KEFUROX
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KEFUROX (KEFUROX).
Cefuroxime inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), inhibiting the final transpeptidation step of peptidoglycan synthesis, leading to cell lysis.
| Metabolism | Cefuroxime is not metabolized and is excreted unchanged in urine via glomerular filtration and tubular secretion. |
| Excretion | Primarily renal (80-90% unchanged via glomerular filtration and tubular secretion); biliary/fecal <10%. |
| Half-life | 1.2-1.6 hours in adults with normal renal function (Clcr >80 mL/min); prolonged to 10-20 hours in end-stage renal disease (Clcr <10 mL/min). |
| Protein binding | 50-60% (primarily to albumin). |
| Volume of Distribution | 0.16-0.23 L/kg (low Vd, consistent with limited extravascular distribution; primarily remains in extracellular fluid). |
| Bioavailability | IM: 100%; Oral: Not available (parenteral administration only). |
| Onset of Action | IV: Immediate (peak concentration at end of infusion); IM: 15-30 minutes; Oral: Not applicable (parenteral only). |
| Duration of Action | 6-8 hours for susceptible organisms; prolonged in renal impairment. Clinical effect persists ~12-24 hours in severe renal failure. |
750 mg to 1.5 g intramuscularly or intravenously every 8 hours; for severe infections, 1.5 g intravenously every 6 to 8 hours.
| Dosage form | INJECTABLE |
| Renal impairment | GFR 50-20 mL/min: 750 mg every 12 hours; GFR 20-10 mL/min: 750 mg every 24 hours; GFR <10 mL/min: 750 mg every 48 hours; hemodialysis: 750 mg after each dialysis session. |
| Liver impairment | No dose adjustment required for mild to moderate hepatic impairment; Child-Pugh class C: no specific data, use with caution. |
| Pediatric use | Children 3 months to 18 years: 30-100 mg/kg/day intravenously divided every 6 to 8 hours; maximum 6 g/day. Neonates: 30-50 mg/kg/day intravenously divided every 8 to 12 hours based on gestational and postnatal age. |
| Geriatric use | Elderly patients: no specific dose adjustment, but dose selection should be cautious based on renal function; monitor renal function and adjust per renal adjustment guidelines. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for KEFUROX (KEFUROX).
| Breastfeeding | Cefuroxime is excreted into human milk in small amounts. M/P ratio not established. Consider risk-benefit; may cause alteration of infant gut flora. |
| Teratogenic Risk | No evidence of teratogenicity in animal studies. Insufficient human data; risk cannot be excluded. Use only if clearly needed during pregnancy. |
| Fetal Monitoring | No specific fetal monitoring required. Standard maternal monitoring for adverse effects (e.g., hypersensitivity, diarrhea). |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Known hypersensitivity to cefuroxime or other cephalosporins","Severe hypersensitivity reaction (e.g., anaphylaxis) to penicillins or other beta-lactam antibiotics"]
| Precautions | ["Serious hypersensitivity reactions (anaphylaxis) may occur, especially in patients with penicillin allergy.","Clostridioides difficile-associated diarrhea (CDAD) can occur and may range from mild diarrhea to fatal colitis.","Seizures may occur, especially in patients with renal impairment when doses are not reduced.","Prolonged use may result in overgrowth of non-susceptible organisms."] |
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| Fertility Effects | No known adverse effects on fertility in animal or human studies. |