cefuroxime Nursing Considerations & Management

Drug Name

Generic Name : cefuroxime, cefuroxime axetil, cefuroxime sodium

Brand Name: Ceftin , Zinacef

Classification: Antibiotic, Cephalosporin (second generation)

Pregnancy Category B

Dosage & Route
  • PO Uncomplicated UTI 125 mg twice daily. Respiratory tract infections 250-500 mg twice daily. Uncomplicated gonorrhea W/ oral probenecid: 1 g as a single dose. IV Meningitis 3 g 8 hrly. IM Gonorrhea W/ oral probenecid: 1.5 g as a single dose. IV/IM Surgical prophylaxis 1.5 g IV per-op, then 750 mg IM 8 hrly for up to 24-48 hr. Susceptible infections750 mg 8 hrly, up to 1.5 g 6-8 hrly for severe infections.
Therapeutic actions
  • Cefuroxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
    • Absorption: Absorbed from the GI tract with peak plasma concentrations after 2-3 hr (oral); may be enhanced by the presence of food.
    • Distribution: Pleural and synovial fluid, sputum, bone and aqueous fluids; CSF (therapeutic concentrations). Crosses the placenta and enters breast milk. Protein-binding: Up to 50%.
    • Metabolism: Rapidly hydrolysed (intestinal mucosa and blood).
    • Excretion: Via the urine by glomerular filtration and renal tubular secretion (as unchanged); via bile (small amounts); 70 min (elimination half-life); prolonged in neonates and renal impairment.
Indications
Oral (cefuroxime axetil)
  • Pharyngitis, tonsillitis caused by Streptococcus pyogenes
  • Otitis media caused by Streptococcus pneumoniae, S. pyogenes, Haemophilus influenzae, Moraxella catarrhalis
  • Lower respiratory infections caused by S. pneumoniae, Haemophilus parainfluenzae, H. influenzae
  • UTIs caused by Escherichia coli, Klebsiella pneumoniae
  • Uncomplicated gonorrhea (urethral and endocervical)
  • Dermatologic infections, including impetigo caused by Streptococcus aureus, S. pyogenes
  • Treatment of early Lyme disease
Parenteral (cefuroxime sodium)
  • Lower respiratory infections caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae, S. pyogenes
  • Dermatologic infections caused by S. aureus, S. pyogenes, E. coli, Klebsiella, Enterobacter
  • UTIs caused by E. coli, Klebsiella
  • Uncomplicated and disseminated gonorrhea caused by N. gonorrhoeae
  • Septicemia caused by S. pneumoniae, S. aureus, E. coli, Klebsiella, H. influenzae
  • Meningitis caused by S. pneumoniae, H. influenzae, S. aureus, N. meningitidis
  • Bone and joint infections caused by S. aureus
  • Perioperative prophylaxis
  • Treatment of acute bacterial maxillary sinusitis in patients 3 mo–12 yr
Adverse effects
  • Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhea, GI disturbances; erythema multiforme, Stevens-Johnson syndrome, epidermal necrolysis.
  • Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.
Contraindications
  • Hypersensitivity to cephalosporins.
Nursing considerations
Assessment
  • History: Hepatic and renal impairment, lactation, pregnancy
  • Physical: Skin status, LFTs, renal function tests, culture of affected area, sensitivity tests
Interventions
  • Culture infection, and arrange for sensitivity tests before and during therapy if expected response is not seen.
  • Give oral drug with food to decrease GI upset and enhance absorption.
  • Give oral drug to children who can swallow tablets; crushing the drug results in a bitter, unpleasant taste.
  • Have vitamin K available in case hypoprothrombinemia occurs.
  • Discontinue if hypersensitivity reaction occurs.
Teaching points

Oral drug

  • Take full course of therapy even if you are feeling better.
  • This drug is specific for this infection and should not be used to self-treat other problems.
  • Swallow tablets whole; do not crush them. Take the drug with food.
  • You may experience these side effects: Stomach upset or diarrhea.
  • Report severe diarrhea with blood, pus, or mucus; rash; difficulty breathing; unusual tiredness, fatigue; unusual bleeding or bruising; unusual itching or irritation.

Parenteral drug

  • Avoid alcohol while taking this drug and for 3 days after because severe reactions often occur.
  • You may experience these side effects: Stomach upset or diarrhea.
  • Report severe diarrhea, difficulty breathing, unusual tiredness or fatigue, pain at injection site.
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