Cefuroxime
Cefuroxime is a semi-synthetic **2nd generation cephalosporin** antibiotic available in both oral (axetil) and parenteral (sodium) formulations. * **Spectrum of Activity**: It offers enhanced activity against certain **gram-negative pathogens** (e.g., *E. coli*, *Klebsiella pneumoniae*, *Salmonella*, *Enterobacter*) compared to 1st generation cephalosporins like cephalexin, while retaining good efficacy against many gram-positive organisms. * **Clinical Utility**: It is particularly useful in small animal medicine when treating infections resistant to 1st generation cephalosporins, when broader gram-negative coverage is needed for **surgical prophylaxis**, or when **high central nervous system (CNS) concentrations** are required (as it can cross inflamed meninges). * **Limitations**: It is not effective against methicillin-resistant *Staphylococcus* (MRSA/MRSP), *Pseudomonas*, *Serratia*, or *Enterococcus*.
กลไกการออกฤทธิ์: Cefuroxime is a **bactericidal** time-dependent antibiotic. It binds to specific **penicillin-binding proteins (PBPs)** located inside the bacterial cell wall → inhibits the third and final stage of bacterial cell wall synthesis (peptidoglycan cross-linking) → weakens the cell wall → leads to **cell lysis and death** due to osmotic pressure. *Clinical Pearl*: Like other beta-lactams, its efficacy depends on the amount of time the drug concentration remains above the Minimum Inhibitory Concentration (MIC) at the site of infection.
ขนาดยาตามชนิดสัตว์
- Soft tissue infections · 10 mg/kg PO q12h · PO · q12h · 10 days · Extrapolated from human dosages.
- Systemic infections · 15 mg/kg IV q8h · IV · q8h · Extrapolated from human dosages.
- Meningitis · 30 mg/kg IV q8h · IV · q8h · Extrapolated from human dosages.
- Surgery prophylaxis · 20 mg/kg IV 30 minutes prior to surgery and every 2 hours during surgery. · IV · 30 mins prior and q2h during · Perioperative
- Surgical prophylaxis · 20 mg/kg · IV · 30 min prior to surgery and then repeat q1.5-3h during surgery · Perioperative · Administer slowly over 5 min
- Susceptible infections · 10-30 mg/kg · IV · q8-12h · As directed
- Surgical prophylaxis · 20 mg/kg · IV · 30 min prior to surgery and then repeat q1.5-3h during surgery · Perioperative · Administer slowly over 5 min
- Susceptible infections · 10-30 mg/kg · IV · q8-12h · As directed
ขนาดยาเป็นข้อมูลอ้างอิงทางคลินิกสำหรับสัตวแพทย์ผู้มีใบอนุญาต โปรดตรวจสอบกับฉลากล่าสุดและผู้ป่วยแต่ละรายเสมอ
วิธีการให้ยา
ข้อห้ามใช้
- Known hypersensitivity to cefuroxime or other cephalosporins
อาการไม่พึงประสงค์
- Inappetence
- Vomiting
- Diarrhea
- Injection site inflammation (IV use)
- Eosinophilia
- Hypersensitivity reactions (including anaphylaxis)
- Neurologic effects (hearing loss, seizures - rare)
- Pseudomembranous colitis (rare)
- Serious dermatologic reactions (TEN, Stevens-Johnson syndrome - rare)
- Hematologic effects (pancytopenia, thrombocytopenia - rare)
- Interstitial nephritis (rare)
อันตรกิริยาระหว่างยา
- Aminoglycosides · Potential for increased risk of nephrotoxicity; monitor renal function. However, may have synergistic or additive actions against some gram-negative bacteria (Enterobacteriaceae). · minor
- Furosemide · Possible increased risk of nephrotoxicity. · moderate
- Torsemide · Possible increased risk of nephrotoxicity.
- Probenecid · Reduced renal excretion of cephalosporins, potentially increasing serum levels.
- Oxytetracycline · Bacteriostatic agents may antagonize the bactericidal activity of cefuroxime. · moderate
- Erythromycin · Bacteriostatic agents may antagonize the bactericidal activity of cefuroxime. · moderate
- Amphotericin B · Increased risk of nephrotoxicity; monitor renal function. · major
การติดตาม
- Clinical efficacy (resolution of infection signs)
- Renal function in patients with pre-existing renal insufficiency
- Gastrointestinal tolerance
การได้รับยาเกินขนาด
Cefuroxime has a wide margin of safety. Beagles receiving daily dosages up to 1600 mg/kg/day orally tolerated the drug well, with only minor vomiting, slight weight gain suppression, and minor hematologic changes at the highest doses. In humans, massive overdoses have caused **cerebral irritation and seizures**. If severe toxicity occurs, plasma levels can be reduced via hemodialysis or peritoneal dialysis. Treatment is largely supportive.
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