Clarithromycin is a macrolide antibiotic that fights bacteria in your body.

Clarithromycin is used to treat many different types of bacterial infections affecting the skin and respiratory system.

Clarithromycin is also used together with other medicines to treat stomach ulcers caused by Helicobacter pylori.

Warnings

Take clarithromycin for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. This medicine will not treat a viral infection such as the common cold or flu.

You should not use this medicine if you are allergic to clarithromycin or similar antibiotics, if you have ever had jaundice or liver problems caused by taking this medicine, or if you have liver or kidney disease and are also taking colchicine.

Tell your doctor about all your current medicines and any you start or stop using. Many drugs can interact with clarithromycin, and some drugs should not be used together.

Before taking this medicine

You should not use this medicine if you are allergic to clarithromycin or similar medicines such as azithromycin (Zithromax, Z-Pak, Zmax), erythromycin, or telithromycin, or if:

• you have had jaundice or liver problems caused by taking clarithromycin; or
• you have liver or kidney disease and you also take a medicine called colchicine.

Some medicines can cause unwanted or dangerous effects when used with clarithromycin. Your doctor may need to change your treatment plan if you use any of the following drugs:

• cisapride;
• pimozide;
• lomitapide
• lovastatin or simvastatin; or
• ergotamine or dihydroergotamine.

To make sure this medicine is safe for you, tell your doctor if you have ever had:

• heart problems;
• long QT syndrome (in you or a family member);
• coronary artery disease (clogged arteries);
• myasthenia gravis;
• liver disease;
• kidney disease;
• diabetes; or
• an electrolyte imbalance (such as low levels of potassium or magnesium in your blood).

Clarithromycin may harm an unborn baby. Use effective birth control to prevent pregnancy while you are using this medicine. Tell your doctor if you become pregnant.

In animal studies, clarithromycin caused birth defects. However, it is not known whether these effects would occur in humans. Ask your doctor about your risk.

Clarithromycin can pass into breast milk and may cause side effects in the nursing baby. Tell your doctor if you are breast-feeding.

This medicine is not approved for use by anyone younger than 6 months old.

How should I take clarithromycin?

Take clarithromycin exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Do not use this medicine to treat any condition that has not been checked by your doctor. Do not share this medicine with another person, even if they have the same symptoms you have.

You may take the regular tablets and oral suspension (liquid) with or without food.

Clarithromycin extended-release tablets (Biaxin XL) should be taken with food.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Shake the oral liquid well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Clarithromycin is usually given for 7 to 14 days. Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Clarithromycin will not treat a viral infection such as the flu or a common cold.

Store this medicine in the original container at room temperature, away from moisture, heat, and light.

Do not keep the oral liquid in a refrigerator. Throw away any liquid that has not been used within 14 days.

If your infection is treated with a combination of drugs, use all medications as directed by your doctor. Read the instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include severe stomach pain, nausea, vomiting, or diarrhea.

What to avoid

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Clarithromycin side effects

Get emergency medical help if you have signs of an allergic reaction to clarithromycin: (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• confusion, spinning sensation;
• liver problems – loss of appetite, upper stomach pain, tiredness, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or
• kidney problems – little or no urination, swelling in your feet or ankles, feeling tired or short of breath.

If you’ve ever had heart problems, clarithromycin may cause a heart attack or stroke years after you’ve taken this medicine. Seek medical attention right away if you have chest pain spreading to your jaw or shoulder, trouble breathing, slurred speech, or sudden numbness or weakness on one side of your body.

Older adults may be more likely to have heart rhythm side effects, including a life-threatening fast heart rate.

Common clarithromycin side effects may include:

• stomach pain, nausea, vomiting;
• diarrhea; or
• unusual or unpleasant taste in your mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect clarithromycin?

When you start or stop taking clarithromycin, your doctor may need to adjust the doses of any other medicines you take on a regular basis.

Clarithromycin can cause a serious heart problem, especially if you use certain medicines at the same time, such as antibiotics, antifungal medicine, antidepressants, anti-malaria medicine, asthma inhalers, antipsychotic medicine, cancer medicine, certain HIV/AIDS medicine, heart or blood pressure medicine, or medicine to prevent vomiting.

Many drugs can interact with clarithromycin, and some drugs should not be used together. Tell your doctor about all your current medicines and any medicine you start or stop using. This includes prescription and over-the-counter medicines, vitamins, and herbal products.

Ciprofloxacin is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic, it is used to treat different types of bacterial infections. It is also used to treat people who have been exposed to anthrax or certain types of plague. Ciprofloxacin extended-release is only approved for use in adults.

Fluoroquinolone antibiotics can cause serious or disabling side effects that may not be reversible.

Ciprofloxacin should be used only for infections that cannot be treated with a safer antibiotic.

Warnings

Ciprofloxacin can cause serious side effects, including tendon problems, nerve damage, serious mood or behavior changes, or low blood sugar.

Stop using ciprofloxacin and call your doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, problems with memory or concentration, thoughts of suicide, or sudden pain or movement problems in any of your joints.

In rare cases, ciprofloxacin may cause damage to your aorta, which could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

You may not be able to use this medicine if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

Before taking this medicine

You should not use ciprofloxacin if you are allergic to it, or if:

• you also take tizanidine; or
• you are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).

Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles’ tendon of the heel. This can happen during treatment or several months after you stop taking ciprofloxacin. Tendon problems may be more likely in children and older adults, or people who use steroid medicine or have had an organ transplant.

To make sure ciprofloxacin is safe for you, tell your doctor if you have ever had:

• arthritis or problems with your tendons, bones or joints (especially in children);
• diabetes, low blood sugar;
• nerve problems;
• an aneurysm or blood circulation problems;
• heart problems, or a heart attack;
• muscle weakness, myasthenia gravis;
• liver or kidney disease;
• a seizure, head injury, or brain tumor;
• trouble swallowing pills;
• long QT syndrome (in you or a family member); or
• low levels of potassium in your blood (hypokalemia).

Do not give this medicine to a child without medical advice.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

You should not breastfeed while taking ciprofloxacin and for 2 days after your last dose. Ask your doctor about breastfeeding if you take this medicine for anthrax exposure.

How should I take ciprofloxacin?

Take ciprofloxacin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Take ciprofloxacin at the same time each day, with or without food.

Shake the oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Do not give ciprofloxacin oral suspension through a feeding tube.

Swallow the extended-release tablet whole and do not crush, chew, or break it.

Drink plenty of liquids while you are taking this medicine.

Use ciprofloxacin for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection such as the flu or a common cold.

Do not share this medicine with another person.

Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze. Throw away any unused liquid after 14 days.

What happens if I miss a dose?

If you take regular tablets or oral suspension: Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 6 hours.

If you take extended-release tablets: Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 8 hours.

Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products with your meals, but do not use them alone when taking this medicine.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

Ciprofloxacin could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Tell your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Avoid driving or hazardous activity until you know how ciprofloxacin will affect you. Your reactions could be impaired.

Ciprofloxacin side effects

Get emergency medical help if you have signs of an allergic reaction to ciprofloxacin (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Ciprofloxacin can cause serious side effects, including tendon problems, damage to your nerves (which may be permanent), serious mood or behavior changes (after just one dose), or low blood sugar (which can lead to coma).

Stop taking this medicine and call your doctor at once if you have:

• low blood sugar – headache, hunger, irritability, dizziness, nausea, fast heart rate, or feeling shaky;
• nerve damage symptoms – numbness, tingling, burning pain in your hands, arms, legs, or feet:
• serious mood or behavior changes – nervousness, confusion, agitation, paranoia, hallucinations, memory problems, trouble concentrating, thoughts of suicide; or
• signs of tendon rupture – sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions).

In rare cases, ciprofloxacin may cause damage to your aorta, the main blood artery of the body. This could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

Also, stop using this medicine and call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• any skin rash, no matter how mild;
• muscle weakness, breathing problems;
• little or no urination;
• jaundice (yellowing of the skin or eyes); or
• increased pressure inside the skull – severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Common ciprofloxacin side effects may include:

• nausea, vomiting, diarrhea, stomach pain;
• headache; or
• abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect ciprofloxacin?

Some medicines can make ciprofloxacin much less effective when taken at the same time. If you take any of the following medicines, take your ciprofloxacin dose 2 hours before or 6 hours after you take the other medicine.

• the ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (such as Maalox, Milk of Magnesia, Mylanta, Pepcid Complete, Rolaids, Tums, and others);
• didanosine (Videx) powder or chewable tablets;
• vitamin or mineral supplements that contain calcium, iron, magnesium, or zinc.

Tell your doctor about all your other medicines, especially:

• clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
• a blood thinner (warfarin, Coumadin, Jantoven);
• heart medication or a diuretic or “water pill”;
• oral diabetes medicine;
• products that contain caffeine;
• medicine to treat depression or mental illness;

Cipro is a fluoroquinolone (flor-o-KWIN-o-lone) antibiotic that fights bacteria in the body.

Cipro is used to treat different types of bacterial infections. Cipro is also used to treat people who have been exposed to anthrax or certain types of plague.

Fluoroquinolone antibiotics can cause serious or disabling side effects that may not be reversible.

Cipro should be used only for infections that cannot be treated with a safer antibiotic.

Warnings

Cipro can cause serious side effects, including tendon problems, nerve damage, serious mood or behavior changes, or low blood sugar.

Stop using this medicine and call your doctor at once if you have: headache, hunger, irritability, numbness, tingling, burning pain, confusion, agitation, paranoia, problems with memory or concentration, thoughts of suicide, or sudden pain or movement problems in any of your joints.

In rare cases, ciprofloxacin may cause damage to your aorta, which could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

You may not be able to use Cipro if you have a muscle disorder. Tell your doctor if you have a history of myasthenia gravis.

Before taking this medicine

You should not use Cipro if you are allergic to ciprofloxacin, or if:

• you also take tizanidine; or
• you are allergic to other fluoroquinolones (levofloxacin, moxifloxacin, norfloxacin, ofloxacin).

Ciprofloxacin may cause swelling or tearing of a tendon (the fiber that connects bones to muscles in the body), especially in the Achilles’ tendon of the heel. This can happen during treatment or several months after you stop taking Cipro. Tendon problems may be more likely in children and older adults, or people who use steroid medicine or have had an organ transplant.

To make sure Cipro is safe for you, tell your doctor if you have ever had:

• arthritis or problems with your tendons, bones or joints (especially in children);
• diabetes, low blood sugar;
• nerve problems;
• an aneurysm or blood circulation problems;
• heart problems, or a heart attack;
• muscle weakness, myasthenia gravis;
• liver or kidney disease;
• a seizure, head injury, or brain tumor;
• trouble swallowing pills;
• long QT syndrome (in you or a family member); or
• low levels of potassium in your blood (hypokalemia).

Do not give Cipro to a child without medical advice.

It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant.

You should not breastfeed while taking ciprofloxacin and for 2 days after your last dose. Ask your doctor about breastfeeding if you take ciprofloxacin for anthrax exposure.

How should I take Cipro?

Take Cipro exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Take Cipro at the same time each day, with or without food.

Shake the Cipro oral suspension (liquid) for 15 seconds before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Do not give Cipro oral suspension through a feeding tube.

Drink plenty of liquids while you are taking this medicine .

Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Ciprofloxacin will not treat a viral infection such as the flu or a common cold.

Do not share Cipro with another person.

Store at room temperature away from moisture and heat. Do not allow the liquid medicine to freeze. Throw away any unused liquid after 14 days.

What happens if I miss a dose?

If you take regular tablets or oral suspension: Take the medicine as soon as you can, but skip the missed dose if your next dose is due in less than 6 hours.

Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Do not take Cipro with dairy products such as milk or yogurt, or with calcium-fortified juice. You may eat or drink these products with your meals, but do not use them alone when taking Cipro.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

Ciprofloxacin could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Tell your doctor if you have severe burning, redness, itching, rash, or swelling after being in the sun.

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Ciprofloxacin side effects

Get emergency medical help if you have signs of an allergic reaction to Cipro (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Ciprofloxacin can cause serious side effects, including tendon problems, damage to your nerves (which may be permanent), serious mood or behavior changes (after just one dose), or low blood sugar (which can lead to coma).

Stop taking this medicine and call your doctor at once if you have:

• low blood sugar – headache, hunger, irritability, dizziness, nausea, fast heart rate, or feeling shaky;
• nerve damage symptoms – numbness, tingling, burning pain in your hands, arms, legs, or feet:
• serious mood or behavior changes – nervousness, confusion, agitation, paranoia, hallucinations, memory problems, trouble concentrating, thoughts of suicide; or
• signs of tendon rupture – sudden pain, swelling, bruising, tenderness, stiffness, movement problems, or a snapping or popping sound in any of your joints (rest the joint until you receive medical care or instructions).

In rare cases, ciprofloxacin may cause damage to your aorta, the main blood artery of the body. This could lead to dangerous bleeding or death. Get emergency medical help if you have severe and constant pain in your chest, stomach, or back.

Also, stop using Cipro and call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness (like you might pass out);
• any skin rash, no matter how mild;
• muscle weakness, breathing problems;
• little or no urination;
• jaundice (yellowing of the skin or eyes); or
• increased pressure inside the skull – severe headaches, ringing in your ears, dizziness, nausea, vision problems, pain behind your eyes.

Common Cipro side effects may include:

• nausea, vomiting, diarrhea, stomach pain;
• headache; or
• abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect Cipro?

Some medicines can make Cipro much less effective when taken at the same time. If you take any of the following medicines, take your dose 2 hours before or 6 hours after you take the other medicine.

• the ulcer medicine sucralfate, or antacids that contain calcium, magnesium, or aluminum (such as Maalox, Milk of Magnesia, Mylanta, Pepcid Complete, Rolaids, Tums, and others);
• didanosine (Videx) powder or chewable tablets;
• vitamin or mineral supplements that contain calcium, iron, magnesium, or zinc.

Tell your doctor about all your other medicines, especially:

• clozapine, cyclosporine, methotrexate, phenytoin, probenecid, ropinirole, sildenafil, or theophylline;
• a blood thinner (warfarin, Coumadin, Jantoven);
• heart medication or a diuretic or “water pill”;
• oral diabetes medicine;
• products that contain caffeine;
• medicine to treat depression or mental illness;
• steroid medicine (such as prednisone)

Cephalexin is a cephalosporin (SEF a low spor in) antibiotic. It works by fighting bacteria in your body.

Cephalexin is used to treat infections caused by bacteria, including upper respiratory infections, ear infections, skin infections, urinary tract infections and bone infections.

Cephalexin is used to treat infections in adults and children who are at least 1 year old.

Warnings

You should not use this medicine if you are allergic to cephalexin or to similar antibiotics, such as Ceftin, Cefzil, Omnicef, and others. Tell your doctor if you are allergic to any drugs, especially penicillins or other antibiotics.

Before taking this medicine

Do not use this medicine if you are allergic to cephalexin or to other cephalosporin antibiotics, such as:

• cefaclor (Ceclor, Raniclor);
• cefadroxil (Duricef);
• cefazolin (Ancef, Kefzol);
• cefdinir (Omnicef);
• cefditoren (Spectracef);
• cefpodoxime (Vantin);
• cefprozil (Cefzil);
• ceftibuten (Cedax);
• cefuroxime (Ceftin); and others

To make sure cephalexin is safe for you, tell your doctor if you have ever had

• an allergy to any drug (especially penicillin);
• liver or kidney disease; or
• intestinal problems, such as colitis.

Cephalexin is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant.

Cephalexin can pass into breast milk. Tell your doctor if you are breast-feeding a baby.

How should I take cephalexin?

Take cephalexin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Do not use cephalexin to treat any condition that has not been checked by your doctor.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

Use cephalexin for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. This medicine will not treat a viral infection such as the flu or a common cold.

Do not share cephalexin with another person, even if they have the same symptoms you have.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using this medicine.

Store the tablets and capsules at room temperature away from moisture, heat, and light.

Store the liquid medicine in the refrigerator. Throw away any unused liquid after 14 days.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include nausea, vomiting, stomach pain, diarrhea, and blood in your urine.

What to avoid

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.

Cephalexin side effects

Get emergency medical help if you have signs of an allergic reaction to cephalexin (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody (even if it occurs months after your last dose);
• unusual tiredness, feeling light-headed or short of breath;
• easy bruising, unusual bleeding, purple or red spots under your skin;
• a seizure;
• pale skin, cold hands and feet;
• yellowed skin, dark colored urine;
• fever, weakness; or
• pain in your side or lower back, painful urination.

Common cephalexin side effects may include:

• diarrhea;
• nausea, vomiting;
• indigestion, stomach pain; or
• vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect cephalexin?

Tell your doctor about all your other medicines, especially:

• metformin; or
• probenecid.

Antibacterial; β-lactam antibiotic; second generation cephalosporin.

Uses for Cefuroxime

Acute Otitis Media (AOM)

Treatment of AOM caused by Streptococcus pneumoniae, Haemophilus influenzae (including β-lactamase-producing strains), Moraxella catarrhalis (including β-lactamase-producing strains), or S. pyogenes in adults and pediatric patients ≥13 years of age.

When anti-infectives indicated, AAP recommends high-dose amoxicillin or amoxicillin and clavulanate as drugs of choice for initial treatment of AOM; certain cephalosporins (cefdinir, cefpodoxime, cefuroxime, ceftriaxone) recommended as alternatives for initial treatment in penicillin-allergic patients without a history of severe penicillin-allergic reactions.

Bone and Joint Infections

Parenteral treatment of bone and joint infections caused by susceptible Staphylococcus aureus (including penicillinase-producing strains).

Gonorrhea and Associated Infections

Has been used orally or parenterally for treatment of uncomplicated urethral, endocervical, or rectal gonorrhea caused by susceptible Neisseria gonorrhoeae.

Has been used parenterally for treatment of disseminated gonococcal infections caused by susceptible N. gonorrhoeae.

Not included in current CDC recommendations for gonococcal infections.

Because of concerns related to reports of N. gonorrhoeae with reduced susceptibility to cephalosporins, CDC states that oral cephalosporins no longer recommended as first-line treatment for uncomplicated gonorrhea. For treatment of uncomplicated urogenital, anorectal, or pharyngeal gonorrhea, CDC recommends a single dose of IM ceftriaxone.

Lyme Disease

Treatment of early Lyme disease manifested as erythema migrans in adults and pediatric patients ≥13 years of age. IDSA, the American Academy of Neurology (AAN), the American College of Rheumatology (ACR), AAP, and other clinicians recommend oral doxycycline, oral amoxicillin, or oral cefuroxime axetil as first-line therapy for treatment of Lyme disease associated with erythema migrans, in the absence of specific neurologic involvement or advanced atrioventricular (AV) heart block.

In patients with acute neurologic Lyme disease^{† [off-label]} including Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or with other peripheral nervous system manifestations, recommended treatment is parenteral therapy with ceftriaxone, cefotaxime, or penicillin G, or oral therapy with doxycycline. Route of therapy may be changed from IV to oral during treatment in patients who have experienced clinical improvement. Recommended treatment duration is 14–21 days. In patients with acute neurologic Lyme disease with parenchymal involvement of the brain or spinal cord, IV antibiotic treatment recommended for entire 14–21 days.

In outpatients with Lyme carditis^{† [off-label]}, oral antibiotics (doxycycline, amoxicillin, cefuroxime axetil, or azithromycin) recommended by IDSA/AAN/ACR. In patients with or at high risk of severe cardiac complications, including those with a PR interval >0.3 seconds, other arrhythmias, or clinical manifestations of myopericarditis, hospitalization with continuous ECG monitoring and treatment with IV ceftriaxone recommended; upon clinical improvement, may switch to oral antibiotics to complete recommended 14–21 days of treatment. For patients with symptomatic bradycardia that cannot be managed medically, temporary pacing modalities recommended over a permanent pacemaker.

In pediatric patients with Lyme disease associated with atrioventricular heart block or carditis^{† [off-label]}, oral treatment with doxycycline, amoxicillin, or cefuroxime axetil for 14 days (range: 14–21 days) or IV treatment with ceftriaxone for 14 days (range: 14–21 days for a hospitalized patient) recommended by AAP. May substitute oral antibiotics for IV treatment when patient stabilized or discharged from hospital to complete recommended 14–21 days of treatment. According to AAP, azithromycin not sufficiently studied for manifestations of Lyme disease other than erythema migrans.

Treatment of Lyme disease associated arthritis^{† [off-label]} without clinical evidence of neurologic disease. In patients with Lyme disease-associated arthritis^{† [off-label]}, recommended initial treatment is a 28-day course of oral antibiotics (doxycycline, amoxicillin, or cefuroxime axetil). In patients who experience a partial response to an initial course of treatment, a second course of oral antibiotics for up to 1 month may be reasonable. In patients with minimal or no response (moderate to severe joint swelling with minimal reduction of the joint effusion) to an initial 28-day course of oral antibiotic, a 2- to 4-week course of IV ceftriaxone is recommended. In patients who have failed one course of oral antibiotics and one course of IV antibiotics, refer to rheumatologist or other trained specialist. Antibiotic therapy for >8 weeks (including one course of IV antibiotic) not expected to provide additional benefit to patients with persistent arthritis.

For patients with persistent or recurring nonspecific symptoms (e.g., fatigue, pain, cognitive impairment) following recommended treatment for Lyme disease, but without objective evidence of reinfection or treatment failure, IDSA/AAN/ACR and AAP recommend against additional antibiotic therapy. However, retreatment in patients who experience subsequent acute infections caused by B. burgdorferi considered appropriate.

Meningitis

Parenteral treatment of meningitis caused by susceptible S. pneumoniae, H. influenzae (including ampicillin-resistant strains), Neisseria meningitidis, or S. aureus (including penicillinase-producing strains).

Not a drug of choice for meningitis; treatment failures have been reported, especially in meningitis caused by H. influenzae. In addition, bacteriologic response to cefuroxime appears to be slower than that reported with ceftriaxone, which may increase the risk for hearing loss and neurologic sequelae. When a cephalosporin is indicated for the treatment of bacterial meningitis, a parenteral third generation cephalosporin (usually ceftriaxone or cefotaxime) generally recommended.

Perioperative Prophylaxis

Perioperative prophylaxis in patients undergoing cardiac surgery; a drug of choice for cardiac procedures (e.g., coronary artery bypass, pacemaker or other cardiac device insertion, ventricular assist devices).

Perioperative prophylaxis in patients undergoing clean head and neck surgery involving placement of prosthesis (excluding tympanostomy); perioperative prophylaxis in conjunction with metronidazole in patients undergoing clean-contaminated cancer surgery of the head and neck or other clean-contaminated head and neck procedures (excluding tonsillectomy and functional endoscopic sinus procedures). A drug of choice.

Has been used for perioperative prophylaxis in patients undergoing noncardiac thoracic surgery, GI or biliary tract surgery, gynecologic or obstetric surgery (e.g., vaginal hysterectomy), orthopedic procedures, or heart transplantation. Other anti-infectives (e.g., cefazolin) usually preferred.

Pharyngitis and Tonsillitis

Treatment of mild to moderate pharyngitis and tonsillitis caused by S. pyogenes (group A β-hemolytic streptococci) in adults and pediatric patients ≥13 years of age. Efficacy in prevention of subsequent rheumatic fever not established.

AAP, IDSA, AHA, and others recommend a penicillin regimen (10 days of oral penicillin V or oral amoxicillin or single dose of IM penicillin G benzathine) as treatments of choice for S. pyogenes pharyngitis and tonsillitis; other anti-infectives (oral cephalosporins, oral macrolides, oral clindamycin) recommended as alternatives in penicillin-allergic patients.

If an oral cephalosporin used treatment for S. pyogenes pharyngitis and tonsillitis, 10 day regimen of first generation cephalosporin (cefadroxil, cephalexin) preferred instead of other cephalosporins with broader spectrums of activity (e.g., cefaclor, cefdinir, cefixime, cefpodoxime, cefuroxime).

Respiratory Tract Infections

Treatment of acute maxillary sinusitis caused by susceptible S. pneumoniae or H. influenzae (non-β-lactamase-producing strains only) in adults and pediatric patients ≥13 years of age. Safety and effectiveness of cefuroxime axetil for pediatric patients 3 months to 12 years of age have been established for acute bacterial maxillary sinusitis based upon its approval in adults. Data insufficient to date to establish efficacy for treatment of acute maxillary sinusitis known or suspected to be caused by β-lactamase-producing strains of H. influenzae or M. catarrhalis. Because of variable activity against S. pneumoniae and H. influenzae, IDSA no longer recommends second or third generation oral cephalosporins for empiric monotherapy of acute bacterial sinusitis. Oral amoxicillin or amoxicillin and clavulanate usually recommended by IDSA and AAP for empiric treatment. If an oral cephalosporin used as an alternative in children (e.g., in penicillin-allergic individuals), combination regimen that includes a third generation cephalosporin (cefixime or cefpodoxime) and clindamycin (or linezolid) recommended.

Treatment of secondary bacterial infections of acute bronchitis^† caused by susceptible S. pneumoniae, H. influenzae (non-β-lactamase-producing strains only), or H. parainfluenzae (non-β-lactamase-producing strains only).

Treatment of acute exacerbations of chronic bronchitis caused by susceptible S. pneumoniae, H. influenzae (non-β-lactamase-producing strains only), or H. parainfluenzae (non-β-lactamase-producing strains only) in adults and pediatric patients ≥13 years of age.

Parenteral treatment of lower respiratory tract infections (including pneumonia) caused by susceptible S. pneumoniae, S. aureus (including penicillinase-producing strains), S. pyogenes (group A β-hemolytic streptococci), H. influenzae (including ampicillin-resistant strains), Escherichia coli, or Klebsiella.

Treatment of community-acquired pneumonia (CAP)^†. Recommended by ATS and IDSA as an alternative in certain combination regimens used for empiric treatment of CAP. Select regimen for empiric treatment of CAP based on most likely pathogens, local susceptibility patterns, and individual patient characteristics.

For empiric outpatient treatment of CAP in adults with comorbidities (e.g., chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; asplenia), IDSA/ATS recommend either combination therapy with a ß-lactam antibiotic (amoxicillin/clavulanate, cefpodoxime, or cefuroxime) and a macrolide (azithromycin, clarithromycin, or extended-release clarithromycin) or doxycycline; or, monotherapy with a respiratory fluoroquinolone (levofloxacin, moxifloxacin, or gemifloxacin).

Septicemia

Parenteral treatment of septicemia caused by susceptible S. aureus (including penicillinase-producing strains), S. pneumoniae, E. coli, H. influenzae (including ampicillin-resistant strains), or Klebsiella.

In the treatment of known or suspected sepsis or the treatment of other serious infections when the causative organism is unknown, concomitant therapy with an aminoglycoside may be indicated.

Skin and Skin Structure Infections

Oral treatment of uncomplicated skin and skin structure infections caused by susceptible S. aureus (including β-lactamase-producing strains) or S. pyogenes in adults and pediatric patients ≥13 years of age.

Parenteral treatment of skin and skin structure infections caused by susceptible S. aureus (including β-lactamase-producing strains), S. pyogenes, E. coli, Klebsiella, or Enterobacter.

Urinary Tract Infections (UTIs)

Oral treatment of uncomplicated UTIs caused by susceptible E. coli or K. pneumoniae in adults and pediatric patients ≥13 years of age.

Parenteral treatment of UTIs caused by susceptible E. coli or K. pneumoniae.

Cefuroxime Dosage and Administration

General

Pretreatment Screening

• Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs.

Patient Monitoring

• Monitor prothrombin time (PT) in patients at risk of cephalosporin-associated decreased prothrombin activity, including those with renal or hepatic impairment, poor nutritional state, receiving prolonged cefuroxime therapy, or stabilized on anticoagulant therapy. Administer vitamin K when indicated.
• Carefully monitor patients receiving prolonged cefuroxime therapy for superinfection. Institute appropriate therapy if superinfection occurs.
• Periodically evaluate renal status during therapy, especially in seriously ill patients receiving maximum dosage. Renal function monitoring also may be useful in geriatric patients because of possible age-related decreases in renal function.

Other General Considerations

• To reduce development of drug-resistant bacteria and maintain effectiveness of cefuroxime and other antibacterials, use cefuroxime only for the treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.

Administration

Administer cefuroxime axetil orally. Administer cefuroxime sodium by IV injection or infusion or deep IM injection.

IV route may be preferred in patients with septicemia or other severe or life-threatening infections or in patients with lowered resistance, particularly if shock is present or impending.

Oral Administration

Tablets may be given orally without regard to meals, but administration with food maximizes bioavailability. The manufacturer states that the tablets should be swallowed whole.

Oral suspension of cefuroxime axetil is no longer commercially available in the US. Although the tablets have been crushed and mixed with food (e.g., applesauce, ice cream), the crushed tablets have a strong, persistent taste and the manufacturers state that the drug should not be administered in this manner.

IV Injection

Reconstitution

Reconstitute vials of cefuroxime sodium containing 750 mg or 1.5 g of cefuroxime with 8.3 or 16 mL of sterile water for injection, respectively, to provide solutions containing approximately 90 mg/mL. Withdraw entire contents of vial for each dose.

Rate of Administration

Inject appropriate dose of reconstituted solution directly into a vein over a period of 3–5 minutes or slowly into the tubing of a freely flowing compatible IV solution.

IV Infusion

Other IV solutions flowing through a common administration tubing or site should be discontinued while cefuroxime is being infused. If an aminoglycoside is administered concomitantly with cefuroxime, the drugs should be administered at separate sites.

Reconstitution and Dilution

Reconstitute 7.5-g pharmacy bulk vial with 77 mL of sterile water for injection to provide solution containing approximately 750 mg of cefuroxime per 8 mL; then, further dilute in a compatible IV infusion solution.

Rate of Administration

Intermittent IV infusions generally infused over 15–60 minutes.

IM Injection

Administer IM injections deeply into a large muscle mass such as the gluteus or lateral aspect of the thigh. Use aspiration to ensure needle is not in a blood vessel.

Reconstitution

Prepare IM injections by reconstituting vial containing 750 mg of cefuroxime with 3 mL of sterile water for injection to provide a suspension containing approximately 225 mg/mL.

Shake IM suspension gently prior to administration.

Dosage

Available as cefuroxime axetil or cefuroxime sodium ; dosage expressed in terms of cefuroxime.

Pediatric Patients

General Pediatric Dosage

Neonates

IV or IM

Neonates with gestational age (GA) ≤31 weeks and 6 days and postnatal age (PNA) of <7 days of age: 50 mg/kg every 12 hours.

Neonates with GA ≤31 weeks and 6 days and PNA 7–28 days of age: 50 mg/kg every 8 hours.

Neonates with GA ≥32 weeks and PNA ≤7 days: 50 mg/kg every 12 hours.

Neonates with GA ≥32 weeks and PNA 8–28 days: 50 mg/kg every 8 hours.

Mild to Moderate Infections

Oral

Children beyond neonatal period: AAP recommends 20–30 mg/kg daily (maximum 1 g/day) given in 2 divided doses.

Children beyond neonatal period with bone or joint infections: AAP recommends up to 100 mg/kg daily (maximum 3 g/day) given in 3 divided doses.IV or IM

Children beyond neonatal period: AAP recommends 100–150 mg/kg daily (maximum 6 g/day) given in 3 divided doses.

Children ≥3 months of age: Manufacturer states 50–100 mg/kg daily given in 3 or 4 equally divided doses has been effective for most infections in children .

Severe Infections

IV or IM

Children ≥3 months of age: Manufacturer recommends 100 mg/kg daily (not to exceed the maximum adult dosage) given in 3 or 4 equally divided doses.

Acute Otitis Media (AOM)

Children 3 Months to 12 Years of Age

Oral

Tablets (for children able to swallow tablets whole): 250 mg every 12 hours for 10 days.

Has been given in a 5-day regimen^†. AAP does not recommend oral anti-infective regimens of <10 days’ duration in children <2 years of age or in patients with severe symptoms.

Pharyngitis and Tonsillitis

Children 2 to 15 Years of Age

Oral

Oral suspension (no longer commercially available in US) has been given in a dosage of 20 mg/kg daily in 2 divided doses for 10 days.

Adolescents ≥13 Years of Age

Oral

Tablets: 250 mg every 12 hours for 10 days.

Bone and Joint Infections

Children ≥3 Months

IV or IM

150 mg/kg daily (not to exceed the maximum adult dosage) given in equally divided doses every 8 hours.

Meningitis

Children ≥3 Months

IV or IM

200–240 mg/kg daily given in equally divided doses every 6–8 hours.

Respiratory Tract Infections

Acute Sinusitis in Children 3 Months to 12 Years of Age

Oral

Tablets (for children able to swallow tablets whole): 250 mg every 12 hours for 10 days.

Acute Sinusitis in Adolescents ≥13 Years of Age

Oral

Tablets: 250 mg every 12 hours for 10 days.

Acute Exacerbations of Chronic Bronchitis in Adolescents ≥13 Years of Age

Oral

Tablets: 250 or 500 mg every 12 hours for 10 days. Efficacy of regimens <10 days has not been established.

Skin and Skin Structure Infections

Uncomplicated Infections in Adolescents ≥13 Years of Age

Oral

Tablets: 250 or 500 mg every 12 hours for 10 days.

Urinary Tract Infections (UTIs)

Uncomplicated Infections in Adolescents ≥13 Years of Age

Oral

Tablets: 250 mg every 12 hours for 7–10 days.

Gonorrhea and Associated Infections

Uncomplicated Urethral, Cervical, or Rectal Gonorrhea In Adolescents ≥13 Years of Age

Oral

Tablets: 1 g as a single dose recommended by manufacturer.

Not recommended by CDC as treatment for gonorrhea.

Lyme Disease

Lyme Disease Manifested as Erythema Migrans

Oral

Tablets: 500 mg twice daily for 20 days in adolescents ≥13 years of age.

AAP, IDSA, AAN, ACR, and others recommend 30 mg/kg administered in 2 divided doses (up to 500 mg per dose) for 14 days in children without specific neurologic involvement or advanced AV heart block.

Lyme Carditis†

Oral

30 mg/kg daily in 2 equally divided doses (up to 500 mg per dose) for 14–21 days recommended by IDSA, AAN, ACR, AAP, and others.

Lyme Arthritis†

Oral

30 mg/kg daily in 2 equally divided doses (up to 500 mg per dose) for 28 days recommended by IDSA, AAN, ACR, AAP, and others for children with uncomplicated Lyme arthritis without clinical evidence of neurologic disease.

Perioperative Prophylaxis

Cardiac, Cardiothoracic, or Noncardiac Thoracic Surgery

IV

50 mg/kg given within 1 hour prior to incision. If procedure is prolonged (>4 hours) or if major blood loss occurs, additional 50-mg/kg doses may be given. No evidence of benefit if continued beyond 48 hours and no evidence to support continuing prophylaxis until all drains and indwelling catheters are removed.

Adults

General Adult Dosage

IV or IM

750–1.5 g every 8 hours for 5–10 days.

Severe or complicated infections generally require 1.5 g every 8 hours.

Life-threatening Infections or Those Caused by Less Susceptible Organisms

IV or IM

1.5 g every 6 hours.

Pharyngitis and Tonsillitis

Oral

Tablets: 250 mg every 12 hours for 10 days.

Bone and Joint Infections

IV or IM

1.5 g every 8 hours.

Meningitis

IV or IM

Up to 3 g every 8 hours.

Respiratory Tract Infections

Acute Sinusitis

Oral

Tablets: 250 mg every 12 hours for 10 days.

Secondary Bacterial Infections of Acute Bronchitis†

Oral

Tablets: 250 mg twice daily for 5–10 days.

Acute Exacerbations of Chronic Bronchitis

Oral

Tablets: 250 or 500 mg every 12 hours for 10 days. Efficacy of regimens <10 days has not been established.

Pneumonia

Oral

500 mg twice daily recommended by ATS and IDSA for empiric treatment of community-acquired pneumonia^† (CAP). Must be used in conjunction with other anti-infectives for empiric treatment of CAP.IV or IM

750 mg every 8 hours. For severe or complicated infections, 1.5 g every 8 hours.

Skin and Skin Structure Infections

Uncomplicated Infections

Oral

Tablets: 250 or 500 mg every 12 hours for 10 days.IV or IM

750 mg every 8 hours.

Severe or Complicated Infections

IV or IM

1.5 g every 8 hours.

Urinary Tract Infections (UTIs)

Uncomplicated Infections

Oral

Tablets: 250 mg every 12 hours for 7–10 days.IV or IM

750 mg every 8 hours.

Severe or Complicated Infections

IV or IM

1.5 g every 8 hours.

Gonorrhea and Associated Infections

Uncomplicated Urethral, Cervical, or Rectal Gonorrhea

Oral

Tablets: 1 g as a single dose has been used.

Not recommended by CDC as treatment for gonorrhea.IM

1.5 g as a single dose recommended by manufacturer; divide the dose, give at 2 different sites. Given in conjunction with 1 g of oral probenecid.

Not included in CDC recommendations.

Disseminated Gonococcal Infections

IV or IM

750 mg every 8 hours recommended by manufacturer.

Not included in CDC recommendations.

Lyme Disease

Early Localized or Early Disseminated Lyme Disease Manifested as Erythema Migrans

Oral

Tablets: 500 mg every 12 hours for 20 days.

IDSA, AAN, ACR, and others recommend 500 mg twice daily for 14 days in adults without specific neurologic involvement or advanced AV heart block.

Lyme Carditis†

Oral

500 mg twice daily for 14–21 days recommended by IDSA, AAN, ACR, and others.

Lyme Arthritis†

Oral

500 mg twice daily for 28 days recommended by IDSA, AAN, ACR, and others for adults with uncomplicated Lyme arthritis without clinical evidence of neurologic disease.

Perioperative Prophylaxis

Cardiac Surgery

IV

For open-heart surgery, manufacturers recommend 1.5 g given at the time of induction of anesthesia and 1.5 g every 12 hours thereafter for a total dosage of 6 g.

For cardiac procedures, some experts recommend 1.5 g given within 1 hour prior to surgical incision and additional 1.5-g doses every 4 hours during prolonged procedures (>4 hours) or if major blood loss occurs.

Various data support a duration of perioperative prophylaxis ranging from a single preoperative dose to continuation for 24 hours postoperatively; no evidence of benefit beyond 48 hours and no evidence to support continuing prophylaxis until all drains and indwelling catheters are removed.

Other Surgery

IV or IM

Manufacturer recommends 1.5 g given IV just prior to surgery (approximately 0.5–1 hour prior to initial incision) and, in lengthy operations, 750 mg given IV or IM every 8 hours. Postoperative doses usually unnecessary and may increase risk of bacterial resistance.

Some experts recommend 1.5 g given within 1 hour prior to surgical incision and additional 1.5-g doses every 4 hours during prolonged procedures (>4 hours) or if major blood loss occurs.

Special Populations

Hepatic Impairment

Systemic exposure to cefuroxime not expected to be altered in patients with hepatic impairment.

Renal Impairment

Dosage adjustments of parenteral cefuroxime necessary in patients with Cl_cr ≤20 mL/minute.

Adults with impaired renal function: 750 mg IM or IV every 12 hours in those with Cl_cr 10–20 mL/minute or 750 mg IM or IV every 24 hours in those with Cl_cr <10 mL/minute.

Patients undergoing hemodialysis: Give a supplemental dose of parenteral or oral cefuroxime after each dialysis period.

Children with impaired renal function: Make adjustments to dosing frequency for IM or IV cefuroxime similar to those recommended for adults with renal impairment.

Dosage interval adjustments of oral cefuroxime necessary in patients with Cl_cr ≤30 mL/minute.

Adults with impaired renal function: Give standard oral dose once every 24 hours in those with Cl_cr 10 to <30 mL/minute or standard oral dose once every 48 hours in those with Cl_cr <10 mL/minute who are not receiving hemodialysis.

Geriatric Patients

Cautious dosage selection because of age-related decreases in renal function.

Cautions for Cefuroxime

Contraindications

• Known hypersensitivity to cefuroxime or other ß-lactam antibacterial drugs (e.g., penicillins, cephalosporins).

Warnings/Precautions

Clostridioides difficile-associated Diarrhea and Colitis (CDAD)

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridioides difficile. C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) reported with nearly all anti-infectives, including cefuroxime, and may range in severity from mild diarrhea to fatal colitis. C. difficile produces toxins A and B, which contribute to development of CDAD; hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.

Consider CDAD if diarrhea develops during or after therapy and manage accordingly. Obtain careful medical history since CDAD may occur as late as 2 months or longer after anti-infective therapy is discontinued.

If CDAD is suspected or confirmed, may need to discontinue anti-infectives not directed against C. difficile. Initiate appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.

Hypersensitivity Reactions

Possible hypersensitivity reactions, including rash, pruritus, fever, eosinophilia, urticaria, potentially fatal anaphylaxis, erythema multiforme, interstitial nephritis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.

If an allergic reaction occurs, discontinue and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen). Partial cross-sensitivity among cephalosporins and other β-lactam antibiotics, including penicillins.

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs. Cautious use recommended in individuals hypersensitive to penicillins or other drugs; manufacturer states cefuroxime axetil contraindicated in patients with known hypersensitivity to β-lactam antibiotics.

Potential for Microbial Overgrowth

Possible emergence and overgrowth of nonsusceptible organisms with prolonged therapy. Careful observation of the patient is essential. Institute appropriate therapy if superinfection occurs.

History of GI Disease

Use with caution in patients with a history of GI disease, particularly colitis.

Prolonged Prothrombin Time (PT)

Prolonged PT reported with some cephalosporins.

Monitor PT in patients at risk, including those with renal or hepatic impairment, poor nutritional state, receiving prolonged therapy, or stabilized on anticoagulant therapy. Administer vitamin K when indicated.

Renal Effects

Periodically evaluate renal status during therapy, especially in seriously ill patients receiving maximum dosage.

Caution if used concomitantly with nephrotoxic drugs (e.g., aminoglycosides, potent diuretics).

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of cefuroxime and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing. In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.

Interference with Glucose Tests

Possible false-positive result for urine glucose with copper reduction tests in patients receiving cefuroxime axetil.

Possible false-negative result for blood/plasma glucose with ferricyanide tests in patients receiving cefuroxime axetil.

Patients with Meningitis

Mild to moderate hearing loss reported rarely in pediatric patients who received cefuroxime for treatment of meningitis.

Persistence of positive CSF cultures at 18–36 hours reported; clinical importance unknown.

Sodium Content

Cefuroxime sodium contains approximately 54.2 mg (2.4 mEq) of sodium per g of cefuroxime.

Specific Populations

Pregnancy

No adequate and controlled studies to date using cefuroxime in pregnant women; use cefuroxime during pregnancy only when clearly needed. Manufacturer of cefuroxime axetil states that while available studies cannot definitively establish absence of risk, published data from epidemiologic studies, case series, and case reports have not identified an association with the use of cephalosporins (including cefuroxime axetil) during pregnancy and major birth defects, miscarriage, or other adverse maternal or fetal outcomes.

Lactation

Distributed into milk; use cefuroxime sodium with caution.

According to the manufacturer of cefuroxime axetil, no data available on drug’s effects on breastfed infant or milk production. Consider developmental and health benefits of breastfeeding along with mother’s clinical need for cefuroxime and any potential adverse effects on the breastfed infant from cefuroxime or from the underlying maternal condition.

Pediatric Use

Safety and efficacy of oral or parenteral cefuroxime not established in children <3 months of age. Other cephalosporins accumulate in neonates resulting in prolonged serum half-life.

Safety and efficacy of oral cefuroxime for treatment of acute bacterial maxillary sinusitis in pediatric patients 3 months to 12 years of age have been established based on safety and efficacy of the drug in adults. In addition, use of oral cefuroxime in pediatric patients is supported by pharmacokinetic and safety data in adult and pediatric patients, clinical and microbiologic data from adequate and well-controlled studies of the treatment of acute bacterial maxillary sinusitis in adults and acute otitis media with effusion in pediatric patients, and postmarketing surveillance of adverse effects.

Tablets should not be crushed for pediatric administration since the drug has a strong, persistent, bitter taste; vomiting was induced aversively in some children who received crushed tablets.

Geriatric Use

No overall differences in safety and efficacy in those ≥65 years of age compared with younger adults, but the possibility of increased sensitivity in some geriatric individuals cannot be ruled out.

Substantially eliminated by kidneys; risk of toxicity may be greater in those with impaired renal function. Select dosage with caution; renal function monitoring may be useful because of age-related decreases in renal function.

Hepatic Impairment

Cefuroxime pharmacokinetics not expected to be altered in patients with hepatic impairment.

Renal Impairment

Possible decreased clearance and increased serum half-life.

Dosage adjustments of parenteral cefuroxime necessary in patients with Cl_cr ≤20 mL/minute. Dosage interval adjustments of oral cefuroxime necessary in patients with Cl_cr ≤30 mL/minute.

In patients undergoing hemodialysis, give a supplemental dose of oral or parenteral cefuroxime after each dialysis period.

Common Adverse Effects

Cefuroxime axetil (≥3% of patients: diarrhea, nausea/vomiting, and, in patients receiving the drug for early Lyme disease, Jarisch-Herxheimer reaction, vaginitis.

Cefuroxime sodium (approximately 2% of patients): Local reactions at IV injection sites.

Drug Interactions

Specific Drugs and Laboratory Tests

Cefuroxime Pharmacokinetics

Absorption

Bioavailability

Following oral administration of cefuroxime axetil, the drug is absorbed from the GI tract and rapidly hydrolyzed to cefuroxime. Cefuroxime axetil has little, if any, microbiologic activity until hydrolyzed in vivo to cefuroxime.

In adults receiving film-coated tablets, peak serum concentrations attained approximately 2–3 hours after the dose.

Cefuroxime sodium not appreciably absorbed from the GI tract; must be given parenterally. Following IM administration in healthy adults, peak serum concentrations attained within 15–60 minutes.

In women, serum cefuroxime concentrations are lower when IM injections are given into the gluteus maximus rather than into the thigh.

Food

In adults, bioavailability following oral administration of film-coated tablets averages about 37% when given in the fasting state and 52% when given with or shortly after food.

Absorption increased when cefuroxime axetil given with milk or infant formula. The extent (but not rate) of absorption is substantially greater when administered concomitantly with milk compared with applesauce or fasting.

Distribution

Extent

Following IM or IV administration, widely distributed into body tissues and fluids including pleural fluid, joint fluid, bile, sputum, bone, and aqueous humor.

Therapeutic concentrations may be attained in CSF following IV administration in patients with inflamed meninges.

Readily crosses the placenta and is distributed into milk.

Plasma Protein Binding

33–50%.

Elimination

Metabolism

Following oral administration, cefuroxime axetil rapidly hydrolyzed to cefuroxime by nonspecific esterases in the intestinal mucosa and blood.

Cefuroxime not metabolized.

Elimination Route

Eliminated unchanged principally in urine.

Half-life

Adults: 1.2–1.6 hours following oral administration and 1–2 hours following IV or IM administration.

Neonates and children: Half-life inversely proportional to age.

Special Populations

Patients with renal impairment: Serum half-life prolonged and generally ranges from 1.9–16.1 hours depending on the degree of impairment. Serum half-life of 15–22 hours has been reported in anuric patients.

Stability

Storage

Oral

Tablets

20–25°C; store in tight container.

Parenteral

Powder for Injection or Infusion

20–25°C; protect from light.

Powder for injection and solutions may darken; does not indicate loss of potency.

Reconstituted 750-mg or 1.5-g vials or 7.5-g pharmacy bulk vial are stable for 24 hours at room temperature or 48 hours (750-mg and 1.5-g vials) or 7 days (7.5-g pharmacy bulk vial) at 5°C. More dilute solutions (e.g., 750 mg or 1.5 g in 100 mL of sterile water for injection, 5% dextrose injection, or 0.9% sodium chloride injection) also stable for 24 hours at room temperature or 7 days when refrigerated.

IM suspensions containing 225 mg/mL prepared using sterile water for injection are stable for 24 hours at room temperature or 48 hours at 5°C.

Injection (Frozen) for Infusion

−20°C or lower. After thawing, stable for up to 24 hours at room temperature (25°C) or up to 28 days under refrigeration (5°C).

Do not refreeze after thawing.

Actions and Spectrum

• Based on spectrum of activity, classified as a second generation cephalosporin. Generally no more active in vitro against susceptible gram-positive cocci than first generation cephalosporins, but has an expanded spectrum of activity against gram-negative bacteria compared with first generation drugs.
• Usually bactericidal.
• Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.
• Spectrum of activity includes many gram-positive aerobic bacteria, some gram-negative aerobic bacteria, and some anaerobic bacteria. Susceptibility to cefuroxime will vary with geography and time; consult local susceptibility data if available.
• Cefuroxime has activity in the presence of some β-lactamases, both penicillinases and cephalosporinases, of gram-negative and gram-positive bacteria.
• Resistance to cefuroxime is primarily through hydrolysis by β-lactamase, alteration of penicillin-binding proteins (PBPs), decreased permeability, and the presence of bacterial efflux pumps.

Advice to Patients

• Advise patients that antibacterials (including cefuroxime) should only be used to treat bacterial infections; they do not treat viral infections (e.g., the common cold).
• Stress importance of completing full course of therapy, even if feeling better after a few days.
• Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefuroxime or other antibacterials in the future.
• Instruct patients to swallow cefuroxime axetil tablets whole and not to crush the tablets.
• Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued. Stress importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.
• Advise patients to inform a clinician if an allergic reaction occurs.
• Advise patients to inform clinicians if they are or plan to become pregnant or plan to breast-feed.
• Stress importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.
• Inform patients of other important precautionary information.

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cefixime is an antibiotic that may be used to treat many different types of infections caused by bacteria.

Cefixime stops bacteria from forming a cell wall, which bacteria need to survive. This decreases the number of bacteria in your body, which helps your body fight the infection.

Cefixime was FDA approved in 1989.

Warnings

You should not take cefixime if you are allergic to cefixime, or to similar antibiotics, such as Ceftin, Cefzil, Keflex, Omnicef, and others. Tell your doctor if you are allergic to penicillins.

Before taking this medicine

You should not take this medicine if you are allergic to cefixime or to other cephalosporin antibiotics, such as:

• cefaclor (Raniclor);
• cefadroxil (Duricef);
• cefazolin (Ancef);
• cefdinir (Omnicef);
• cefditoren (Spectracef);
• cefpodoxime (Vantin);
• cefprozil (Cefzil);
• ceftibuten (Cedax);
• cefuroxime (Ceftin);
• cephalexin (Keflex);
• cephradine (Velosef); and others.

To make sure cefixime is safe for you, tell your doctor if you are allergic to any drugs, especially penicillins.

The chewable tablet form of cefixime may contain phenylalanine. Talk to your doctor before using this form if you have phenylketonuria (PKU).

It is not known whether cefixime will harm an unborn baby. Tell your doctor if you are pregnant.

It is not known whether cefixime passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding. You may need to stop nursing while you are taking cefixime.

The cefixime suspension (liquid) contains sucrose. Talk to your doctor before using this form of cefixime if you have diabetes.

How should I take cefixime?

Follow all directions on your cefixime label. Do not take cefixime in larger or smaller amounts or for longer than recommended.

You may take cefixime with or without food.

The cefixime chewable tablet must be chewed before you swallow it.

Shake the oral cefixime suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Cefixime can cause unusual results with certain lab tests for glucose (sugar) in the urine. Tell any doctor who treats you that you are taking this medication.

Use cefixime for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Cefixime will not treat a viral infection such as the common cold or flu.

Store cefixime at room temperature away from moisture, heat, and light.

You may also store cefixime oral liquid in the refrigerator. Throw away any unused liquid after 14 days.

What happens if I miss a dose?

Take the missed dose of cefixime as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while taking cefixime?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Cefixime side effects

Get emergency medical help if you have signs of an allergic reaction to cefixime: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Cefixime may cause serious side effects. Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody;
• jaundice (yellowing of the skin or eyes);
• pale or yellowed skin, dark colored urine, confusion or weakness;
• a seizure (convulsions);
• low blood cell counts–sudden weakness or ill feeling, fever, chills, flu-like symptoms, swollen gums, mouth sores, skin sores, rapid heart rate, pale skin, easy bruising, unusual bleeding, feeling light-headed;
• kidney problems–little or no urination, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath; or
• severe skin reaction–fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects of cefixime may include:

• indigestion, stomach pain;
• nausea, vomiting; or
• vaginal itching or discharge.

Cefdinir is a cephalosporin (SEF a low spor in) antibiotic that is used to treat many different types of infections caused by bacteria.

Cefdinir may also be used for purposes not listed in this medication guide.

Cefdinir side effects

Get emergency medical help if you have signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Cefdinir may cause serious side effects. Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody (even if it occurs months after your last dose);
• fever, chills, body aches, flu symptoms;
• pale skin, easy bruising, unusual bleeding;
• seizure (convulsions);
• fever, weakness, confusion;
• dark colored urine, jaundice (yellowing of the skin or eyes); or
• kidney problems–little or no urination, swelling in your feet or ankles, feeling tired or short of breath.

Common side effects of cefdinir may include:

• nausea, vomiting, stomach pain, diarrhea;
• vaginal itching or discharge;
• headache; or
• rash (including diaper rash in an infant taking liquid cefdinir.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

Do not take cefdinir if you are allergic to cefdinir, or to similar antibiotics, such as Ceftin, Cefzil, Keflex, and others.

Before taking this medicine

You should not take this medicine if you are allergic to cefdinir or any other cephalosporin antibiotic (cefadroxil, cefprozil, cefazolin, cefalexin, Keflex, and others).

Tell your doctor if you have ever had:

• kidney disease (or if you are on dialysis);
• intestinal problems, such as colitis; or
• an allergy to any drugs (especially penicillins).

Cefdinir liquid contains sucrose. Talk to your doctor before using this form of cefdinir if you have diabetes.

Tell your doctor if you are pregnant or breastfeeding.

How should I take cefdinir?

Follow all directions on your prescription label and read all medicine guides or instruction sheets. Use the medicine exactly as directed.

Shake the oral suspension (liquid) before you measure a dose. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

You may take cefdinir with or without food.

Use cefdinir for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Cefdinir will not treat a viral infection such as the flu or a common cold.

Cefdinir can affect the results of certain medical tests. Tell any doctor who treats you that you are using cefdinir.

Store at room temperature away from moisture and heat. Throw away any unused cefdinir liquid that is older than 10 days.

Cefdinir dosing information

Usual Adult Dose for Pneumonia:

Community acquired: 300 mg orally every 12 hours for 10 to 14 days

Usual Adult Dose for Bronchitis:

Acute exacerbations of chronic bronchitis: 300 mg orally every 12 hours for 5 to 10 days or 600 mg orally every 24 hours for 10 days

Usual Adult Dose for Sinusitis:

Acute maxillary sinusitis: 300 mg orally every 12 hours or 600 mg orally every 24 hours for 10 days

Usual Adult Dose for Skin or Soft Tissue Infection:

Uncomplicated: 300 mg orally every 12 hours for 10 days

Usual Adult Dose for Tonsillitis/Pharyngitis:

300 mg orally every 12 hours for 5 to 10 days or 600 mg orally every 24 hours for 10 days

Usual Pediatric Dose for Pneumonia:

Community acquired:
13 years or older: 300 mg orally every 12 hours for 10 to 14 days

Usual Pediatric Dose for Bronchitis:

Acute exacerbations of chronic bronchitis:
13 years or older: 300 mg orally every 12 hours for 5 to 10 days or 600 mg orally every 24 hours for 10 days

Usual Pediatric Dose for Otitis Media:

Acute bacterial otitis media:
6 months through 12 years: 7 mg/kg orally every 12 hours for 5 to 10 days or 14 mg/kg orally every 24 hours for 10 days
Maximum dose: 600 mg/day

Usual Pediatric Dose for Tonsillitis/Pharyngitis:

6 months through 12 years: 7 mg/kg orally every 12 hours for 5 to 10 days or 14 mg/kg orally every 24 hours for 10 days
Maximum dose: 600 mg/day

13 years or older: 300 mg orally every 12 hours for 5 to 10 days or 600 mg orally every 24 hours for 10 days

Usual Pediatric Dose for Sinusitis:

Acute maxillary sinusitis:
6 months through 12 years: 7 mg/kg orally every 12 hours or 14 mg/kg orally every 24 hours for 10 days
Maximum dose: 600 mg/day

13 years or older: 300 mg orally every 12 hours or 600 mg orally every 24 hours for 10 days

Usual Pediatric Dose for Skin and Structure Infection:

Uncomplicated:
6 months through 12 years: 7 mg/kg orally every 12 hours for 10 days
Maximum dose: 600 mg/day

13 years or older: 300 mg orally every 12 hours for 10 days

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include nausea, vomiting, stomach pain, diarrhea, or a seizure.

What should I avoid while taking cefdinir?

Avoid using antacids or mineral supplements that contain aluminum, magnesium, or iron within 2 hours before or after taking cefdinir. Antacids or iron can make it harder for your body to absorb cefdinir. This does not include baby formula fortified with iron.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, call your doctor before using anti-diarrhea medicine.