Cefuroxime side effects. Medicinal reference book geotar
Cefuroxime sodium in terms of cefuroxime 0.75 g or 1.5 g.
Description:White or white with a yellowish tint powder, hygroscopic.
Pharmacotherapeutic group:Antibiotic cephalosporin. ATX:J.01.D.C.02 Cefuroxime
Pharmacodynamics:2nd generation cephalosporin antibiotic for parenteral use. It acts bactericidal (breaks the synthesis of the bacterial cell wall). Possesses a wide range antimicrobial action.
Highly active against gram-positive microorganisms, including strains resistant to penicillins (with the exception of strains resistant to methicillin), Staphylococcus aureus, Streptococcus pyogenes (and other beta-hemolytic streptococci), Streptococcus pneumoniae, Group B Streptococcus (Streptococcus agalactiae), Streptococcus mitis (viridans groups), Bordetella pertussis, majority. Clostridium spp.; gram-negative microorganisms (Escherichia coli, Klebsiella spp., Proteus mirabilis, Providencia spp., Proteus rettgeri, Haemophilus influenzae, including strains resistant to ampicillin; Haemophilus parainfluenzae, including strains resistant to ampicillin; Moraxella catarrhalis, Neisseria gonorrhoeae, including strains producing and not producing penicillinase, Neisseria meningitidis, Salmonella spp., Borrelia burgdorferi; gram-positive and gram-negative anaerobes (Peptococcus spp., Peptostreptococcus spp., Fusobacterium spp., Propionibacterium spp.).
Insensitive to cefuroxime: Clostridium difficile, Pseudomonas spp., Campylobacter spp., Acinetobacter calcoaceticus, Listeria monocytogenes, methicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Legionella spp. , Citrobacter spp., Serratia spp., Bacteroides fragilis.
Pharmacokinetics:Parenteral administration: after intramuscular administration of 750 mg, the maximum concentration (Cmax) is reached after 15-60 minutes and is 27 μg / ml. With intravenous administration of 0.75 and 1.5 g, Cmax after 15 minutes is 50 and 100 μg / ml, respectively. Therapeutic concentration is maintained for 5.3 and 8 hours, respectively. The half-life (T1 / 2) with intravenous and intramuscular injection is 1.3-1.5 hours, in newborns - 2-2.5 hours. Communication with plasma proteins is 33-50%. Not metabolized in the liver. Excreted by the kidneys by glomerular filtration and tubular secretion 85-90% unchanged for 8 hours ( most of the drug is excreted during the first 6 hours, while creating high concentrations in the urine); after 24 hours, it is completely eliminated (50% by tubular secretion, 50% by glomerular filtration). Therapeutic concentrations are recorded in the pleural fluid, bile, sputum, myocardium, skin and soft tissues. Cefuroxime concentrations above the minimum inhibitory concentration (MIC) for most organisms can be achieved in bone tissue, synovial and intraocular fluids. When meningitis penetrates the blood-brain barrier (BBB). Passes through the placenta and passes into breast milk. Indications: Infectious and inflammatory diseases caused by susceptible microorganisms: infections respiratory tract(bronchitis, pneumonia, lung abscess, pleural empyema, etc.), ENT organs (sinusitis, tonsillitis, pharyngitis, otitis media, etc.), urinary tract(pyelonephritis, cystitis, asymptomatic bacteriuria, gonorrhea, etc.), skin and soft tissues (erysipelas, pyoderma, impetigo, furunculosis, phlegmon, wound infection, erysipeloid, etc.), bones and joints (osteomyelitis, septic arthritis, etc.) , pelvic organs (endometritis, adnexitis, cervicitis), sepsis, meningitis, Lyme disease (borreliosis); prevention of infectious complications during operations on organs chest, abdominal cavity, pelvis, joints (including during operations on the lungs, heart, esophagus, in vascular surgery with high degree risk of infectious complications during orthopedic operations). Contraindications:Hypersensitivity (including to other cephalosporins, penicillins and carbapenems). Carefully:In newborns, premature; during pregnancy and lactation; with chronic kidney failure(CKD); in debilitated and debilitated patients; with bleeding and diseases of the gastrointestinal tract in history, incl. with nonspecific ulcerative colitis. Dosage and administration:In / in and / m adults are prescribed 750 mg 3 times a day; in severe infections, the dose is increased to 1500 mg 3-4 times a day (if necessary, the interval between injections can be reduced to 6 hours). Medium daily dose- 3-6 g. Children are prescribed 30-100 mg / kg / day in 3-4 doses. For most infections, the optimal dose is 60 mg/kg/day. Newborns and children under 3 months are prescribed 30 mg / kg / day in 2-3 doses.
With gonorrhea - in / m, 1500 mg (in the form of 2 injections of 750 mg each with an injection in different areas, for example, in both gluteal muscles).
With bacterial meningitis - in / in, 3 g every 8 hours; children of younger and older age - 150-250 mg / kg / day in 3-4 doses, newborns - 100 mg / kg / day. During operations on the abdominal cavity, pelvic organs and orthopedic operations - in / in, 1500 mg during the induction of anesthesia, then additionally - in / m, 750 mg, 8 and 16 hours after the operation. For total joint replacement, 1500 mg of powder is dry mixed with each sachet of methyl methacrylate cement polymer before adding the liquid monomer.
During operations on the heart, lungs, esophagus and blood vessels - in / in, 1500 mg during the induction of anesthesia, then - in / m, 750 mg 3 times a day for the next 24-48 hours. With pneumonia - in / in, according to 1500 mg 2-3 times a day for 48-72 hours, then switch to oral administration, 500 mg 2 times a day for 7-10 days.
With an exacerbation chronic bronchitis appoint in / m or / in, 750 mg 2-3 times a day for 48-72 hours, then switch to oral administration, 500 mg 2 times a day for 5-10 days.
With chronic renal failure, a correction of the dosing regimen is necessary: with a creatinine clearance (CC) of 10-20 ml / min, 750 mg is prescribed intravenously or intramuscularly 2 times a day, with CC less than 10 ml / min - 750 mg 1 time per day .
Patients on continuous hemodialysis using an arteriovenous shunt or on high-speed hemofiltration in intensive care units are prescribed 750 mg 2 times a day; for patients on low-speed hemofiltration, doses recommended for impaired renal function are prescribed.
Preparation of solution for injection:
for i / m injections:
Add 3 ml water for injection to 750 mg cefuroxime. Shake gently until a suspension forms. When administered intramuscularly, it is compatible with aqueous solutions containing up to 1% lidocaine hydrochloride. at a dose of 1500 mg is intended only for intravenous administration.
Solution for intravenous administration
Dissolve
- 750 mg of cefuroxime in 6 ml or more of water for injection, -1.5 g of cefuroxime in 15 ml or more of water for injection.
For short-term intravenous infusions (up to 30 minutes), 1.5 g of the drug is dissolved in 50 ml of water for injection. These solutions can be administered directly into a vein or into an infusion line.
When mixing a solution of cefuroxime (1.5 g in 15 ml of water for injection) and metronidazole (50 mg/100 ml), both components retain their activity for up to 24 hours at a temperature of 4 ° C or up to 6 hours at a temperature below 25 ° C.
Cefuroxime is compatible with the most commonly used intravenous fluids. The drug is stable for up to 24 hours at room temperature when mixed with the following solutions:
- 0.9% sodium chloride solution; -5% dextrose solution;
- Ringer's solution;
- Hartmann's solution.
Cefuroxime remains stable in 0.9% sodium chloride solution and in 5% dextrose solution in the presence of hydrocortisone sodium phosphate.
Compatible with the following solutions for 24 hours at room temperature:
- heparin (10 units/ml and 50 units/ml) in 0.9% sodium chloride solution;
- potassium chloride (10 mEq/l and 40 mEq/l) in 0.9% sodium chloride solution. should not be mixed in the same syringe with antibiotics from the aminoglycoside group.
A solution of sodium bicarbonate 2.74% has a pH value that significantly affects the color of the cefuroxime solution, so it is not recommended to use it for dilution. If necessary, sodium bicarbonate solution can be injected into the patient directly into the tube of the infusion system.
Side effects:Allergic reactions: chills, rash, itching, urticaria, rarely - multiforme exudative erythema(including Stevens-Johnson syndrome), bronchospasm, anaphylactic shock.
Local reactions: irritation, infiltration and pain at the injection site, phlebitis.
From the side genitourinary system: itching in the perineum, vaginitis.
From the side of the central nervous system(CNS): convulsions.
From the urinary system: impaired renal function, dysuria.
From the side digestive system: diarrhea, nausea, vomiting, abdominal cramps and pain,
ulceration of the oral mucosa, oral candidiasis, rarely - pseudomembranous enterocolitis.
From the senses: hearing loss.
From the side of the hematopoietic organs: hemolytic anemia.
Laboratory indicators: increased activity of "liver" enzymes, alkaline phosphatase, lactate dehydrogenase, hyperbilirubinemia.
Overdose:Symptoms: CNS stimulation, convulsions.
Treatment: prescription of antiepileptic drugs, control and maintenance of vital body functions, hemodialysis and peritoneal dialysis.
Interaction:Simultaneous oral administration of "loop" diuretics slows down tubular secretion, reduces renal clearance, increases plasma concentration and increases T1 / 2 of cefuroxime.
With simultaneous use with aminoglycosides and diuretics, the risk of nephrotoxic effects increases. Pharmaceutically compatible with aqueous solutions containing up to 1% lidocaine hydrochloride, 0.9% sodium chloride solution, 5% and 10% dextrose solution, 0.18% sodium chloride solution and 4% dextrose solution, 5% dextrose solution and 0.9% sodium chloride solution, Ringer's solution , Hartman's solution, sodium lactate solution, heparin (10 IU / ml and 50 IU / ml) in 0.9% sodium chloride solution. Pharmaceutically incompatible with aminoglycosides, sodium bicarbonate solution 2.74%.
Special instructions:Patients with a history of allergic reactions to penicillins, may have hypersensitivity to cephalosporin antibiotics. During treatment, it is necessary to monitor kidney function, especially in patients receiving the drug in high doses. Treatment is continued for 48-72 hours after the symptoms disappear, in the case of infections caused by Streptococcus pyogenes, the course of treatment is at least 7-10 days. During treatment, a false-positive direct Coombs reaction and false positive reaction urine for glucose. Ready-to-use solution can be stored at room temperature for 7 hours, in the refrigerator - for 48 hours. It is allowed to use a solution that has turned yellow during storage. In patients receiving, when determining the concentration of glucose in the blood, it is recommended to use tests with glucose oxidase or hexokinase. When switching from parenteral to oral administration, consideration should be given to the severity of the infection, the sensitivity of microorganisms and general state patient. If after 72 hours after oral administration of cefuroxime there is no improvement, it is necessary to continue parenteral administration.
Composition
Powder for solution for injection contains 250, 750 or 1500 mg of the active substance cefuroxime .
1 tablet contains 125, 250 or 500 mg of active ingredient.
Release form
Tablets and powder for solution for injection.
pharmachologic effect
Pharmacodynamics and pharmacokinetics
Resistant to most beta-lactamases. Mechanism of action antibacterial agent is aimed at disrupting the course of the normal process of synthesizing the microbial wall. Cefuroxime is bactericidal. medicinal product acts on a wide range of bacterial cells.
Some microorganisms are insensitive to cefuroxime.
Plasma concentration reaches its maximum after about half an hour. The half-life is about an hour. Communication with blood proteins varies from 33 to 50%. Active substance does not turn into metabolites and is excreted within a day with urine almost in its original form. The drug crosses the blood-brain barrier inflammatory processes meninges.
Indications for use of Cefuroxime
The drug is prescribed for bacterial infections.
Respiratory system: pleural empyema , lung abscess, pneumonia, .
Skin and soft tissue erysipeloid, wound infection, phlegmon, furunculosis, impetigo , pyoderma, erysipelas.
Skeletal system: septic arthritis , .
The antibacterial drug is effective in Lyme disease , meningitis, sepsis, adnexitis, borreliosis.
The drug Cefuroxime is prescribed for the prevention of postoperative complications.
Contraindications
Cefuroxime is not prescribed for intolerance to carbapenem, penicillin and cephalosporin antibiotics.
The drug is contraindicated for bleeding in the digestive system, exhaustion, non-specific, with weakened immunity.
Side effects
Local reaction: phlebitis, infiltration at the injection site, irritation.
Allergic reactions: bronchospasm , the development of exudative erythema is possible, anaphylactic shock rarely develops.
Urogenital system: vaginitis, passing itching of the perineum.
Digestive tract: spasms and epigastric pain, vomiting, nausea, , oral cavity, oral ulceration, pseudomembranous enterocolitis .
Possible hearing loss hemolytic anemia , convulsions, hyperbilirubinemia .
Cefuroxime, instructions for use (Method and dosage)
The drug is administered intramuscularly, intravenously, taken orally.
Instructions for the solution
Injections antibacterial drug: three times a day, 750 mg, in severe cases, the dose of the drug is increased to 1500, taken three times.
Optimal dosage for most infections: 60mg/kg/day.
Treatment for gonorrhea: intramuscularly 1500 mg once or the dose is divided into 2 injections.
Bacterial meningitis: every 8 hours, 3 grams of antibiotic are administered intravenously.
At surgical interventions: intravenously 1500 mg, then intramuscularly three times a day, 750 mg for two days.
With pneumonia intravenously or intramuscularly 2-3 times a day, 1500 mg, the course of treatment is 2-3 days, then they switch to oral forms: twice a day, 500 mg, the course of treatment is 7-10 days.
Treatment of exacerbation of chronic bronchitis: intravenously, intramuscularly, 750 mg twice a day, 2-3 days.
Cefuroxime tablets, instructions for use
Usually applied after meals for a week.
For most infections, adults are given 250 mg every 12 hours.
For infections of the urinary system 125 mg every 12 hours.
For respiratory tract infections moderate 250 mg every 12 hours is used, and in severe cases, 500 mg is used twice a day.
For Lyme disease, 500 mg twice a day for 20 days is used.
According to the instructions for Cefuroxime Sandoz in tablets for pyelonephritis, 250 mg should be taken twice a day.
Overdose
In case of an overdose, convulsions, excitation of the nervous system are recorded.
Requires timely intake of antiepileptic drugs, peritoneal dialysis, maintenance of body functions,.
Interaction
Tubular secretion slows down when simultaneous reception oral forms of "loop" diuretics, there is also an increase in the concentration of the antibiotic in the blood and a decrease in renal clearance.
The risk of developing nephrotic effects increases with simultaneous use with aminoglycosides .
Cefuroxime is incompatible with dextrose solution, sodium chloride, Ringer's solution , Hartmann's solution.
Terms of sale
Requires a prescription.
Storage conditions
In a place inaccessible to children at a temperature not exceeding 25 degrees Celsius. The solution can be stored for a day at a temperature of 2-8 degrees Celsius.
Best before date
No more than two years.
special instructions
During the period of application medicinal product registration of a false-positive Coombs reaction is possible.
The prepared solution is stored for no more than 7 hours at room temperature, when stored in a refrigerator for two days. A slightly yellowed antibiotic solution is considered suitable for use.
Analogues
Coincidence in the ATX code of the 4th level:These are drugs that have active substance cefuroxime or cefuroxime axetil: Abicef , Aksetin , Aksef , Biofuroxime , Zocef , Yokel , Kimatsef , Spizef , Furexa , Cefoctam , Cefumax , Cefunort , Cefur .
Analogues in tablets: Auroxetil , Bactyl , Mikreks , cetyl , Enfexia .
International name
Cefuroxime (Cefuroxime)Group affiliation
Antibiotic cephalosporinDosage form
Coated tablets, powder for solution for intravenous administration, powder for the preparation of a solution for intravenous and intramuscular administration, granules for the preparation of a suspension for oral administration, powder for the preparationpharmachologic effect
Cephalosporin antibiotic II generation for oral and parenteral use. It acts bactericidal (breaks the synthesis of the bacterial cell wall). It has a wide spectrum of antimicrobial activity.
Highly active against gram-positive microorganisms, including strains resistant to penicillins (with the exception of strains resistant to methicillin), Staphylococcus aureus, Streptococcus pyogenes (and other beta-hemolytic streptococci), Streptococcus pneumoniae, Group B Streptococcus (Streptococcus agalactiae), Streptococcus mitis (viridans groups), most Clostridium spp.);
gram-negative microorganisms (Escherichia coli, Klebsiella spp., Proteus mirabilis, Providencia spp., Proteus rettgeri, Haemophilus influenzae, including strains resistant to ampicillin; Haemophilus parainfluenzae, including strains resistant to ampicillin; Moraxella catarrhalis, Neisseria gonorrhoeae, including strains producing and non-penicillinase producing, Neisseria meningitidis, Salmonella spp., Borrelia burgdorfer, Bordetella pertussis;
gram-positive (Peptococcus spp., Peptostreptococcus spp., Propionibacterium spp.) and gram-negative anaerobes (Fusobacterium spp.).
Insensitive to cefuroxime: Clostridium difficile, Pseudomonas spp., Campylobacter spp., Acinetobacter calcoaceticus, Listeria monocytogenes, methicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Legionella spp. , Citrobacter spp., Serratia spp., Bacteroides fragilis.
Indications
Bacterial infections caused by susceptible microorganisms: diseases of the respiratory tract (bronchitis, pneumonia, lung abscess, pleural empyema, etc.), ENT organs (sinusitis, tonsillitis, pharyngitis, otitis media, etc.), urinary tract diseases (pyelonephritis, cystitis, asymptomatic bacteriuria , gonorrhea, etc.), skin and soft tissues (erysipelas, pyoderma, impetigo, furunculosis, phlegmon, wound infection, erysipeloid, etc.), bones and joints (osteomyelitis, septic arthritis, etc.), pelvic organs (endometritis, adnexitis, cervicitis), sepsis, meningitis, Lyme disease (borreliosis), prevention of infectious complications during operations on the organs of the chest, abdomen, pelvis, joints (including operations on the lungs, heart, esophagus, in vascular surgery with high risk of infectious complications during orthopedic operations).Contraindications
Hypersensitivity (including to other cephalosporins, penicillins and carbapenems).Side effects
Allergic reactions: chills, rash, itching, urticaria, rarely - erythema multiforme exudative (including Stevens-Johnson syndrome), bronchospasm, anaphylactic shock.
Local reactions: irritation, infiltration and pain at the injection site, phlebitis.
From the genitourinary system: itching in the perineum, vaginitis.
From the side of the central nervous system: convulsions.
From the urinary system: impaired renal function, dysuria.
From the digestive system: diarrhea, nausea, vomiting, abdominal cramps and pain, ulceration of the oral mucosa, oral candidiasis, rarely pseudomembranous colitis.
From the senses: hearing loss.
On the part of the hematopoietic organs: hemolytic anemia.
Laboratory indicators: increased activity of "liver" enzymes, alkaline phosphatase, LDH, hyperbilirubinemia.
Application and dosage
In / m, in / in or inside. In / in and / m adults are prescribed 750 mg 3 times a day; for severe infections - the dose is increased to 1500 mg 3-4 times a day (if necessary, the interval between injections can be reduced to 6 hours). The average daily dose is 3-6 g.
Children are prescribed 30-100 mg / kg / day in 3-4 doses. For most infections, the optimal dose is 60 mg/kg/day. Newborns and children under 3 months are prescribed 30 mg / kg / day in 2-3 doses.
With gonorrhea - in / m, 1500 mg once (or in the form of 2 injections of 750 mg administered in different areas, for example, in both gluteal muscles).
With bacterial meningitis - in / in, 3 g every 8 hours; children of younger and older age - 150-250 mg / kg / day in 3-4 doses, newborns - 100 mg / kg / day.
During operations on the abdominal cavity, pelvic organs and orthopedic operations - in / in, 1500 mg during the induction of anesthesia, then additionally - in / m, 750 mg, 8 and 16 hours after the operation.
During operations on the heart, lungs, esophagus and blood vessels - in / in, 1500 mg during the induction of anesthesia, then - in / m, 750 mg 3 times a day for the next 24-48 hours.
With pneumonia - in / m or / in, 1500 mg 2-3 times a day for 48-72 hours, then they switch to oral administration, 500 mg 2 times a day for 7-10 days.
In case of exacerbation of chronic bronchitis, it is prescribed intramuscularly or intravenously, 750 mg 2-3 times a day for 48-72 hours, then they switch to oral administration, 500 mg 2 times a day for 5-10 days.
With chronic renal failure, a correction of the dosing regimen is necessary: with CC 10-20 ml / min, 750 mg 2 times a day are prescribed intravenously or intramuscularly, with CC less than 10 ml / min - 750 mg 1 time per day.
Patients on continuous hemodialysis using an arteriovenous shunt or on high-speed hemofiltration in intensive care units are prescribed 750 mg 2 times a day; for patients on low-speed hemofiltration, doses recommended for impaired renal function are prescribed.
special instructions
Patients with a history of allergic reactions to penicillins may have hypersensitivity to cephalosporin antibiotics. During treatment, it is necessary to monitor kidney function, especially in patients receiving the drug in high doses. Treatment is continued for 48-72 hours after the symptoms disappear, in the case of infections caused by Streptococcus pyogenes, the course of treatment is at least 7-10 days.
During treatment, a false-positive direct Coombs reaction and a false-positive urine test for glucose are possible.
Ready-to-use solution can be stored at room temperature for 7 hours, in the refrigerator - for 48 hours. It is allowed to use a solution that has turned yellow during storage.
In patients receiving cefuroxime, it is recommended to use tests with glucose oxidase or hexokinase when determining the concentration of glucose in the blood.
When switching from parenteral to oral administration, the severity of the infection, the sensitivity of microorganisms and the general condition of the patient should be taken into account. If after 72 hours after oral administration of cefuroxime there is no improvement, it is necessary to continue parenteral administration.
Interaction
Simultaneous oral administration of "loop" diuretics slows down tubular secretion, reduces renal clearance, increases plasma concentration and increases T1 / 2 of cefuroxime.
With simultaneous use with aminoglycosides and diuretics, the risk of nephrotoxic effects increases.
Drugs that reduce the acidity of gastric juice, reduce the absorption of cefuroxime and its bioavailability.
Pharmaceutically compatible with aqueous solutions containing up to 1% lidocaine hydrochloride, 0.9% NaCl solution, 5% and 10% dextrose solution, 0.18% NaCl solution and 4% dextrose solution, 5% dextrose solution and 0.9% NaCl solution, Ringer's solution, Hartman's solution , sodium lactate solution, heparin (10 units/ml and 50 units/ml) in 0.9% NaCl solution.
Pharmaceutically incompatible with aminoglycosides, sodium bicarbonate solution 2.74%.
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Do you use Cefuroxime as an analogue or vice versa?Cephalosporin II generation
Active substance
Cefuroxime (as sodium salt) (cefuroxime)
Release form, composition and packaging
Powder for solution for intravenous and intramuscular administration almost white or yellowish.
Glass bottles (1) - packs of cardboard.
pharmachologic effect
Cephalosporin antibiotic II generation. It acts bactericidal (breaks the synthesis of the bacterial cell wall). Has a wide spectrum of action.
Highly active against Gram-positive microorganisms, including strains resistant to penicillins (with the exception of strains resistant to methicillin), Staphylococcus aureus, beta-hemolytic streptococci (including Streptococcus pyogenes), Streptococcus pneumoniae, Group B Streptococcus (Streptococcus agalactiae), Streptococcus mitis (viridans group ), Bordetella pertussis, most Clostridium spp.; Gram-negative microorganisms: Escherichia coli, Klebsiella spp., Proteus mirabilis, Providencia spp., Proteus rettgeri, Haemophilius influenzae (including strains resistant to ampicillin); Haemophilus parainfluenzae, including strains resistant to ampicillin; Moraxella catarrhalis, Neisseria gonorrhoeae (including strains producing and not producing penicillinase), Neisseria meningitidis, Salmonella spp., Borrelia burgdorferi; Gram-positive and Gram-negative anaerobes: Peptococcus spp., Peptostreptococcus spp., Fusobacterium spp., Propionibacterium spp.
To cefuroxime insensitive: Clostridium difficile, Pseudomonas spp., Campylobacter spp., Acinetobacter calcoaceticus, Listeria monocytogenes, methicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Legionella spp. , Serratia spp., Bacteroides fragilis.
Pharmacokinetics
Suction
After i / m administration at a dose of 750 mg, Cmax in plasma is reached after 15-60 minutes and is 27 μg / ml. When administered intravenously at doses of 0.75 and 1.5 g, C max after 15 minutes is 50 and 100 μg / ml, respectively. Therapeutic concentration is maintained for 5.3 and 8 hours, respectively.
Distribution and metabolism
Plasma protein binding is 33-50%.
Therapeutic concentrations are recorded in the pleural fluid, bile, sputum, myocardium, skin and soft tissues. Concentrations of cefuroxime in excess of the minimum inhibitory concentration for most common microorganisms can be achieved in bone tissue, synovial fluid and intraocular fluid. When meningitis penetrates through the BBB. Penetrates through the placental barrier, excreted in breast milk.
Not metabolized in the liver.
breeding
T 1/2 with intravenous and intramuscular administration of the drug - 1.3-1.5 hours, in newborns - 2-2.5 hours.
Excreted by the kidneys by glomerular filtration and tubular secretion 85-90% unchanged within 8 hours (most of the drug is excreted during the first 6 hours, while creating high concentrations in the urine); after 24 hours, it is completely eliminated (50% by tubular secretion, 50% by glomerular filtration).
Indications
Infectious and inflammatory diseases caused by susceptible microorganisms:
- respiratory tract infections (including bronchitis, pneumonia, lung abscess, pleural empyema);
- infections of ENT organs (including sinusitis, tonsillitis, pharyngitis, otitis media);
- urinary tract infections (including pyelonephritis, cystitis, asymptomatic bacteriuria, gonorrhea);
- infections of the skin and soft tissues (including erysipelas, pyoderma, impetigo, furunculosis, phlegmon, erysipeloid);
- wound infection;
- infections of bones and joints (including osteomyelitis, septic arthritis);
- infections of the pelvic organs (endometritis, adnexitis, cervicitis);
- sepsis;
- meningitis;
- Lyme disease (borreliosis).
Prevention of infectious complications during operations on the organs of the chest, abdomen, pelvis, joints (including operations on the lungs, heart, esophagus, in vascular surgery with a high risk of infectious complications, during orthopedic operations).
Contraindications
— hypersensitivity to the drug and other cephalosporins, penicillins and carbapenems.
FROM caution the drug should be used in newborns and premature babies, with chronic renal failure, bleeding and gastrointestinal diseases (including a history of NUC), during pregnancy and lactation, in debilitated and malnourished patients.
Dosage
The drug is administered intravenously and intramuscularly.
Adults appoint 750 mg 3 times / day; at severe infections- the dose is increased to 1.5 g 3-4 times / day (if necessary, the interval between injections can be reduced to 6 hours). The average daily dose is 3-6 g.
children appoint 30-100 mg / kg / day in 3-4 doses. For most infections, the optimal dose is 60 mg/kg/day. Newborns and children up to 3 months appoint 30 mg / kg / day in 2 - 3 doses.
At gonorrhea- in / m at a dose of 1.5 mg once (or in the form of 2 injections of 750 mg each with injection into different areas, for example, into both gluteal muscles).
At bacterial meningitis- in / in 3 g every 8 hours; younger and older children- 150-250 mg / kg / day in 3-4 doses, newborns- 100 mg / kg / day.
At abdominal, pelvic and orthopedic surgeries- intravenously at a dose of 1.5 g at the induction of anesthesia, then additionally - intramuscularly at 750 mg 8 and 16 hours after the operation.
At operations on the heart, lungs, esophagus and blood vessels- in / in a dose of 1.5 g at the induction of anesthesia, then - in / m at 750 mg 3 times / day for the next 24-48 hours.
At pneumonia- intramuscularly or intravenously, 1.5 g 2-3 times a day for 48-72 hours, then they switch to oral administration, 500 mg 2 times a day for 7-10 days.
At exacerbation of chronic bronchitis appoint / m or / in 750 mg 2-3 times / day for 48-72 hours, then switch to oral administration of 500 mg 2 times / day for 5-10 days.
At total joint replacement- 1.5 g of the powder is dry mixed with each sachet of methyl methacrylate cement polymer before adding the liquid monomer.
At chronic renal failure correction of the dosing regimen is necessary: when CC from 10 to 20 ml / min appoint in / in or / m 750 mg 2 times / day, with QC<10 мл/мин - 750 mg 1 time / day.
Patients who are on continuous hemodialysis
Preparation of solution for injection
Solution for i / m injections: add 3 ml of water for injection to 750 mg of the drug. Shake gently until a suspension forms. Cefuroxime is compatible with aqueous solutions containing up to 1%.
Solution for intravenous injection: dissolve 750 mg of the drug in 6 or more ml of water for injection, and 1.5 g in 15 or more ml of water for injection.
For short-term IV infusions (up to 30 minutes): 1.5 g of the drug is dissolved in 50 ml of water for injection. These solutions can be administered directly into a vein or into an infusion line.
Side effects
Allergic reactions: chills, rash, itching, urticaria, rarely - erythema multiforme exudative, bronchospasm, malignant exudative erythema (Stevens-Johnson syndrome), anaphylactic shock.
From the digestive system: diarrhea, nausea, vomiting or constipation, flatulence, abdominal cramps and pain, ulceration of the oral mucosa, oral candidiasis, glossitis, pseudomembranous enterocolitis, liver dysfunction (increased activity of AST, ALT, alkaline phosphatase, LDH, bilirubin), cholestasis.
From the urinary system: impaired renal function, dysuria.
From the reproductive system: itching in the perineum, vaginitis.
From the side of the central nervous system: convulsions.
From the sense organs: hearing loss.
From the hematopoietic system: decrease in hemoglobin concentration and hematocrit, anemia (aplastic or hemolytic), eosinophilia, neutropenia, leukopenia, agranulocytosis, thrombocytopenia, hypoprothrombinemia, prolongation of prothrombin time.
Local reactions: irritation, infiltration and pain at the injection site, phlebitis.
Overdose
Symptoms: CNS excitation, convulsions.
Treatment: prescription of antiepileptic drugs, control and maintenance of vital body functions, hemodialysis and peritoneal dialysis.
drug interaction
Simultaneous oral administration of "loop" diuretics slows down tubular secretion, reduces renal clearance, increases plasma concentration and increases T 1/2 of cefuroxime.
With simultaneous use with aminoglycosides and diuretics, the risk of nephrotoxic effects increases.
Pharmaceutical interaction
Pharmaceutically compatible with aminoglycosides, 2.74% solution, as well as with metronidazole, azlocillin, xylitol, aqueous solutions containing up to 1% lidocaine hydrochloride, 0.9% sodium chloride solution, 5% dextrose solution, 0.18% solution and 4% dextrose solution, 5% dextrose solution and 0.9% sodium chloride solution, 5% dextrose solution and 0.45% sodium chloride solution, 5% dextrose solution and 0.225% sodium chloride solution, 10% dextrose solution; 10% invert sugar in , Ringer's solution, sodium lactate solution, Hartmann's solution, 0.9% sodium chloride solution, 5% dextrose solution and hydrocortisone, heparin (10 U / ml and 50 U / ml) in 0.9% sodium chloride solution, (10 meq/l and 40 meq/l) in 0.9% sodium chloride solution.
special instructions
Patients with a history of allergic reactions to penicillins may have hypersensitivity to cephalosporin antibiotics.
During treatment, it is necessary to monitor kidney function, especially in patients receiving the drug in high doses.
Treatment is continued for 48-72 hours after the disappearance of symptoms; in case of infections caused by Streptococcus pyogenes, the course of treatment is at least 7-10 days.
During treatment, a false-positive direct Coombs reaction and a false-positive urine test for glucose are possible.
Ready-to-use solution can be stored at room temperature for 7 hours, in the refrigerator - for 48 hours. It is allowed to use a solution that has turned yellow during storage.
In patients receiving cefuroxime, it is recommended to use tests with glucose oxidase or hexokinase when determining the concentration of glucose in the blood.
When switching from parenteral to oral administration, the severity of the infection, the sensitivity of microorganisms and the general condition of the patient should be taken into account. If after 72 hours after oral administration of cefuroxime there is no improvement, it is necessary to continue parenteral administration.
Pregnancy and lactation
The use of the drug during pregnancy is possible only in cases where the intended benefit to the mother outweighs the potential risk to the fetus.
If necessary, the use of cefuroxime during lactation should decide on the termination of breastfeeding.
For impaired renal function
With chronic renal failure dosing regimen needs to be adjusted: at CC 10-20 ml / min appoint in / in or / m 750 mg 2 times / day, with CC less than 10 ml / min- 750 mg 1 time / day.
Patients who are on continuous hemodialysis using an arteriovenous shunt or high speed hemofiltration in ICU, appoint 750 mg 2 times / day; for patients on low-speed hemofiltration, doses recommended for impaired renal function are prescribed.
Terms of dispensing from pharmacies
The drug is dispensed by prescription.
Terms and conditions of storage
List B. The drug should be stored out of the reach of children, dry, dark place at a temperature not exceeding 25°C. Shelf life - 2 years.
Catad_pgroup Antibiotics cephalosporins
Cefuroxime powder - instructions for use
Registration number:
Trade name:
Cefuroxime
International non-proprietary name:
cefuroxime
Dosage form.
Powder for solution preparation for intravenous and intramuscular administration.
Composition for 1 bottle
Cefuroxime sodium - 1.578 g in terms of cefuroxime - 1.5 g.
Description.
Powder from white to yellow. Hygroscopic.
Pharmacotherapeutic group.
Antibiotic, cephalosporin.
Pharmacological properties
Pharmacodynamics.
Mechanism of action. Cefuroxime belongs to the 2nd generation cephalosporin antibiotics. Active against a wide range of pathogens, including strains producing beta-lactamase. Resistant to bacterial beta-lactamases and, accordingly, active against a wide range of ampicillin- and amoxicillin-resistant strains of gram-positive and gram-negative microorganisms. The bactericidal effect of cefuroxime is associated with the suppression of the synthesis of the bacterial cell wall as a result of binding to penicillin-binding transpeptidase proteins.
The prevalence of acquired bacterial resistance to cefuroxime varies by region and over time, and resistance can be very high in certain microorganism species. It is preferable to have local data on sensitivity, especially when treating severe infections.
Cefuroxime is usually active in vitro against the following microorganisms:
Gram-positive aerobes: Staphylococcus aureus (methicillin-sensitive strains)1, coagulase-negative staphylococci (methicillin-sensitive strains), Streptococcus pyogenes1, beta-hemolytic streptococci; Gramotrate aerobes: Haemophilus influenzae (including ampicillin-resistant strains), Haemophilus parainfluenzae\ Moraxella catarrhalis, Neisseria gonorrhoeae1, including penicillinase-producing and non-penicillinase-producing strains. Neisseria meningitides, Shigella spp.;
Gram-positive anaerobes: Peptostreptococcus spp., Propionibacterium spp.; Spirochetes: Borrelia burgdorferi.
Bacteria for which acquired resistance to cefuroxime is likely:
Hyampositive aerobes: Streptococcus pneumoniae1, streptococci of the Viridans group; Guamotriating aerobes: Bordetella pertussis, Citrobacter spp. except C freundii, Enterobacter spp., except E. aerogenes and E. cloacae, Escherichia co//1, Klebsiella spp., including K. pneumoniae1, Proteus mirabilis, Proteus spp., except P. penneri and P. vulgaris, Providencia spp. ., Salmonella spp./
Gram-positive anaerobes: Clostridium spp., except C. difficile;
Guamotriating anaerobes: Bacteroides spp., except for B. fragilis, Fusobacterium spp.
Bacteria that are naturally resistant to cefuroxime:
Gram-positive aerobes: Enterococcus spp., including E. faecalis and E. faecium, Listeria monocytogenes;
Gram-reducing aerobes: Acinetobacter spp., Burkholderia cepacia, Campylobacter spp., Citrobacter freundii, Enterobacter aerogenes, Enterobacter cloacae, Morganella morganii, Proteus penneri, Proteus vulgaris, Pseudomonas spp., including P. aeruginosa, Serratia spp., Stenotrophomonos maltophilia;
Gram-positive anaerobes: Clostridium difficile; Grammarizing anaerobes: Bacteroides fragilis; Others: Chlamydia spp., Mycoplasma spp., Legionella spp.
1 - for these bacteria, the clinical efficacy of cefuroxime has been demonstrated in clinical studies.
Pharmacokinetics.
Suction. The maximum concentration of cefuroxime in plasma is observed in the period from 30 to 45 minutes after intramuscular administration. Distribution. Plasma protein binding - 33-50% of the administered dose. Concentrations of cefuroxime in excess of the minimum inhibitory concentration (MIC) for most microorganisms are achieved in bone tissue, synovial and intraocular fluids. Cefuroxime crosses the blood-brain barrier during inflammation of the meninges.
Metabolism. Cefuroxime is not metabolized and is eliminated by glomerular filtration and tubular secretion.
Withdrawal. The serum half-life of cefuroxime after intramuscular administration is approximately 70 minutes. In newborns, the half-life of cefuroxime can be 3-5 times longer than in adults. Concomitant administration of probenecid prolongs the excretion of cefuroxime. which leads to an increase in the maximum concentration of cefuroxime in serum. Within 24 hours after parenteral administration, cefuroxime is almost completely (85-90%) excreted through the kidneys unchanged, with most of the drug in the first 6 hours. Serum concentrations of cefuroxime decrease during dialysis.
Indications for use
Bacterial infections caused by bacteria sensitive to cefuroxime, as well as in cases where the pathogen has not yet been identified:
Lower respiratory tract infections, eg, bacterial pneumonia, acute bacterial bronchitis and exacerbation of chronic bronchitis, infected bronchiectasis, lung abscess, postoperative chest infections;
ENT infections, for example, otitis media, sinusitis, tonsillitis, pharyngitis;
Urinary tract infections, for example, acute and chronic pyelonephritis, cystitis, asymptomatic bacteriuria;
Gonorrhea;
Skin and soft tissue infections, such as cellulitis, erysipelas and wound infections;
Bone and joint infections, such as osteomyelitis and septic arthritis;
obstetric and gynecological infections such as pelvic inflammatory disease;
Other infections including septicemia, bacterial meningitis, intra-abdominal infections such as peritonitis;
Prevention of infectious complications during operations on the abdominal organs, small pelvis, orthopedic operations, operations on the heart, lungs, esophagus and blood vessels - where there is an increased risk of infectious complications. The sensitivity of bacteria to cefuroxime varies by region and over time. Where possible, local data on sensitivity should be taken into account (see subsection "Pharmacodynamics").
If necessary, cefuroxime can be used for stepwise therapy with the transition to oral cefuroxime axetil, mainly for the treatment of pneumonia and exacerbations of chronic bronchitis.
Contraindications
Hypersensitivity to cephalosporins, penicillins and carbapenems in history.
Carefully.
Should be used with caution in renal failure; diseases of the gastrointestinal tract in history, such as ulcerative colitis; if necessary, the combined appointment of high doses of the drug with "loop" diuretics and aminoglycosides; in early pregnancy and lactation, as well as in newborns (especially in premature babies).
Use during pregnancy and during breastfeeding.
There are no data on the development of embryotoxic or teratogenic effects of cefuroxime. I use the drug during pregnancy! only If the expected benefit to the mother outweighs the risk to the fetus. Cefuroxime is excreted in breast milk. If necessary, the appointment of the drug during lactation should be careful.
Dosage and administration
Intravenously (in / in) and / or intramuscularly (in / m). With intramuscular injection at one injection site, a dose of the drug can be administered no more than 750 mg.
Cefuroxime is also available as cefuroxime axetil, an oral dosage form. This allows the use of stepwise therapy with the same antibiotic in the presence of clinical indications for switching from parenteral to oral administration.
In the presence of clinical indications, the administration of cefuroxime at a dose of 750 mg or 1.5 g 2 times a day (i.v. or i.m.) is effective, followed by a switch to the dosage form of the drug for oral administration.
Dosing in special cases
bacterial meningitis. Cefuroxime is recommended as a basic therapy for bacterial meningitis caused by strains of microorganisms sensitive to the drug. The recommended dose for adults is 3 g IV every 8 hours; children - 150-250 mg / kg / day in / in, divided into 3-4 injections; newborns - 100 mg/kg/day IV.
Prevention of postoperative complications.
Adults during operations on the organs of the abdominal cavity, pelvis and orthopedic interventions - 1.5 g of cefuroxime intravenously during induction of anesthesia. After the operation, if necessary, an additional 750 mg intramuscularly is administered 8 hours and 16 hours after the first dose. During operations on the heart, lungs, esophagus and blood vessels - 1.5 g of cefuroxime intravenously during induction of anesthesia, then 750 mg intramuscularly 3 times a day for 24-48 hours. For joint replacement, 1.5 g of dry powder cefuroxime can be mixed into the contents of each of the methyl methacrylate cement polymer packets immediately prior to adding the liquid monomer.
step therapy.
Adults. The duration of parenteral administration and oral administration of cefuroxime is determined depending on the severity of the infection and the patient's condition.
For the treatment of pneumonia - 1.5 g of cefuroxime every 8-12 hours for 2-3 days, followed by the transition to oral cefuroxime axetil at a dose of 500 mg 2 times a day for 7-10 days.
For the treatment of exacerbation of chronic bronchitis - 750 mg of cefuroxime every 8-12 hours for 2-3 days, followed by a switch to cefuroxime axetil at a dose of 500 mg 2 times a day for 5-10 days.
Patients with impaired, "functions of the nights. Cefuroxime is excreted by the kidneys. That's why,
as with other antibiotics that are excreted by the kidneys, in severe renal failure, a dose reduction is recommended to compensate for its delayed excretion. There is no need to reduce the standard dose of the drug (750 mg - 1.5 g 3 times a day) in patients with a creatinine clearance of 20 ml / min or higher.
Cefuroxime Dosages in Adult Patients with Renal Impairment
Patients on hemodialysis at the end of each hemodialysis session should be given an additional dose of the drug, equal to 750 mg. In addition to parenteral administration, cefuroxime can be added to the peritoneal dialysis solution (usually 250 mg for every 2 liters of dialysis solution). For patients with renal insufficiency who are in the intensive care unit on continuous hemodialysis using an arterio-venous shunt or on high-speed hemofiltration, the recommended dose is 750 mg 2 times a day. If low-rate hemofiltration is used, then doses recommended for patients with impaired renal function are used, depending on the values of creatinine clearance.
Preparation of solutions for intravenous and intramuscular administration
To prepare a solution for intramuscular injection, the following minimum amounts of solvent are added to the antibiotic powder vial: 6 ml of water for injection or 10 mg/ml lidocaine solution. Shake gently until a homogeneous suspension is formed; complete dissolution of the powder is possible with the formation of a clear solution. Enter into two intramuscular injections of 3 ml of a suspension containing 750 mg of cefuroxime in different parts of the body (for example, in both buttocks). Cefuroxime solutions prepared using water for injection, lidocaine solution can be stored at room temperature (25 ° C) for 24 hours, in the refrigerator (from 2 to 8 ° C) - for 30 hours. It is allowed to use a solution that has turned yellow during storage.
To prepare a solution for intravenous bolus administration, at least 15 ml of water for injection is added to the vial with antibiotic powder. Shake gently until the powder is completely dissolved. Enter slowly over 3-5 minutes directly into a vein or into the tube of the infusion system if the patient is receiving infusion therapy.
To prepare a solution for intravenous infusion, at least 15 ml of water for injection is added to the vial with the antibiotic powder. Shake gently until the powder is completely dissolved. The resulting solution is added to 50 ml or 100 ml of a compatible infusion solution (see section "Interaction with other drugs"). It is administered intravenously by drip through an intravenous infusion system for at least 30 minutes.
Side effect
The adverse reactions presented below are listed according to the damage to organs and organ systems and the frequency of occurrence. All adverse reactions listed below are presented in accordance with the classification of MedDRA by organs and systems according to their frequency: very often £ 1/10), often (> 1/100 and<1/10), нечасто (>1/1000 and<1/100), редко £1/10000 И <1/1000), очень редко (< 1/10000 включая отдельные случаи).
Blood and lymphatic system disorders: often - neutropenia, eosinophilia; infrequently - leukopenia, a decrease in hemoglobin levels, a positive Coombs test; rarely - thrombocytopenia; very rarely - hemolytic anemia. Cephalosporins as a class tend to be absorbed onto the surface of the erythrocyte membrane and interact with antibodies to the drug, resulting in a positive Coombs test (which may affect cross-compatibility) and, very rarely, hemolytic anemia.
Immune system disorders: hypersensitivity reactions, including: rarely - drug fever; very rarely - interstitial nephritis, anaphylaxis, skin vasculitis. See also "Renal and Urinary Tract Disorders".
Gastrointestinal disorders: infrequently - gastrointestinal upset; very rarely - pseudomembranous colitis (see section "Special Instructions").
Liver and biliary tract disorders: often - a transient increase in the activity of "liver" enzymes; infrequently - a transient increase in the concentration of bilirubin. These adverse reactions occur in patients with a history of liver disease, but no symptoms of liver damage have been noted.
Skin and subcutaneous tissue disorders: infrequently - skin rash, urticaria and itching; very rarely - erythema multiforme, toxic epidermal necrolysis, Stevens-Johnson syndrome. Also see Immune system disorders.
On the part of the kidneys and urinary tract: very rarely - an increase in serum creatinine concentration, an increase in residual nitrogen in the blood, a decrease in creatinine clearance (see section "Special Instructions"). Also see Immune System Disorders.
Hearing and labyrinth disorders: mild to moderate hearing loss in children in the treatment of meningitis.
General disorders and disorders at the injection site: often - reactions at the injection site, which may include soreness or thrombophlebitis. Soreness at the site of the intramuscular injection, which is more likely with high doses (this is usually not the reason for discontinuing the drug).
Overdose.
Symptoms: increased excitability of the cerebral cortex with the development of seizures.
Treatment: symptomatic, in severe cases, hemodialysis and peritoneal dialysis are indicated.
Interaction
Simultaneous administration with "loop" diuretics (furosemide) and aminoglycosides slows down tubular secretion, reduces renal clearance, increases plasma concentration and increases the half-life of cefuroxime, which increases the risk of nephrotoxic effects. Cefuroxime in combination with aminoglycosides acts additively, but synergism can sometimes be observed. Cefuroxime cannot be mixed in the same syringe with aminoglycosides due to pharmaceutical incompatibility; if necessary, the simultaneous use of them should be administered in different parts of the body.
Solution compatibility
When mixing a solution of the drug Cefuroxime (1.5 g in 15 ml of water for injection) and metronidazole (500 mg / 100 ml), both components retain their activity for up to 24 hours at a temperature not exceeding 25 ° C. Cefuroxime at a dose of 1.5 g is compatible with a solution of azlocillin (1 g in 15 ml or 5 g in 50 ml); both components retain their activity up to 24 hours at a temperature of about 4 ° C or up to 6 hours at a temperature not exceeding 25 ° C. A solution of cefuroxime (5 mg/ml) in 5% or 10% xylitol solution can be stored for up to 24 hours at a temperature not exceeding 25°C.
Cefuroxime is compatible with aqueous solutions containing up to 10 mg/ml lidocaine hydrochloride.
Cefuroxime is compatible with the most commonly used infusion solutions. When mixed with the following solutions, the drug is stable for up to 24 hours at room temperature: 0.9% sodium chloride solution, 5% dextrose solution, 0.18% sodium chloride solution and 4% dextrose solution for injection, 5% dextrose solution and 0.9 % sodium chloride solution, 5% dextrose solution and 0.45% sodium chloride solution. 5% dextrose solution and 0.225% sodium chloride solution, 10% dextrose solution for injection. Cefuroxime solutions prepared using Ringer's solution, Ringer's lactate solution and Hartman's solution should be administered immediately after preparation.
The stability of cefuroxime sodium in 0.9% sodium chloride solution and in 5% dextrose solution is not impaired in the presence of hydrocortisone sodium phosphate. Cefuroxime is compatible with the following drugs when administered as an intravenous infusion and is stable for 24 hours at room temperature:
Heparin (10 U/ml and 50 U/ml) in 0.9% sodium chloride solution;
Potassium chloride (10 mEq/l and 40 mEq/l) in 0.9% sodium chloride solution.
A 2.74% sodium bicarbonate solution has a pH value that significantly affects the color of the cefuroxime solution, so it is not recommended to use it for preparing drug solutions. However, if sodium bicarbonate solution is administered to the patient by infusion, then cefuroxime can be administered directly into the tubing of the infusion system if necessary.
Special instructions.
Antibiotics of the cephalosporin group in high doses should be used with caution in patients receiving concomitant therapy with strong diuretics, such as furosemide or aminoglycosides, since the risk of renal failure is increased. As a result, it is necessary to monitor renal function when using this combination of drugs, especially in elderly patients and in patients with a history of kidney disease.
Mild to moderate hearing loss has been reported in some children with cefuroxime for the treatment of meningitis. Persistence of Haemophilus influenzae in the cerebrospinal fluid was observed 18-36 hours after injection. Similar events have also been observed with other antibiotics, but their clinical significance is not known.
As with other antibiotics, Candida growth may occur with cefuroxime. Long-term therapy with cefuroxime may lead to overgrowth of other non-susceptible microorganisms (eg, enterococci and Clostridium difficile), and it may be necessary to stop the course of treatment with the drug.
Pseudomembranous colitis has been described with antibiotics, the severity of which can range from mild to life-threatening. Therefore, it is important to consider the possibility of developing pseudomembranous colitis in patients with diarrhea during or after antibiotic use. If the diarrhea is prolonged or severe, or the patient experiences abdominal cramps, treatment should be stopped immediately and the patient should be examined.
With stepwise therapy, the time to switch to oral therapy is determined by the severity of the infection, the clinical condition of the patients and the sensitivity of the pathogen. If there is no clinical improvement within 72 hours of starting treatment, parenteral therapy should be continued. Before starting stepwise therapy, it is necessary to read the instructions for use of the dosage form of the drug for oral administration of cefuroxime axetil.
Cefuroxime does not affect the results of the determination of glucose in urine using enzymatic methods. When using other methods (Benedict, Fehling, Clinitest), an interaction can be observed, which, however, does not lead to false positive results, which was observed or the example of some other cephalosporins. In patients receiving cefuroxime, it is recommended to use the method with glucose oxidase or hexokinase to determine the level of glucose in the blood / plasma. Cefuroxime does not affect the quantitative determination of creatinine by the alkaline-picrate method.