For the treatment of the following infections, cefuroxime, a second-generation cephalosporin antibiotic, is offered as oral tablets, capsules, suspensions, as well as an intravenous formulation.:

• Treatment of bone and joint infections caused by:

  • Staphylococcus aureus strains that produce penicillinase and those that do not. 

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• Treatment for mild to moderate bacterial acute exacerbations of chronic bronchitis in adults and adolescents older than 13:

  • Streptococcus pneumoniae
  • Beta-lactamase negative strains of Haemophilus influenzae, or
  • Beta-lactamase negative strains of Haemophilus parainfluenzae.

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• Treatment of lower respiratory tract infections including pneumonia caused by:

  • S. pneumoniae
  • H. influenzae including ampicillin resistant strains
  • Klebsiella spp.
  • Penicillinase- and non-penicillinase-producing strains of S. aureus
  • Streptococcus pyogenes
  • Escherichia coli.

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• Treatment of early Lyme disease brought on by adults and children older than 13:

  • Borrelia burgdorferi.

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• Acute bacterial otitis media caused by bacteria in children older than three months of age is treated with:

  • S. pneumoniae
  • H. influenzae including beta-lactamase-producing strains
  • Moraxella catarrhalis including beta-lactamase-producing strains
  • S. pyogenes.

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• Treating mild to moderate tonsillitis and pharyngitis brought on by:

  • S. pyogenes

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• Treatment of septicemia caused by:

  • Penicillinase- and nonpenicillinase- producing strains of S. aureus
  • S. pneumoniae
  • E. coli
  • H. influenzae including ampicillin resistant strains
  • Klebsiella spp.

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• Treatment for mild to moderate acute bacterial maxillary sinusitis caused by:

  • S. pneumoniae
  • non-beta-lactamase producing strains of H. influenzae.

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• Treatment of skin or soft tissue infections like impetigo caused by in children older than three months:

  • Staph. aureus including beta-lactamase-producing strains
  • S. pyogenes
  • E. coli
  • Klebsiella spp.
  • Enterobacter spp

• Prophylaxis of surgical infections

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• Treatment of bacterial urinary tract infections in adults and children older than three months:

  • E. coli
  • Klebsiella spp.

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• Off-Label Use of Cefuroxime in Adults include:

  • Prophylaxis or treatment of animal or human bite Bite wound.
  • Mild to moderate Intra-abdominal community-acquired infection
  • In early disseminated or late Lyme disease.

Cefuroxime axetil dose in Adults:

• Off-label use as an alternative agent in the treatment of animal or human bite or prophylaxis of Bite wound:

  • 500 mg used twice day for 3 to 5 days (for prophylaxis) or for 5 to 14 days in conjunction with metronidazole or clindamycin (for the treatment)

• Cefuroxime use in the treatment of acute exacerbation of Chronic obstructive pulmonary disease:

  • For five to seven days, take 250 to 500 mg twice daily.

• Cefuroxime use as off-label use in mild to moderate community-acquired Intraabdominal infection:

  • Acute Cholecystitis:

    • 1.5 gms intravenous thrice daily for at least 24 hours (in combination with metronidazole ) after removal of the gallbladder or until clinical resolution.

• Other intraabdominal infections like a perforated appendix, diverticulitis, and intra-abdominal abscess:

  • Following effective source control, 1.5 gm intravenously administered three times daily in combination with metronidazole for 4–7 days.

• Cefuroxime use in the treatment of Lyme disease:

  • Early localized disease(erythema migrans):

    • For 14 to 21 days, take 500 mg orally two times each day.

  • Early disseminated disease as in carditis with 1st-degree atrioventricular block:

    • For 21 to 28 days, take 500 mg orally twice a day.

  • Illness that spreads early and only has little neurological effects (isolated facial nerve palsy):

    • For 14 to 21 days, take 500 mg orally two times each day.

  • Late disease as in arthritis without neurologic involvement:

    • 500 mg orally two times a day for 28 days.

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• Cefuroxime dose in Acute Otitis media:

  • 500 mg orally two times a day for 5 - 10 days.

• Cefuroxime axetil for outpatient empiric therapy or pathogen-directed therapy in community-acquired Pneumonia:

  • Taking 500 mg orally twice a day for a minimum of five days while also taking other suitable antibiotics, like macrolides, is recommended.

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• Cefuroxime as an alternative agent for Streptococcal pharyngitis:

  • For ten days, take 250 mg orally twice each day.

• Cefuroxime for surgical prophylaxis in cardiac or head and neck surgery:

  • 1.5 gms intravenous within one hour prior to surgical incision.
  • The dose may be repeated within 4 hours in lengthy procedures and in patients with excessive blood loss.

• Cefuroxime axetil in Acute uncomplicated Urinary tract infections ( like Cystitis):

  • For five to seven days, take 250 mg orally twice a day.

Cefuroxime dose in Children

General dosing of cefuroxime axetil in susceptible infections:

• Infants, Children, and Adolescents:

  • Mild to moderate infection:

    • Up to 500 mg/dose, or 20 to 30 mg/kg/day, given orally in two separate doses.
    • 75 to 100 mg/kg/day intramuscular or intravenous in 3 divided doses to a maximum dose of 1.5 gms/dose

  • In Severe infections:

    • 100 - 200 mg/kg/day intramuscular or intravenous in 3 or 4 divided doses to a maximum dose of 1.5 gms/dose

Cefuroxime dose in Bone and joint infections:

• Infants older than 3 months, Children, and Adolescents:
  • 50 mg/kg/dose intramuscular or intravenous thrice daily to a maximum dose of 1.5 gms/dose.

Cefuroxime dose in acute exacerbations of Chronic Bronchitis:

• Adolescents:
  • 250 - 500 mg orally twice daily for 10 days

Zinacef (Cefuroxime) dose in Impetigo:

• Infants older than 3 months and Children:
  • 15 mg/kg/dose orally (suspension) two times a day for 10 days to a maximum dose of 500 mg/dose.

Cefuroxime dose in complicated community-acquired Intra-abdominal infections:

• Infants, Children, and Adolescents:
  • 150 mg/kg/day intravenous in three or four divided doses to a maximum dose of 1.5 gms/dose.

Cefuroxime dose in Lyme disease:

• Infants, Children, and Adolescents:

  • Acrodermatitis Chronica atrophicans:

    • 15 mg/kg/dose orally twice daily for 21 days to a maximum dose of 500 mg/dose.

  • Early localized disease:

    • 15 mg/kg/dose orally twice daily for 14 days to a maximum dose of 500 mg/dose.

  • Late disease as in arthritis:

    • 15 mg/kg/dose orally twice daily for 28 days to a maximum dose of 500 mg/dose.

Cefuroxime dose in Acute Otitis media:

• Infants older than 3 months and Children:
  • 15 mg/kg/dose orally (suspension) two times a day for 10 days to a maximum dose of 500 mg/dose or
  • 250 mg of oral tablets two times a day for 10 days (in patients who can swallow the tablets.

Cefuroxime dose in Pharyngitis & tonsillitis:

• Infants older than 3 months and Children:

  • 10 mg/kg/dose orally (suspension) two times a day for 10 days to a maximum dose of 250 mg/dose.

• Adolescents:

  • two 250 mg oral tablet doses every day for ten days.

Cefuroxime dose in Bacterial Pneumonia in HIV-exposed or HIV-positive patients:

• Infants and Children:
  • 35 - 50 mg/kg/dose intravenous thrice daily to a maximum dose of 2 gms/dose.

Cefuroxime dose in Sinusitis:

• Infants older than 3 months and Children:

  • 15 mg/kg/dose orally (suspension) two times a day for 10 days to a maximum dose of 500 mg/dose or
  • 250 mg oral tablets two times a day for 10 days

• Adolescents:

  • Two 250 mg oral pills every day for ten days.

Cefuroxime dose in Uncomplicated Skin and soft-tissue infections:

• Adolescents:
  • For ten days, take two 250–500 mg oral tablets.

Cefuroxime dose in Surgical prophylaxis:

• Children and Adolescents:
  • 50 mg/kg intravenous within one hour before the procedure.
  • The dose may be repeated in four hours in lengthy procedures or in patients with excessive blood loss (more than 1.5 liters) to a maximum dose of 1.5 gms/dose.

Cefuroxime dose in Uncomplicated Urinary tract infection:

• Infants and Children 2 - 24 months:

  • 10 to 15 mg/kg/dose orally (suspension) two times a day.

• Children older than 2 years:

  • Moderate to severe disease including the possibility of pyelonephritis:
    • 20 to 30 mg/kg/day orally (suspension) in two divided doses to a maximum dose of 500 mg/dose.

• Adolescents:

  • Two 250 mg oral pills every day for seven to ten days.

Cefuroxime Pregnancy Risk Factor B

• Cefuroxime crosses over the placenta but has not been linked to any adverse effects in fetal health.
• Prior to a caesarean delivery, it is advised to utilise it as a preventative measure.

Cefuroxime axetil use during breastfeeding:

• Breast milk contains cefuroxime, which is excreted in it.
• Infants should be watched for any gastrointestinal issues, such as vomiting and diarrhoea, even though it is normally compatible with breastfeeding.

Cefuroxime dose in Renal disease:

• Dose adjustment for oral tablets as per Manufacturer’s labeling:

  • CrCl of 30 mL/minute or more:

    • Dose adjustment is not required

  • CrCl 10 - 30 mL/minute:

    • Administer the recommended dose once a day.

  • CrCl of less than 10 mL/minute:

    • Administer the recommended dose every 2nd day.

  • ESRD requiring intermittent hemodialysis (IHD):

    • Give an additional recommended dose after each dialysis.

• Dose adjustment for Intravenous Cefuroxime as per Manufacturer’s labeling:

  • CrCl of 20 mL/minute or more:

    • Dose adjustment is not required

  • CrCl 10 - 20 mL/minute:

    • Administer the recommended dose twice daily

  • CrCl of less than 10 mL/minute:

    • Administer the recommended dose once a day.

  • Patient with Hemodialysis:

    • Administer an additional recommended dose after dialysis.

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• Alternative dosing of Cefuroxime axetil:

  • Peritoneal dialysis:

    • Administer the recommended dose once a day.

  • Continuous renal replacement therapy (CRRT):

    • 1 gm twice daily

Cefuroxime axetil (ZInacef) dose in liver disease:

Dose adjustment in patients with liver disease is not recommended.

Cefuroxime axetil Side effects (Common):

• Gastrointestinal:

  • Diarrhea

Less Common Side Effects Of Cefuroxime (Zinacef) include:

• Cardiovascular:

  • Local thrombophlebitis

• Dermatologic:

  • Diaper rash

• Endocrine & metabolic:

  • Increased lactate dehydrogenase

• Gastrointestinal:

  • Nausea and vomiting
  • Unpleasant taste

• Genitourinary:

  • Vaginitis

• Hematologic & oncologic:

  • Decreased hematocrit
  • Decreased hemoglobin
  • Eosinophilia

• Hepatic:

  • Increased serum transaminases
  • Increased serum alkaline phosphatase

• Immunologic:

  • Jarisch-Herxheimer reaction

Contraindication to Cefuroxime include:

• Cefuroxime, other beta-lactam antibiotics, penicillins, cephalosporins, and any ingredient in this formulation-related allergic reactions

Zinacef Warnings and Precautions

• Elevated INR

  • A rise in INR can lead to coagulopathy, which may be a sign of Cefuroxime therapy for patients with nutritional deficiencies or hepatic impairment.

• Hypersensitivity reactions

  • Anaphylactic reactions can occur.
  • It is important to stop using the drug and immediately start treatment with antihistamines, epinephrine and steroids.

• Superinfection

  • Cefuroxime therapy for longer periods (more than two months) can lead to superinfections, including fungal or bacterial superinfections. C. difficile-associated diarrhea, (CDAD), and pseudomembranous collitis can occur.

• Gastrointestinal Disease:

  • Patients who have had colitis in the past should not take this drug.

• Renal impairment

  • Patients with impaired renal function should be cautious when taking the drug. Adjusting the dose may be necessary.

• Seizure disorders:

  • Patients taking large doses or those with compromised renal function are at risk for seizures.
  • The use of this drug is not recommended for people with seizure disorders or a history of seizures.

Cefuroxime: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitor (periodically with prolonged therapy):

• Renal functions
• Liver functions
• CBC & other hematologic parameters
• Prothrombin time and INR especially in malnourished individuals
• Observe for clinical features of anaphylaxis during the first dose.

How to take Cefuroxime axetil?

• Oral suspension:

  • Before using, thoroughly shake the suspension, and take it with meals.

• Oral tablet:

  • Oral tablets have a very bitter taste and should be swallowed whole with or without food.

• Intramuscular injection:

  • Deep IM injections into substantial muscle mass.

• Intravenous:

  • Intravenously administer the medication over a 3- to 5-minute period. A 15- to 30-minute IV infusion may be administered.

Mechanism of action of Cefuroxime axetil:

Cefuroxime, It prevents the synthesis of proteins and peptidoglycans by interacting with proteins that bind to penicillin. The autolytic enzymes eventually cause cell lysis as a result of this.

With eating, oral tablet absorption increases. It is readily available to human tissues and fluids including bile, bone, kidney, liver, and heart fluids, as well as synovial and pericardial fluids.

 It crosses the blood-brain border. 33 to 50% of the drug areprotein-bound.Oral Cefuroxime Axetil is metabolized by the intestinal mucosa.

BioavailabilityThe oral tablet's efficiency is 37% when consumed in fasting. When taken with food, the bioavailability of the oral tablet is up to 50%. The oral suspension is less bioavailable.

Half-life eliminationAdults can take the drug for 1 to 2 hours while children need it for 1.4 to 1.9 hours. It increases in patients with kidney failure, neonatal and premature babies.

Time to get therepeak serum concentrationAfter intramuscular injection, it takes 15 to 60 minutes. After intravenous injection, it takes 2 – 3 minutes. Oral administration takes 3 – 4 hours.

It is primarilyexcretedVia urine (66 - 100%) .

Cefuroxime axetil Brand Names (International):

• APO-Cefuroxime
• Auro-Cefuroxime
• Ceftin
• PRO-Cefuroxime-500
• RATIO-Cefuroxime
• Actixim
• Adrox
• Aksef
• Alporin
• Altacef
• Altamax
• Anbacim
• Aprok
• Aprokam
• Axet
• Axetine
• Axim
• Axurocef
• C-Tri T
• Carvixime
• Cef2
• Cefabiot
• Cefasun
• Cefero
• Ceflour
• Cefmono
• Cefora
• Cefosan
• Ceftil
• Cefudura
• Cefuhexal
• Cefumax
• Cefuracet
• Cefurax
• Cefuro-Puren
• Cefurocos
• Cefurox
• Cefuroxwolff
• Cefutil
• Cefutin
• Cefuxime
• Cefxin
• Cefzime
• Celocid
• Ceprosim
• Cerox A
• Ceroxim
• Cethixim
• Cetil
• Cetoxil
• Cexil
• Cexim
• CMaxid
• Cortum
• Curoxime
• Daliroxim
• Daroxime
• Daroxine
• Deltrox
• Efox
• Efurox
• Elobact
• Eroxmit
• Famicef
• Farmacef
• Fornax
• Froxime
• Furacam
• Furobioxin
• Furoxim
• Furoxime
• Gomcef
• Jectocef
• Keef-250
• Kefezy
• Kefloxa
• Kefrox
• Kefurox
• Ketocef
• Kimatcef
• Magnaspor
• Maxil
• Medxime
• Milcef
• Neurox-250
• Novador
• Novocef
• Olcef
• Oratil
• Oraxim
• Oxtercid
• Profurex
• Rucef
• Sefuxim
• Sharox-500
• Shincef
• Situroxime
• Teikeden
• U-Cef
• Vekfazolin
• Vexuro
• Xorim
• Xorimax
• Xorufec
• Zamur
• Zegen
• Zenon
• Zetnil
• Zilisten
• Zinacef
• Zinat
• Zincef
• Zinnat
• Zinoximor
• Zocef
• Zoref

Cefuroxime axetil Brand Names in Pakistan: