CEFUROXIME SODIUM IN PLASTIC CONTAINER
Clinical safety rating: safe
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
Cefuroxime is a beta-lactam cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to cell lysis and death. It has bactericidal activity against susceptible organisms.
| Metabolism | Not significantly metabolized; primarily eliminated unchanged by the kidneys via glomerular filtration and tubular secretion. |
| Excretion | Renal excretion: 80-90% unchanged by glomerular filtration and tubular secretion. Biliary/fecal: <10%. |
| Half-life | Terminal elimination half-life: 1.2-1.9 hours. Prolonged in renal impairment (up to 15-20 hours with CrCl <20 mL/min). |
| Protein binding | 33-50% bound to plasma proteins, primarily albumin. |
| Volume of Distribution | 0.2-0.4 L/kg. Low Vd indicates limited extravascular distribution; distributes well into tissues including pleural fluid, synovial fluid, and aqueous humor. |
| Bioavailability | IM: 85-100%. Oral (cefuroxime axetil): 30-50% (fasted); 52-70% with food. |
| Onset of Action | IV: immediate; IM: within 15-30 minutes. |
| Duration of Action | Approximately 8-12 hours for susceptible pathogens; dosing interval typically q8h. |
1.5 g IV every 8 hours for moderate to severe infections; may be increased to 3 g IV every 8 hours for severe or life-threatening infections.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 20-50 mL/min: 1.5 g IV every 12 hours. CrCl 10-19 mL/min: 1.5 g IV every 24 hours. CrCl <10 mL/min: 1.5 g IV every 48 hours. Intermittent hemodialysis: 1.5 g IV after each dialysis session. |
| Liver impairment | No dose adjustment required for hepatic impairment. Use with caution in severe hepatic dysfunction. |
| Pediatric use | Neonates and infants <3 months: 20-50 mg/kg IV every 8 hours. Children ≥3 months: 50-100 mg/kg/day IV divided every 8 hours, maximum 3 g/day. |
| Geriatric use | Adjust dose based on renal function (see renal adjustment). Monitor for bleeding and superinfection. No specific age-related dose modification beyond renal adjustment. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Probenecid may decrease cephalosporin excretion May cause diarrhea including Clostridium difficile-associated diarrhea.
| FDA category | Human |
| Breastfeeding | Cefuroxime is excreted into human breast milk in low concentrations (M/P ratio approximately 0.02-0.45). It is considered compatible with breastfeeding due to poor oral bioavailability in infants. However, monitor infant for diarrhea, candidiasis, or rash. |
| Teratogenic Risk | Cefuroxime is classified as FDA Pregnancy Category B. Animal studies do not indicate fetal harm. There are no adequate and well-controlled studies in pregnant women. Cefuroxime crosses the placenta. First trimester: No evidence of teratogenicity. Second and third trimesters: Generally considered safe; no known fetal risks. |
■ FDA Black Box Warning
No FDA black box warning.
| Common Effects | Diarrhea |
| Serious Effects |
["Hypersensitivity to cefuroxime, other cephalosporins, or any component of the formulation","Severe hypersensitivity (e.g., anaphylactic reactions) to penicillins or other beta-lactam antibiotics"]
| Precautions | ["Hypersensitivity reactions (including anaphylaxis) – caution in patients with penicillin or other beta-lactam allergies","Clostridioides difficile-associated diarrhea (CDAD) – may range from mild diarrhea to fatal colitis","Potential for superinfection with prolonged use","Seizures – may occur at high doses, especially in patients with renal impairment","Renal impairment – dose adjustment required for creatinine clearance less than 30 mL/min","Increased INR in patients receiving anticoagulants (e.g., warfarin)","False-positive urine glucose test with non-enzymatic methods (e.g., Clinitest); false-positive Coombs test"] |
Loading safety data…
| Fetal Monitoring | No specific monitoring required beyond standard clinical observation for adverse effects. Assess renal function (dose adjustment if CrCl < 30 mL/min). Monitor for allergic reactions or gastrointestinal disturbances. |
| Fertility Effects | No known adverse effects on human fertility. Animal studies show no impairment of fertility. |
| Food/Dietary |
| No significant food interactions. Alcohol should be avoided due to possible disulfiram-like reaction. |
| Clinical Pearls | Administer intravenously over 15-60 minutes; adjust dose in renal impairment (CrCl <30 mL/min: 1 g q24h). Monitor for Clostridium difficile-associated diarrhea. Use caution in patients with penicillin allergy due to cross-sensitivity. Peak serum levels occur at end of infusion. |
| Patient Advice | Complete entire course even if you feel better. · Report any signs of allergic reaction, severe diarrhea, or unusual bleeding/bruising. · Avoid alcohol for at least 48 hours after the last dose. · This medication is given intravenously; do not use at home unless trained. |