Cefuroxime

INTRODUCTION

Indications

Treatment of Respiratory tract infections, Skin and skin structure infections, Bone and joint infections (IV), Urinary tract infections, Gynecologic infections, Septicemia (IV), Otitis media (PO), Meningitis (IV), Lyme disease (PO). Perioperative prophylaxis (IV).

Action

Binds to bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria. Spectrum: Similar to that of first-generation cephalosporins but has increased activity against several other gram-negative pathogens, including Haemophilus influenzae (including β-lactamase–producing strains), Haemophilus parainfluenzae, Escherichia coli, Klebsiella pneumoniae, Neisseria, Proteus, Moraxella catarrhalis, Borrelia burgdorferi. Not active against methicillin-resistant staphylococci or enterococci.

Adverse Reactions/Side Effects

CNS: SEIZURES (HIGH DOSES). GI: PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting, cramps. Derm: rashes, urticaria, diaper dermatitis. Hemat: bleeding, eosinophilia, hemolytic anemia, leukopenia. Local: pain at IM site, phlebitis at IV site. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS, superinfection.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Watch for seizures; notify physician immediately if patient develops or increases seizure activity.

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor signs of blood dyscrasias, including eosinophilia (fatigue, weakness, myalgia), hemolytic anemia (malaise, dizziness, jaundice, abdominal pain), leukopenia (fever, sore throat, mucosal lesions, signs of infection), and thrombocytopenia (bruising, nose bleeds, bleeding gums, other bleeding problems). Report these signs to the physician.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Employ universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-related Instruction

• Instruct patient to notify physician immediately of signs of superinfection, including black, furry overgrowth on tongue, vaginal itching or discharge, and loose or foul-smelling stools.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged skin problems (rash, hives, dermatitis) or GI problems (nausea, vomiting, diarrhea, cramps).

Pharmacokinetics

Absorption: Well absorbed after oral and IM administration; IV administration results in complete bioavailability.

Distribution: Widely distributed. Penetrates into CSF with IV administration. Crosses the placenta and enters breast milk in low concentrations.

Protein Binding: 50%.