III. Medications

  1. Parenteral Cefuroxime (IV or IM, Zinacef)
  2. Oral Cefuroxime Axetil (Ceftin)
    1. Tablets: 250 or 500 mg
      1. Do not crush
    2. Suspension: 125 or 250 mg/5 ml
      1. Suspension reported to have unpleasant taste
      2. Cefprozil may be better tolerated

IV. Dosing: Adult (or child age >=13 years)

  1. Parenteral Cefuroxime (IV or IM, Zinacef)
    1. Mild to Moderate Infection
      1. Give 750 mg IM or IV every 8 hours
    2. Severe Infection (includes bone and joint infections)
      1. Give 1.5 g IM or IV every 8 hours
    3. Sepsis
      1. Give 1.5 g IV every 6 hours OR
      2. Give 3 g IV every 8 hours
    4. General Surgery Prophylaxis
      1. Give 1.5 g IV at 30 to 60 min before surgery, then 750 mg every 8 hours during procedure
    5. Open Heart Surgery Prophylaxis
      1. GIve 1.5 g IV every 12 hours for 4 doses (start with first dose at Anesthesia induction)
  2. Oral Cefuroxime Axetil (Ceftin)
    1. Typical Dosing
      1. Take 250 to 500 mg orally twice daily with food
    2. Streptococcal Pharyngitis
      1. Take 250 mg orally twice daily for 10 days
  3. Renal Dosing
    1. eGFR 10 to 30 ml/min: Give typical dose every 24 hours
    2. eGFR <10 ml/min: Give typical dose every 48 hours
      1. Give dose after Hemodialysis

V. Dosing: Child (or age <13 years)

  1. Parenteral Cefuroxime (IV or IM, Zinacef)
    1. Mild to Moderate Infection (typical infections)
      1. Give 50-100 mg/kg/day IM or IV divided every 6 to 8 hours (max: 1.5 g/dose)
    2. Severe Infection (includes bone and joint infections)
      1. Give 150 mg/kg/day IM or IV divided every 6 to 8 hours (max: 1.5 g/dose)
  2. Oral Cefuroxime Axetil (Ceftin)
    1. Suspension reported to have unpleasant taste (Cefprozil may be better tolerated)
    2. Typical Dosing
      1. Give 20 to 30 mg/kg/day orally (up to 1 g/day) divided twice daily with food
    3. Streptococcal Pharyngitis
      1. Give 20 mg/kg/day (max 500 mg/day) orally divided twice daily for 10 days
    4. Otitis Media or Acute Sinusitis
      1. Give 30 mg/kg/day (max 1 g/day) orally divided twice daily

VI. Adverse Effects

  1. Gastrointestinal (oral formulations, mild)
    1. Nausea or Vomiting
    2. Diarrhea

VII. Safety

  1. Pregnancy Category B
  2. Safe in Lactation

VIII. Drug Interactions

  1. Antacids (e.g. H2 Blockers, Proton Pump Inhibitors)
    1. Decrease Cefuroxime absorption
    2. Avoid with Proton Pump Inhibitors or H2 Blockers
    3. Take at least 1 hour before or 2 hours after other Antacids

X. References

  1. (2012) Presc Lett, Resource #280706, Comparison of Cephalosporins
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  3. Dellamonica (1994) Int J Antimicrob Agents 4(1):23-36 +PMID: 18611587 [PubMed]

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Related Studies

Cost: Medications

cefuroxime (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CEFUROXIME AXETIL 250 MG TAB Generic $0.32 each
CEFUROXIME AXETIL 500 MG TAB Generic $0.48 each

Ontology: Cefuroxime (C0007562)

Definition (NCI) A semisynthetic, broad-spectrum, beta-lactamase-resistant, second-generation cephalosporin with antibacterial activity. Cefuroxime binds to and inactivates penicillin-binding proteins (PBPs) located on the inner membrane of the bacterial cell wall. PBPs are enzymes involved in the terminal stages of assembling the bacterial cell wall and in reshaping the cell wall during growth and division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis.
Definition (MSH) Broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. It has been proposed for infections with gram-negative and gram-positive organisms, GONORRHEA, and HAEMOPHILUS.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002444
SnomedCT 372833007, 73986003
LNC LP32648-5, MTHU027952
English Cefuroxime, Cephuroxime, 5-Thia-1-azabicyclo(4.2.0)oct-2-ene-2-carboxylic acid, 3-(((aminocarbonyl)oxy)methyl)-7-((2-furanyl(methoxyimino)acetyl)amino)-8-oxo-, (6R-(6alpha,7beta(Z)))-, cefuroxime (medication), Cefuroxime [Chemical/Ingredient], CEFUROXIME, cephuroxime, cefuroxime, Cefuroxime (product), Cefuroxime (substance)
Swedish Cefuroxim
Czech cefuroxim
Finnish Kefuroksiimi
Russian TSEFUROKSIM, ЦЕФУРОКСИМ
Japanese セフロキシム
Croatian CEFUROKSIM
Polish Cefuroksym
Spanish cefuroxima (producto), cefuroxima (sustancia), cefuroxima, Cefuroxima
French Céfuroxime
German Cefuroxim
Italian Cefuroxima
Portuguese Cefuroxima

Ontology: cefuroxime axetil (C0055015)

Definition (NCI) A second generation semi-synthetic cephalosporin and a beta-lactam antibiotic with bactericidal activity. Cefuroxime's effect is dependent on its binding to penicillin-binding proteins (PBPs) located in the bacterial cytoplasmic membrane. Binding results in the inhibition of the transpeptidase enzymes, thereby preventing cross-linking of the pentaglycine bridge with the fourth residue of the pentapeptide and interrupting consequent synthesis of peptidoglycan chains. As a result, cefuroxime inhibits bacterial septum and cell wall synthesis formation.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C040738
SnomedCT 89678001
English cefuroxime 1-acetoxyethyl ester, cefuroxime axetil, acetoxyethylcefuroxime, cefuroxime axetil (medication), Cefuroxime Axetil, CEFUROXIME AXETIL, cefuroxime axetil [Chemical/Ingredient], axetil cefuroxime, Cefuroxime axetil, Cefuroxime axetil (substance)
Spanish acetil cefuroxima (sustancia), acetil cefuroxima

Ontology: Ceftin (C0719197)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C040738
English Ceftin, ceftin