頭孢呋辛
頭孢呋辛是一種半合成的**第二代頭孢菌素類**抗生素，具有口服（酯化物）和注射（鈉鹽）兩種劑型。 * **抗菌譜**：與第一代頭孢菌素（如頭孢氨苄）相比，它對某些**革蘭氏陰性病原體**（如大腸桿菌、克雷伯氏肺炎桿菌、沙門氏菌、腸桿菌）具有更強的抗菌活性，同時保留了對許多革蘭氏陽性菌的良好療效。 * **臨床應用**：在小動物醫學中，當感染對第一代頭孢菌素產生抗藥性、需要更廣泛的革蘭氏陰性菌覆蓋以進行**外科預防**，或需要**高血腦屏障穿透率**（腦膜發炎時可進入中樞神經系統）時，本藥特別有用。 * **限制**：對抗甲氧西林金黃色葡萄球菌 (MRSA/MRSP)、綠膿桿菌、沙雷氏菌或腸球菌無效。
作用機制: 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.
各物種劑量
- 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
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
給藥途徑
禁忌症
- Known hypersensitivity to cefuroxime or other cephalosporins
不良反應
- 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)
藥物相互作用
- 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
監測
- Clinical efficacy (resolution of infection signs)
- Renal function in patients with pre-existing renal insufficiency
- Gastrointestinal tolerance
過量
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.
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用,不能取代專業判斷或廠方最新藥品說明書。