Cefuroxime: Full Review
Cefuroxime is a second-generation cephalosporin antibiotic used to treat a variety of bacterial infections. It offers a broader spectrum of activity than first-generation cephalosporins and is available in both oral and injectable forms.
1. Mechanism of Action
Cefuroxime inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs) located in the bacterial cell wall. This binding interferes with the formation of cross-links between peptidoglycan layers, weakening the cell wall and leading to bacterial lysis and death. Cefuroxime is bactericidal, meaning it kills bacteria rather than merely inhibiting their growth.
2. Uses
Cefuroxime is used to treat a range of infections, including:
- Respiratory Tract Infections: Such as bronchitis, pneumonia, and sinusitis.
- Ear Infections: Including otitis media.
- Skin and Soft Tissue Infections: Such as cellulitis and impetigo.
- Urinary Tract Infections (UTIs): Including cystitis and pyelonephritis.
- Bone and Joint Infections: Such as osteomyelitis.
- Gonorrhea: Cefuroxime is sometimes used to treat uncomplicated gonorrhea.
- Preoperative Prophylaxis: Used to prevent infections in certain surgical procedures.
3. Dosage and Administration
Cefuroxime is administered orally (as tablets or suspension) or parenterally (as IV or IM injection). Dosage varies based on the infection:
- Oral Cefuroxime:
- Adults: 250 mg to 500 mg every 12 hours, with the total daily dose typically ranging from 500 mg to 1 gram.
- Children: 20 mg/kg to 30 mg/kg per day, divided into 2 or 3 doses.
- Parenteral Cefuroxime:
- Adults: 750 mg to 1.5 grams IV/IM every 8 hours, depending on the severity of the infection.
- Children: 30 mg/kg to 100 mg/kg per day, divided into 3 or 4 doses.
4. Contraindications
Cefuroxime is contraindicated in:
- Patients with hypersensitivity to cephalosporins or penicillins (due to potential cross-reactivity).
- Patients with a history of severe allergic reactions to beta-lactam antibiotics.
- Severe renal impairment: Dose adjustments are necessary for patients with significant kidney dysfunction.
5. Side Effects
Common side effects of cefuroxime include:
- Gastrointestinal issues: Nausea, vomiting, diarrhea, and abdominal pain.
- Allergic reactions: Rash, itching, and in rare cases, anaphylaxis.
- Hematologic effects: Rarely, leukopenia, thrombocytopenia, or eosinophilia.
- Renal effects: Rare instances of interstitial nephritis or acute kidney injury.
- Injection site reactions: Pain, redness, or swelling at the injection site (for parenteral forms).
6. Drug Interactions
- Anticoagulants: Cefuroxime can enhance the effects of anticoagulants like warfarin, increasing the risk of bleeding.
- Probenecid: May increase cefuroxime levels by inhibiting its renal excretion.
- Other nephrotoxic drugs: Caution is advised when used with other drugs that affect kidney function.
7. Special Precautions
- Renal Function: Dose adjustments may be necessary for patients with renal impairment to avoid toxicity.
- Allergies: Patients with a history of penicillin allergy should be monitored for potential cross-reactivity.
- Superinfections: Long-term use can lead to the development of resistant organisms or fungal infections.
8. Resistance
Resistance to cefuroxime can develop through various mechanisms:
- Beta-lactamase production: Enzymes that break down cefuroxime, reducing its effectiveness.
- Altered PBPs: Bacteria may alter their PBPs to reduce cefuroxime binding.
- Efflux pumps: Some bacteria may pump cefuroxime out of the cell before it can act.
9. Storage and Stability
Cefuroxime tablets and suspension should be stored at room temperature, away from moisture and heat. The oral suspension should be refrigerated and used within 10 days.
10. Summary
Cefuroxime is a second-generation cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative bacteria. It is used to treat respiratory tract infections, ear infections, skin infections, and more. Available in both oral and injectable forms, cefuroxime is generally well-tolerated but can cause gastrointestinal disturbances, allergic reactions, and other side effects. Careful consideration of patient allergies, renal function, and potential drug interactions is crucial for effective and safe use.
