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Drug dosage identifier

Cefuroxime Sodium

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Dose and administration

  • 25 mg/kg/dose
  • Intravenous dose may be doubled to 50 mg/kg/dose in severe infections1,2,3
Postnatal Age Dosing Interval  (hr)
< 7days q 12 h
7-21 days q 8 h
>21 to term + 28 Days q 8 h

Indications

  • Infants with sepsis, or suspected sepsis.
  • Cefuroxime should not be used when meningitis is suspected and cannot be ruled out.

Contraindications and precautions

  • Hypersensitivity to penicillins / cephalosporins.
  • Caution in preterm infants, especially extreme immaturity.
  • Caution in infants with liver, renal or gastrointestinal disease.

Clinical pharmacology

Cefuroxime is a beta lactamase resistant second-generation cephalosporin which is active against most gram positive organisms (including group B streptococcus) and a wide variety of gram-negative organisms (including group B strep) and a wide variety of gram-negative organisms. It has poor penetration in the central nervous system. It is largely excreted by the kidneys. The plasma half-life falls from around 6 hours at birth to around 3 hours at 2 weeks of age. Babies more than a month old clear cefuroxime almost as quickly as adults (half life of 1 hour), but dosage intervals should be extended in babies with severe renal impairment.

Possible adverse effects

  • Venous irritation, soft tissue injury at IV injection site.
  • Diarrhoea, prolonged or significant, requires further investigation.
  • Neutropenia
  • Transient elevation of hepatic enzymes.
  • Super-infection with non-susceptible organisms including fungi.

Special considerations

Reduce dose in suspected renal impairment2,4

Management of Cefuroxime administration

Description

  • Available as vials of 750 mg and 1.5 g
  • White to pale yellow powder for reconstitution. Reconstituted solution is pale yellow.
  • pH 6 - 8.5.

Prescription

  • Stat doses are charted on stat page of prescription chart in mg/dose.
  • Maintenance doses are charted on the prescription chart in mg/dose.

Administration

Bolus

  • Dilute to 100 mg/ml with water for injection

      Cefuroxime (Zinacef/Mylan) 750mg Cefuroxime (Zinacef/Mylan) 1.5g
    Powder Space 0.5ml 1ml
    Water to be added 7ml 14ml
      100mg/ml 100mg/ml
  • Shake vigorously.
  • Administer over 3-5 minutes5,6. Filter before administration through a 0.2 micron Pall filter.
  • Compatible with sodium chloride 0.9%, glucose 5% and glucose 10%
  • Do NOT mix with other drugs, IV solutions, strongly alkaline solutions, blood or blood products.
  • Do NOT mix with sodium bicarbonate solution, amikacin or gentamicin. These drugs are incompatible with cefuroxime when mixed together.
  • Separate administration from aminoglycoside antibiotics by one hour eg. gentamicin, amikacin.

Storage

Store unopened vials at room temperature . Protect from light

References

  1. Taketomo CK, Hodding JH, Kraus DM, Editors. Pediatric & Neonatal Dosage Handbook. 19th Edition. Hudson (OH): Lexi-Comp; 2012
  2. Woods, DJ (editor), New Zealand Formulary for Children [Internet]. 2013 [updated 2013 Dec 1; cited 2013 Dec 6]. Available from: www.nzformulary.org
  3. Northern Neonatal Network. Neonatal Formulary. 6th edition. Oxford: Wiley-Blackwell Publishing; 2011.
  4. Phelps SJ, Hagemann TM, Lee KR, Thompson AJ. Pediatric Injectable Drugs, The Teddy Bear Book. 10th Edition. Bethesda: American Society of Health-System Pharmacists; 2013.
  5. Auckland District Health Board, Guardrails Administration Guidelines; Paediatrics. Last updated November 2011
  6. Cefuroxime data sheet. Auckland: Mylan New Zealand ltd., 2013.

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Document Control

  • Date last published: 31 January 2015
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years