CEFUROXIME AND DEXTROSE IN DUPLEX CONTAINER
Clinical safety rating: safe
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
Cefuroxime is a second-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death.
| Metabolism | Cefuroxime is not significantly metabolized; it is eliminated primarily unchanged by the kidneys via glomerular filtration and tubular secretion. |
| Excretion | Renal: 80-90% unchanged via glomerular filtration and tubular secretion; fecal: <1% |
| Half-life | Terminal elimination half-life: 1.2-1.6 hours (prolonged to 15-22 hours in severe renal impairment, CrCl <10 mL/min); requires dose adjustment in renal failure |
| Protein binding | 33-50% bound to serum albumin |
| Volume of Distribution | 0.2-0.3 L/kg (10-20 L in adults); indicates limited extravascular distribution, hydrophilic nature |
| Bioavailability | Intramuscular: 100% (absolute bioavailability); oral (cefuroxime axetil): 30-50% (not applicable for this IV formulation) |
| Onset of Action | Intravenous: immediate (peak concentration at end of infusion); Intramuscular: 15-30 minutes |
| Duration of Action | Approximately 8-12 hours for susceptible organisms; maintains bactericidal concentrations for >50% dosing interval |
| Molecular Weight | 446.37 Da (cefuroxime sodium); the dextrose component is not included in the molecular weight. |
750 mg to 1.5 g intravenously every 8 hours; for severe infections, up to 1.5 g every 6 hours.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 10-30 mL/min: 750 mg every 12 hours; CrCl <10 mL/min: 750 mg every 24 hours; hemodialysis: give after dialysis. |
| Liver impairment | No dosage adjustment required for hepatic impairment; use standard dosing. |
| Pediatric use | Neonates: 20-50 mg/kg/day IV divided every 8-12 hours; Infants and children: 50-100 mg/kg/day IV divided every 6-8 hours; severe infections: up to 150 mg/kg/day. |
| Geriatric use | No specific dose adjustment except based on renal function; consider age-related decline in GFR and monitor. |
| 1st trimester | Cefuroxime crosses the placenta. Animal studies have not shown teratogenic effects, but adequate human studies are lacking. Use only if clearly needed. |
| 2nd trimester | No evidence of fetal harm in animal studies. Use during the second trimester if clearly indicated. |
| 3rd trimester | Cefuroxime is considered safe in the third trimester for treatment of maternal infections, including intrapartum prophylaxis. However, monitor for potential adverse effects on fetal gut flora. |
Clinical note
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
| FDA category | Human |
| Placental transfer | Cefuroxime crosses the placenta. Studies indicate fetal serum concentrations reach approximately 50-100% of maternal serum levels at term. |
■ FDA Black Box Warning
No FDA boxed warning.
| Common Effects | Diarrhea |
| Serious Effects |
Known hypersensitivity to cefuroxime or other cephalosporinsHistory of severe immediate hypersensitivity reaction (e.g., anaphylaxis) to penicillins or beta-lactam antibiotics
| Precautions | Hypersensitivity reactions including anaphylaxis, especially in patients with penicillin allergy, Clostridioides difficile-associated diarrhea (CDAD), Potential for nephrotoxicity, especially with concurrent use of aminoglycosides or loop diuretics, Seizures may occur with high doses or in patients with renal impairment, Suprainfections with prolonged use |
| Food/Dietary | No significant food interactions. Avoid alcohol during treatment and for 48 hours after completion due to risk of disulfiram-like reaction. |
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| Breastfeeding |
| Cefuroxime is excreted into breast milk in small amounts (less than 1% of maternal dose). It is generally considered compatible with breastfeeding. However, caution is advised in neonates with hypersensitivity or those with diarrhea or thrush. |
| Lactation Rating | L2 (Safe, likely compatible) |
| Teratogenic Risk | Cefuroxime is a cephalosporin antibiotic classified as FDA Pregnancy Category B. Animal studies have not demonstrated fetal risk, and no adequate well-controlled studies in pregnant women exist. First trimester: Generally considered safe, but data are limited. Second and third trimesters: No known teratogenic effects; crosses placenta with fetal serum concentrations 25-50% of maternal levels. No increased risk of congenital anomalies reported. |
| Fetal Monitoring | Monitor maternal renal function (serum creatinine, BUN) and hepatic function (AST, ALT) periodically during prolonged therapy. Assess for signs of hypersensitivity reactions (rash, urticaria, anaphylaxis). In the fetus, no specific monitoring required, but observe for potential effects such as diarrhea or candidiasis in neonates if given near term. |
| Fertility Effects | No adverse effects on fertility have been reported in animal studies. Cefuroxime does not affect sperm parameters or ovulation in humans based on available data. |
| Clinical Pearls | Cefuroxime is a second-generation cephalosporin with activity against gram-positive and gram-negative organisms. In the DUPLEX container, it is premixed with dextrose; do not use if the container is damaged or the solution is discolored. Administer over 15-60 minutes IV. Dose adjustment required in renal impairment (CrCl <30 mL/min). Monitor for hypersensitivity reactions, especially in penicillin-allergic patients. Can cause false-positive urine glucose tests with non-enzymatic methods; use glucose oxidase methods. |
| Patient Advice | This medication is given intravenously, usually every 8 hours. · Tell your doctor if you are allergic to penicillins or cephalosporins. · Notify your healthcare provider if you experience rash, itching, difficulty breathing, or swelling. · Diarrhea may occur; contact your doctor if it becomes severe or bloody. · Do not stop treatment early without consulting your doctor. · Inform your doctor if you have kidney disease or are on dialysis. |