ted bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria (antimicrobial resistance). Patients should be told to complete the full course of treatment, even if they feel better earlier.
Cephalosporin hypersensitivity, penicillin hypersensitivity
Cefuroxime is contraindicated in patients with cephalosporin hypersensitivity or cephamycin hypersensitivity. Cefuroxime should be used cautiously in patients with hypersensitivity to penicillin. The structural similarity between cefuroxime and penicillin means that cross-reactivity can occur. Penicillins can cause a variety of hypersensitivity reactions ranging from mild rash to fatal anaphylaxis. Patients who have experienced severe penicillin hypersensitivity should not receive cefuroxime. Cross-reactivity to cephalosporins is approximately 3—7% with a documented history to penicillin.
Geriatric, renal failure, renal impairment
Caution is advised when administering cefuroxime to patients with renal impairment or renal failure. The drug is eliminated via renal mechanisms, therefore, patient with impaired renal function will clear it more slowly. To compensate for the prolonged elimination half-life, dosing frequency of the oral formulations should be reduced in patients with CrCl < 30 mL/min and the dosage/dosing frequency of the IV/IM formulations should be reduced in patients with CrCl <= 20 mL/min. No overall differences in safety or effectiveness were observed between the geriatric and younger adult subjects during clinical trials or in subsequent clinical experience. However, the risk of reactions may be higher in those patients with renal dysfunction. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function.
Colitis, diarrhea, GI disease, inflammatory bowel disease, pseudomembranous colitis, ulcerative colitis
Antibacterial agents have been associated with pseudomembranous colitis (antibiotic-associated colitis) which may range in severity from mild to life-threatening. In the colon, overgrowth of Clostridia may exist when normal flora is altered subsequent to antibacterial administration. The toxin produced by Clostridium difficile is a primary cause of pseudomembranous colitis. It is known that systemic use of antibiotics predisposes patients to development of pseudomembranous colitis. Consideration should be given to the diagnosis of pseudomembranous colitis in patients presenting with diarrhea following antibacterial administration. Systemic antibiotics should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis or other GI disease. If diarrhea develops during therapy, the drug should be discontinued. Following diagnosis of pseudomembranous colitis, therapeutic measures should be instituted. In milder cases, the colitis may respond to discontinuation of the offending agent. In moderate to severe cases, fluids and electrolytes, protein supplementation, and treatment with an antibacterial effective against Clostridium difficile may be warranted. Products inhibiting peristalsis are contraindicated in this clinical situation. Practitioners should be aware that antibiotic-associated colitis has been observed to occur over two months or more following discontinuation of sy |
