Cefuroxime is a β-lactam-type antibiotic with bactericidal action (that is, it is able to kill bacterial cells).
Cefalexin - Chemical Structure
Cefuroxime belongs to the second-generation cephalosporin class and - as such - has activity against Gram-positive bacteria just like first-generation cephalosporins, but unlike the latter, it has greater efficacy against Gram-bacteria. negative.
Indications
For what it uses
The use of cefuroxime is indicated in the treatment of infections caused by bacteria sensitive to it.
More precisely, the drug is indicated for the treatment of:
- Upper airway infections, such as - for example - ear, nasal sinus, throat and tonsil infections;
- Thoracic infections, such as - for example - bronchitis;
- Urinary and bladder infections;
- Skin infections;
- Soft tissue infections;
- Bone and joint infections;
- Gynecological infections;
- Septicemia;
- Peritonitis;
- Meningitis;
- Gonorrhea in patients hypersensitive to penicillins;
- Early stage of Lyme disease.
Furthermore, cefuroxime is used in prophylactic therapy of surgical infections.
Warnings
Although cefuroxime is usually well tolerated, great caution should be used when administering the drug in patients who have had anaphylactic reactions following administration of penicillins or other beta-lactam antibiotics.
The onset of any allergic reactions makes it necessary to immediately stop treatment with cefuroxime.
When cefuroxime is used to treat meningitis in pediatric patients, mild to moderate hearing loss may occur.
The use of cefuroxime can cause superinfections with resistant bacteria or fungi that may be naturally present in the body (such as, for example, Clostridium difficile or Candida albicans infections).
Appropriate controls should be performed in patients who develop severe diarrhea during treatment with cefuroxime, as this symptom could be a sign of the occurrence of pseudomembranous colitis.
The main cause of the appearance of pseudomembranous colitis is due to a superinfection with Clostridium difficile that can arise following a long-lasting therapy with cefuroxime. The milder forms of pseudomembranous colitis can be resolved simply by stopping the antibiotic treatment. The most serious forms, on the other hand, may also require adequate therapy.
The use of cefuroxime may alter test results to determine blood glucose levels.
Cefuroxime can cause side effects that can affect alertness and the ability to drive or use machines, therefore, caution should be used.
Interactions
Drugs used to reduce acid secretion of the stomach may interfere with the activity of cefuroxime, as they reduce its absorption.
Simultaneous use of cefuroxime and other antibiotics (such as tetracyclines, macrolides and chloramphenicol ) may prevent cefuroxime from performing its activity adequately.
Probenecid (a drug used to treat gout and hyperuricemia) may increase the plasma concentration of cefuroxime.
Concomitant use of cefuroxime and nephrotoxic drugs - such as, for example, kanamycin, streptomycin, colistin, vancomycin, neomycin, gentamicin (antibiotic drugs), furosemide and etacrinic acid (very potent diuretics) or amphotericin (an antifungal) - is not recommended due to the toxic effects that can occur on the kidneys.
Cefuroxime may decrease the effectiveness of oral contraceptives, therefore, it is recommended to use barrier contraceptive methods throughout the duration of the antibiotic treatment.
Side effects
Cefuroxime can cause various types of adverse effects, although not all patients experience them. The type of side effects and the intensity with which they occur varies from patient to patient depending on the sensitivity that each person has towards the drug.
The following are the main side effects that can occur during treatment with cefuroxime.
Allergic reactions
Cefuroxime can cause allergic reactions in sensitive individuals.
These reactions can occur in the form of itchy skin eruptions and / or swelling of the face and mouth with consequent breathing difficulties.
Acute allergic reactions can also lead to fainting.
Skin and subcutaneous tissue disorders
Treatment with cefuroxime can cause multiform rashes and vesicles. Furthermore, the drug may promote the onset of Stevens-Johnson syndrome or toxic epidermal necrolysis.
Superinfections
Treatment with cefuroxime may promote the development of infections due to resistant bacteria or fungi, such as Candida albicans or Clostridium difficile infections .
Gastrointestinal disorders
Treatment with cefuroxime can cause nausea, vomiting, diarrhea, inflammation of the colon and abdominal pain. If diarrhea occurs in severe form, it could be a sign of the occurrence of pseudomembranous colitis.
Blood and lymphatic system disorders
Treatment with cefuroxime can cause blood and lymphatic system disorders (ie the system responsible for the production of blood cells). Such disturbances can cause:
- Hemolytic anemia;
- Plateletopenia (ie the decrease in the number of platelets in the bloodstream), with consequent increased risk of bleeding;
- Leukopenia, ie the reduction in the number of leukocytes in the bloodstream;
- Eosinophilia, ie an increase in the blood concentration of eosinophils.
Hepatobiliary disorders
Treatment with cefuroxime may cause an increase in blood concentration of liver enzymes and bilirubin and may promote the occurrence of hepatitis and jaundice.
Nervous system disorders
The therapy with cefuroxime can cause:
- Headache;
- dizziness;
- Dizziness;
- Restlessness;
- Nervousness;
- Confusion.
Jarisch-Herxheimer reaction
This reaction takes place when large quantities of bacterial toxins are released into the body following the bacterial lysis caused by the antibiotic, in this case, caused by cefuroxime.
The symptoms of this reaction can be:
- Temperature;
- Chills;
- Headache;
- Muscle pains;
- Skin eruptions.
Generally, these symptoms last from a few hours to a day.
Other side effects
Other side effects that may occur during treatment with cefuroxime are:
- Temperature;
- Alterations in the results of the Coombs test;
- Renal inflammation;
- Inflammation of blood vessels;
- Increased azotemia (ie the amount of non-protein nitrogen in the bloodstream);
- Increased blood concentration of creatinine.
Overdose
If an overdose of cefuroxime is taken, seizures may occur.
If an overdose is suspected, therefore, it is necessary to contact the doctor immediately and go to the nearest hospital.
Mode of Use - Posology
Cefuroxime is available for oral administration in the form of tablets, or it is available for intramuscular or intravenous administration in the form of a powder that must be dissolved in a suitable solvent just before its use.
The tablets should be taken whole with the help of a glass of water, preferably after meals and at regular intervals.
The dosage of cefuroxime must be established by the doctor according to the type and severity of the infection to be treated and according to the patient's condition.
Following are some indications on the doses of medication usually used.
Regardless of the route of administration chosen, in patients with renal insufficiency, doses of cefuroxime usually administered should be reduced.
Oral administration
The dose of cefuroxime usually given in adults is 125-500 mg two or three times a day, depending on the type and severity of the infection.
In children, the dose of medication usually administered is 10-15 mg / kg of body weight twice a day, depending on the type and severity of the infection.
Intramuscular administration
In this case, the dose of cefuroxime usually used in adults is 1.5-3 g per day, to be divided into 2-4 administrations.
In children, the dose of drug used is 30-100 mg / kg of body weight per day, to be divided into 2-4 administrations.
Intravenous administration
For this type of administration, the dose of cefuroxime used varies from 2 to 6 mg per day.
Action mechanism
The cefuroxime carries out its bactericidal action by interfering with the synthesis of the bacterial cell wall, the peptidoglycan.
Peptidoglycan is a polymer made up of parallel chains of nitrogenated carbohydrates, joined together by transverse bonds between amino acid residues. These bonds are formed thanks to the enzyme transammidase.
Cefuroxime binds to transammidase preventing it from forming the aforementioned bonds. In this way, weak areas are generated within the peptidoglycan that lead to the lysis and death of the bacterial cell.
Pregnancy and breastfeeding
Before taking cefuroxime, pregnant women - known or presumed to be - and breastfeeding mothers should definitely seek advice from the doctor who will decide what to do.
The use of the drug during pregnancy or during breastfeeding should be carried out only after a careful evaluation of the relationship between the expected benefit for the mother and the potential risk to the fetus or newborn.
Contraindications
The use of cefuroxime is contraindicated in the following cases:
- Known hypersensitivity to cefuroxime, to other cephalosporins and / or to other β-lactam antibiotics, such as - for example - to penicillins;
- In children less than three months old.
