estradiol; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Estradiol; Norgestimate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethacrynic Acid: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Clinicians should be aware that this may occur even in patients with minor or transient renal impairment.
Ethinyl Estradiol; Norelgestromin: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norethindrone Acetate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethinyl Estradiol; Norgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Ethynodiol Diacetate; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Etonogestrel; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Famotidine: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Furosemide: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Clinicians should be aware that this may occur even in patients with minor or transient renal impairment.
Gentamicin: (Minor) Cefuroxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
H2-blockers: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Ibuprofen; Famotidine: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Lansoprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Lansoprazole; Amoxicillin; Clarithromycin: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Lanthanum Carbonate: (Major) To limit absorption problems, oral cefuroxime should not be taken within 2 hours of dosing with lanthanum carbonate. Oral drugs known to interact with cationic antacids, like cefuroxime, may also be bound by lanthanum carbonate. Separate the times of administration appropriately. Monitor the patient to ensure the appropriate response to cefuroxime is obtained.
Leuprolide; Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Loop diuretics: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Clinicians should be aware that this may occur even in patients with minor or transient renal impairment.
Magnesium Hydroxide: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Magnesium Salts: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Mycophenolate: (Minor) Drugs that alter the gastrointestinal flora may interact with mycophenolate by disrupting enterohepatic recirculation. Cefuroxime may decrease normal GI flora levels and thus lead to less free mycophenolate available for absorption.
Naproxen; Esomeprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Nizatidine: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norethindrone: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norethindrone; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norgestimate; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Norgestrel: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Omeprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Omeprazole; Amoxicillin; Rifabutin: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Omeprazole; Sodium Bicarbonate: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Oral Contraceptives: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Pantoprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Paromomycin: (Minor) Cefuroxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Plazomicin: (Minor) Cefuroxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Proton pump inhibitors: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Rabeprazole: (Major) Avoid the concomitant use of proton pump inhibitors (PPIs) and cefuroxime. Drugs that reduce gastric acidity, such as PPIs, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Ranitidine: (Major) Avoid the concomitant use of H2-blockers and cefuroxime. Drugs that reduce gastric acidity, such as H2-blockers, can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy.
Relugolix; Estradiol; Norethindrone acetate: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Segesterone Acetate; Ethinyl Estradiol: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
Sodium Bicarbonate: (Moderate) Antacids can interfere with the oral absorption of cefuroxime axetil and may result in reduced antibiotic efficacy. If an antacid must be used while a patient is taking cefuroxime, administer the oral dosage of cefuroxime at least 1 hour before or 2 hours after the antacid.
Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Major) Prior or concomitant use of antibiotics with sodium picosulfate; magnesium oxide; anhydrous citric acid may reduce efficacy of the bowel preparation as conversion of sodium picosulfate to its active metabolite bis-(p-hydroxy-phenyl)-pyridyl-2-methane (BHPM) is mediated by colonic bacteria. If possible, avoid coadministration. Certain antibiotics (i.e., tetracyclines and quinolones) may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Therefore, these antibiotics should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution.
Streptomycin: (Minor) Cefuroxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Tobramycin: (Minor) Cefuroxime's product label states that cephalosporins may potentiate the adverse renal effects of nephrotoxic agents, such as aminoglycosides and loop diuretics. Carefully monitor renal function, especially during prolonged therapy or use of high aminoglycoside doses. The majority of reported cases involve the combination of aminoglycosides and cephalothin or cephaloridine, which are associated with dose-related nephrotoxicity as singular agents. Limited but conflicting data with other cephalosporins have been noted.
Torsemide: (Minor) Nephrotoxicity associated with cephalosporins may be potentiated by concomitant therapy with loop diuretics. Clinicians should be aware that this may occur even in patients with minor or transient renal impairment.
Vonoprazan: (Major) Avoid concomitant use of cefuroxime and vonoprazan. Vonoprazan reduces intragastric acidity, which may decrease the absorption of cefuroxime reducing its efficacy.
Vonoprazan; Amoxicillin: (Major) Avoid concomitant use of cefuroxime and vonoprazan. Vonoprazan reduces intragastric acidity, which may decrease the absorption of cefuroxime reducing its efficacy.
Vonoprazan; Amoxicillin; Clarithromycin: (Major) Avoid concomitant use of cefuroxime and vonoprazan. Vonoprazan reduces intragastric acidity, which may decrease the absorption of cefuroxime reducing its efficacy.
Warfarin: (Moderate) The concomitant use of warfarin with many classes of antibiotics, including cephalosporins, may increase the INR thereby potentiating the risk for bleeding. Inhibition of vitamin K synthesis due to alterations in the intestinal flora may be a mechanism; however, concurrent infection is also a potential risk factor for elevated INR. Additionally, certain cephalosporins (cefotetan, cefoperazone, cefamandole) are associated with prolongation of the prothrombin time due to the methylthiotetrazole (MTT) side chain at the R2 position, which disturbs the synthesis of vitamin K-dependent clotting factors in the liver. Monitor patients for signs and symptoms of bleeding. Additionally, increased monitoring of the INR, especially during initiation and upon discontinuation of the antibiotic, may be necessary.
Cefuroxime, a beta-lactam antibiotic, is mainly bactericidal. It inhibits the third and final stage of bacterial cell wall synthesis by preferentially binding to specific penicillin-binding proteins (PBPs) that are located inside the bacterial cell wall. PBPs are responsible for several steps in cell wall synthesis and are found in quantities of several hundred to several thousand molecules per bacterial cell. PBPs vary among different bacterial species. Thus, the intrinsic activity of cefuroxime as well as other beta-lactams against a particular organism depends on their ability to gain access to and bind with the necessary PBP. Like all beta-lactam antibiotics, cefuroxime's ability to interfere with PBP-mediated cell wall synthesis ultimately leads to cell lysis. Lysis is mediated by bacterial cell wall autolytic enzymes (i.e., autolysins). The relationship between PBPs and autolysins is unclear, but it is possible that the beta-lactam antibiotic interferes with an autolysin inhibitor. Prevention of the autolysin response to beta-lactam antibiotic exposure through loss of autolytic activity (mutation) or inactivation of autolysin (low-medium pH) by the microorganism can lead to tolerance to the beta-lactam antibiotic resulting in bacteriostatic activity.
Beta-lactams, including cefuroxime, exhibit concentration-independent or time-dependent killing. In vitro and in vivo animal studies have demonstrated that the major pharmacodynamic parameter that determines efficacy for beta-lactams is the amount of time free (non-protein bound) drug concentrations exceed the minimum inhibitory concentration (MIC) of the organism (free T above the MIC). This microbiological killing pattern is due to the mechanism of action, which is acylation of PBPs. There is a maximum proportion of PBPs that can be acylated; therefore, once maximum acylation has occurred, killing rates cannot increase. Free beta-lactam concentrations do not have to remain above the MIC for the entire dosing interval. The percentage of time required for both bacteriostatic and maximal bactericidal activity is different for the various classes of beta-lactams. Cephalosporins require free drug concentrations to be above the MIC for 35% to 40% of the dosing interval for bacteriostatic activity and 60% to 70% of the dosing interval for bactericidal activity.
The susceptibility interpretive criteria for cefuroxime are delineated by pathogen and dosage form. The MICs are defined for S. pneumoniae as susceptible at 0.5 mcg/mL or less, intermediate at 1 mcg/mL, and resistant at 2 mcg/mL or more for parenteral cefuroxime and as susceptible at 1 mcg/mL or less, intermediate at 2 mcg/mL, and resistant at 4 mcg/mL or more for oral cefuroxime. The MICs are defined for H. influenzae and H. parainfluenzae as susceptible at 4 mcg/mL or less, intermediate at 8 mcg/mL, and resistant at 16 mcg/mL or more for both parenteral and oral cefuroxime. The MICs are defined for M. catarrhalis as susceptible at 4 mcg/mL or less, intermediate at 8 mcg/mL, and resistant at 16 mcg/mL or more for oral cefuroxime. The MICs are defined for Vibrio sp. and Aeromonas sp. as susceptible at 8 mcg/mL or less, intermediate at 16 mcg/mL, and resistant at 32 mcg/mL or more for parenteral cefuroxime (based on a dose of 1.5 g IV every 8 hours). The Clinical and Laboratory Standards Institute (CLSI) and the FDA differ on MIC interpretation for Enterobacterales. The CLSI defines MICs for Enterobacterales as susceptible at 8 mcg/mL or less, intermediate at 16 mcg/mL, and resistant at 32 mcg/mL or more for parenteral cefuroxime (based on a dose of 1.5 g IV every 8 hours) and as susceptible at 4 mcg/mL or less, intermediate at 8 to 16 mcg/mL, and resistant at 32 mcg/mL or more for oral cefuroxime. The FDA defines MICs for Enterobacterales as susceptible at 8 mcg/mL or less and resistant at 16 mcg/mL or more (based on a dose of 1.5 g IV every 8 hours). Oxacillin-susceptible staphylococci may be considered susceptible to cefuroxime. Similarly, for group A beta-hemolytic streptococci, penicillin susceptibility is a surrogate for cefuroxime.
Resistance to cefuroxime is primarily through hydrolysis by beta-lactamases, alteration of PBPs, decreased permeability, and the presence of bacterial efflux pumps.
Cefuroxime is administered intravenously and intramuscularly as the sodium salt and orally as cefuroxime axetil. Approximately 50% of the circulating drug is protein-bound. It is distributed throughout the extracellular fluids and is detectable in therapeutic concentrations in pleural fluid, joint fluid, bile, sputum, bone, and aqueous humor. It penetrates inflamed meninges and reaches therapeutic levels within the cerebrospinal fluid. It does cross the placenta. Cefuroxime is largely excreted unchanged into the urine via glomerular filtration and tubular secretion. A small percentage is excreted in breast milk. Approximately 89% is recovered in the urine over an 8-hour period, leading to high urinary concentrations. The concomitant oral administration of probenecid with cefuroxime slows tubular secretion, decreases renal clearance by approximately 40%, increases the peak serum concentration by approximately 30%, and increases the serum half-life by approximately 30%. Elimination half-life is 1 to 2 hours in patients with normal renal function.
Affected cytochrome P450 isoenzymes and drug transporters: none
-Route-Specific Pharmacokinetics
Oral Route
Cefuroxime axetil is rapidly hydrolyzed in the intestinal mucosa and blood, with approximately 37% of an oral dose reaching the systemic circulation as cefuroxime. Peak serum levels of cefuroxime after administration of cefuroxime axetil occur within 2 to 3 hours of an oral dose. The oral suspension is not bioequivalent to the tablets and these formulations are not substitutable on a mg-per-mg basis. In adults, the AUC and Cmax for the suspension averaged 91% and 71%, respectively, of that for the tablet. Absorption of the tablet was greater when taken after food (absolute bioavailability of tablets increased from 37% to 52%). Despite this difference in absorption, the clinical and bacteriologic responses were independent of food intake. All pharmacokinetic and clinical studies in pediatrics used the suspension and were conducted in the fed state.
Intravenous Route
Following intravenous (IV) doses of 750 mg and 1.5 g of cefuroxime sodium to adults, serum concentrations were approximately 50 and 100 mcg/mL, respectively, at 15 minutes. Therapeutic serum concentrations of approximately 2 mcg/mL or more were maintained for 5.3 hours and 8 hours or more, respectively. There was no evidence of accumulation of cefuroxime in the serum after IV administration of 1.5 g doses every 8 hours to healthy adults. The serum half-life after IV injection is approximately 80 minutes. Approximately 89% of a dose of cefuroxime is excreted by the kidneys over an 8-hour period, resulting in high urinary concentrations. IV doses of 750 mg and 1.5 g produced urinary levels averaging 1,150 and 2,500 mcg/mL, respectively, during the first 8-hour period.
Intramuscular Route
In adults, peak serum levels of cefuroxime sodium occur at roughly 45 minutes (range: 15 to 60 minutes) after intramuscular (IM) injection of a 750 mg dose; the mean peak serum concentration was 27 mcg/mL. The serum half-life after IM injection is approximately 80 minutes. Approximately 89% of a dose of cefuroxime is excreted by the kidneys over an 8-hour period, resulting in high urinary concentrations. Urinary concentrations following IM dosing averaged 1,300 mcg/mL during the first 8 hours.
-Special Populations
Renal Impairment
The elimination half-life of cefuroxime increases as renal function declines. Cefuroxime is removed by hemodialysis.
Pediatrics
Infants and Children
Generally, the pharmacokinetics of cefuroxime in infants and children are similar to those in adults. In a pharmacokinetic study in 28 infants and children who received cefuroxime axetil oral suspension, mean Cmax observed after doses of 10 or 20 mg/kg was 3.3 and 5.1 mcg/mL, respectively, which is comparable to the Cmax reported in adults receiving 250 mg cefuroxime tablets. Mean Cmax observed with doses of 20 mg/kg was 7 mcg/mL, which is comparable to the Cmax reported in adults receiving 500 mg cefuroxime tablets. Mean elimination half-life ranged from 1.4 to 1.9 hours, which is slightly longer than that reported in adults (1 to 1.3 hours).
Neonates
Limited pharmacokinetic data in neonates have shown a decreased clearance of cefuroxime compared with children and adults. Data from 10 neonates (1 to 14 days postnatal age [PNA]) revealed an elimination half-life of approximately 3.5 to 5.5 hours, depending on the age of the neonate. The elimination half-life of the neonate with a PNA of 1 day was 5.5 hours compared with 4 hours in the neonate with a PNA of 14 days. No association was found between gestational age and half-life.
Geriatric
In a study of 20 elderly patients (mean age = 84 years) having a mean creatinine clearance of 34.9 mL/minute, the mean serum elimination half-life of cefuroxime was 3.5 hours. Despite the lower elimination of cefuroxime in geriatric patients, dosage adjustment based on age alone is not necessary. If there is severe renal function impairment, then dosages need adjustment.