CEFUROXIME- cefuroxime injection, powder, for solution
APP Pharmaceuticals, LLC
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Cefuroxime for Injection, USP and other antibacterial drugs, Cefuroxime for Injection, USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
Cefuroxime for Injection, USP is a sterile semisynthetic, broad-spectrum, cephalosporin antibiotic for parenteral administration. It is the sodium salt of (6R,7R)-3-carbamoyloxymethyl-7-[Z-2-methoxyimino-2-(fur-2-yl) acetamido] ceph-3-em-4-carboxylate, and it has the following chemical structure:
The empirical formula is C16 H15 N4 NaO8 S, representing a molecular weight of 446.4.
Cefuroxime for Injection, USP contains approximately 54.2 mg (2.4 mEq) of sodium per gram of cefuroxime activity.
Cefuroxime for Injection, USP in sterile crystalline form is supplied in vials and is equivalent to 750 mg or 1.5 g of cefuroxime as cefuroxime sodium. Solutions of Cefuroxime for Injection, USP range in color from light yellow to amber, depending on the concentration and diluent used. The pH of freshly constituted solutions usually ranges from 6 to 8.5.
After intramuscular (IM) injection of a 750 mg dose of cefuroxime to normal volunteers, the mean peak serum concentration was 27 mcg/mL. The peak occurred at approximately 45 minutes (range, 15 to 60 minutes). Following IV doses of 750 mg and 1.5 g, serum concentrations were approximately 50 and 100 mcg/mL, respectively, at 15 minutes. Therapeutic serum concentrations of approximately 2 mcg/mL or more were maintained for 5.3 hours and 8 hours or more, respectively. There was no evidence of accumulation of cefuroxime in the serum following IV administration of 1.5 g doses every 8 hours to normal volunteers. The serum half-life after either IM or IV injections is approximately 80 minutes.
Approximately 89% of a dose of cefuroxime is excreted by the kidneys over an 8-hour period, resulting in high urinary concentrations.
Following the IM administration of a 750 mg single dose, urinary concentrations averaged 1,300 mcg/mL during the first 8 hours. Intravenous doses of 750 mg and 1.5 g produced urinary levels averaging 1,150 and 2,500 mcg/mL, respectively, during the first 8-hour period.
The concomitant oral administration of probenecid with cefuroxime slows tubular secretion, decreases renal clearance by approximately 40%, increases the peak serum level by approximately 30%, and increases the serum half-life by approximately 30%. Cefuroxime is detectable in therapeutic concentrations in pleural fluid, joint fluid, bile, sputum, bone, and aqueous humor.
Cefuroxime is detectable in therapeutic concentrations in cerebrospinal fluid (CSF) of adults and pediatric patients with meningitis. The following table shows the concentrations of cefuroxime achieved in cerebrospinal fluid during multiple dosing of patients with meningitis.
|Patients||Dose||Number of Patients|| |
Mean (Range) CSF Cefuroxime
Within 8 Hours
|200 to 230 mg/kg/day, divided q 8 hours||6|| |
|Adults||1.5 grams q 8 hours||2|| |
|Adults||1.5 grams q 6 hours||10|| |
Cefuroxime is approximately 50% bound to serum protein.
Cefuroxime has in vitro activity against a wide range of gram-positive and gram-negative organisms, and it is highly stable in the presence of beta-lactamases of certain gram-negative bacteria. The bactericidal action of cefuroxime results from inhibition of cell-wall synthesis.
Cefuroxime is usually active against the following organisms in vitro.
Aerobes, Gram-positive: Staphylococcus aureus ; Staphylococcus epidermidis ; Streptococcus pneumoniae; and Streptococcus pyogenes (and other streptococci). NOTE: Most strains of enterococci, e.g., Enterococcus faecalis (formerly Streptococcus faecalis), are resistant to cefuroxime. Methicillin-resistant staphylococci and Listeria monocytogenes are resistant to cefuroxime.
Aerobes, Gram-negative: Citrobacter spp., Enterobacter spp., Escherichia coli, Haemophilus influenzae (including ampicillin-resistant strains), Haemophilus parainfluenzae, Klebsiella spp. (including Klebsiella pneumoniae), Moraxella (Branhamella) catarrhalis (including ampicillin- and cephalothin-resistant strains), Morganella morganii (formerly Proteus morganii), Neisseria gonorrhoeae (including penicillinase- and non-penicillinase-producing strains), Neisseria meningitidis, Proteus mirabilis, Providencia rettgeri (formerly Proteus rettgeri), Salmonella spp., and Shigella spp.
NOTE: Some strains of Morganella morganii , Enterobacter cloacae , and Citrobacter spp. have been shown by in vitro tests to be resistant to cefuroxime and other cephalosporins. Pseudomonas and Campylobacter spp., Legionella spp., Acinetobacter calcoaceticus , and most strains of Serratia spp. and Proteus vulgaris are resistant to most first- and second-generation cephalosporins.
Anaerobes: Gram-positive and gram-negative cocci (including Peptococcus and Peptostreptococcus spp.), gram-positive bacilli (including Clostridium spp.), and gram-negative bacilli (including Bacteroides and Fusobacterium spp.).
NOTE: Clostridium difficile and most strains of Bacteroides fragilis are resistant to cefuroxime.
Diffusion Techniques: Quantitative methods that require measurement of zone diameters give an estimate of antibiotic susceptibility. One such standard procedure1 that has been recommended for use with disks to test susceptibility of organisms to cefuroxime uses the 30 mcg cefuroxime disk. Interpretation involves the correlation of the diameters obtained in the disk test with the minimum inhibitory concentration (MIC) for cefuroxime.
A report of “Susceptible” indicates that the pathogen is likely to be inhibited by generally achievable blood levels. A report of “Moderately Susceptible” suggests that the organism would be susceptible if high dosage is used or if the infection is confined to tissues and fluids in which high antibiotic levels are attained. A report of “Intermediate” suggests an equivocable or indeterminate result. A report of “Resistant” indicates that achievable concentrations of the antibiotic are unlikely to be inhibitory and other therapy should be selected.
Reports from the laboratory giving results of the standard single-disk susceptibility test for organisms other than Haemophilus spp. and Neisseria gonorrhoeae with a 30 mcg cefuroxime disk should be interpreted according to the following criteria:
|Zone Diameter (mm)||Interpretation|
|≥ 18||(S) Susceptible|
|15-17||(MS) Moderately Susceptible|
|≤ 14||(R) Resistant|
Results for Haemophilus spp. should be interpreted according to the following criteria:
|Zone Diameter (mm)||Interpretation|
|≥ 24||(S) Susceptible|
|≤ 20||(R) Resistant|
Results for Neisseria gonorrhoeae should be interpreted according to the following criteria:
|Zone Diameter (mm)||Interpretation|
|≥ 31||(S) Susceptible|
|26-30||(MS) Moderately Susceptible|
|≤ 25||(R) Resistant|
Organisms should be tested with the cefuroxime disk since cefuroxime has been shown by in vitro tests to be active against certain strains found resistant when other beta-lactam disks are used. The cefuroxime disk should not be used for testing susceptibility to other cephalosporins.
Standardized procedures require the use of laboratory control organisms. The 30 mcg cefuroxime disk should give the following zone diameters.
1. Testing for organisms other than Haemophilus spp. and Neisseria gonorrhoeae:
|Staphylococcus aureus ATCC 25923||27-35|
|Escherichia coli ATCC 25922||20-26|
2. Testing for Haemophilus spp.:
|Haemophilus influenzae ATCC 49766||28-36|
3. Testing for Neisseria gonorrhoeae:
|Neisseria gonorrhoeae ATCC 49226||33-41|
|Staphylococcus aureus ATCC 25923||29-33|
Dilution Techniques: Use a standardized dilution method1 (broth, agar, microdilution) or equivalent with cefuroxime powder. The MIC values obtained for bacterial isolates other than Haemophilus spp. and Neisseria gonorrhoeae should be interpreted according to the following criteria:
|≤ 8||(S) Susceptible|
|16||(MS) Moderately Susceptible|
|≥ 32||(R) Resistant|
MIC values obtained for Haemophilus spp. should be interpreted according to the following criteria:
|≤ 4||(S) Susceptible|
|≥ 16||(R) Resistant|
MIC values obtained for Neisseria gonorrhoeae should be interpreted according to the following criteria:
|≤ 1||(S) Susceptible|
|2||(MS) Moderately Susceptible|
|≥ 4||(R) Resistant|
As with standard diffusion techniques, dilution methods require the use of laboratory control organisms. Standard cefuroxime powder should provide the following MIC values.
1. For organisms other than Haemophilus spp. and Neisseria gonorrhoeae:
|Staphylococcus aureus ATCC 29213||0.5-2|
|Escherichia coli ATCC 25922||2-8|
2. For Haemophilus spp:
|Haemophilus influenzae ATCC 49766||0.25-1|
3. For Neisseria gonorrhoeae:
|Neisseria gonorrhoeae ATCC 49226||0.25-1|
|Staphylococcus aureus ATCC 29213||0.25-1|
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