Pharm 101: Cefuroxime

Class

Second generation cephalosporin
Other second generation cephalosporins: cefotetan, cefoxitin, cefaclor
Second generation cephalosporins are a heterogenous group with individual differences in activity, pharmacokinetics, and toxicity


Pharmacodynamics
  • Beta lactam antibiotic
  • Inhibits transpeptidation reaction of bacterial cell wall synthesis
  • Halts peptidoglycan synthesis, leading to inhibition of bacterial growth, and ultimately cell death (bacteriocidal)
  • Beta-lactam antibiotics kill bacterial cells only when they are actively growing and synthesising cell wall

Pharmacokinetics
  • Crosses blood-brain barrier
  • Renal clearance

Antimicrobial activity of second generation cephalosporins
  • Similiar to first generation cephalosporins, with additional expanded gram negative coverage:
    • Klebsiella sp.
    • H influenzae
    • Moraxella catarrhalis
  • No activity against enterococci or P aeruginosa
  • Cefoxitin and cefotetan have activity against anaerobes (e.g. B fragilis), therefore useful to treat mixed anaerobic infections such as peritonitis, diverticulitis, PID

Adverse effects of cephalosporins
  • Allergy:
    • Cross-allergenicity between penicillins and cephalosporins is ~1%
  • Toxicity:
    • Thrombophlebitis after IVI
    • Renal toxicity: interstitial nephritis, tubular necrosis (rare)
  • Methylthiotetrazole-containing agents (cefotetan, cefoperazone) may cause bleeding disorders and disulfiram-like reactions

Precautions/contraindications
  • Penicillin anaphylaxis
  • Dose adjustment in renal failure

Further reading

References

Pharm 101 700

Pharmacology 101

Top 200 drugs

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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