RiteMED Cefuroxime Special Precautions

Tablet: A thorough inquiry about the patient's previous hypersensitivity history should be made. Cefuroxime, like other cephalosporins, penicillins and other drugs, may cause serious hypersensitivity reactions and should be used with caution in any patient who has demonstrated some allergy to any drug. Although it has not been established, allergic reactions to antibiotics may occur more frequently in atopic individuals.
Serious acute hypersensitivity reactions may require treatment with epinephrine and other emergency measures including oxygen, intravenous (IV) fluids and IV antihistamines, corticosteroids, pressor amines, and airway management, as clinically indicated.
Clostridium difficile-associated diarrhea (CDAD) has been reported with the use of nearly all antibacterial agents, including cefuroxime, and may range in severity from mild diarrhea to fatal colitis. It is important to consider this diagnosis in patients who present with diarrhea following administration of antibacterial agents.
As with other broad-spectrum antibacterial agents, cefuroxime should be used with caution in patients with a history of gastrointestinal disease, particularly colitis.
Cephalosporins, including cefuroxime, have been associated with the development of seizures, particularly in patients with renal impairment, in whom dosage of the drug was not reduced. If seizures due to cefuroxime develop, the drug should be discontinued and treatment with an anticonvulsant be given as clinically indicated.
Cephalosporins may be associated with a fall in prothrombin activity. Patients who are at risk are those with kidney or liver impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy. Prothrombin time should be monitored in patients at risk and exogenous Vitamin K administered as indicated.
The patient's renal function should be carefully monitored when cefuroxime is given concurrently with aminoglycosides and/or diuretics because adverse renal effects may occur (see Interactions).
The Jarisch-Herxheimer reaction, transient immunological reaction lasting 1 to 2 days, has been observed following cefuroxime treatment of Lyme disease.
Cefuroxime is considered to be unsafe in patients with porphyria although there is conflicting experimental evidence of porphyrinogenicity.
Since cefuroxime may cause dizziness, patients should be advised to avoid performing tasks which require complete mental alertness such as driving and operating machinery.
Prescribing cefuroxime in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication in unlikely to provide benefit to the patient and increases the risk of antibiotic resistance.
As with other antibacterial agents, long term or repeated use may result in overgrowth of non-susceptible organisms, including fungi.
Patients with Renal Impairment: The safety and efficacy of oral cefuroxime axetil in patients with renal impairment have not been established. Since cefuroxime is renally eliminated, its half-life will be prolonged in patients with reduced renal function.
Injection: Careful use in patients who have experienced an allergic reaction to penicillins or other beta-lactams. Renal function should be monitored in patients receiving high dose cephalosporins, the elderly, and those with pre-existing renal impairment.
Use in Children: Cefuroxime's serum t_1/2 is inversely proportional to age when given in children and neonates.
Use in Elderly: There are no apparent differences in efficacy and safety of cefuroxime between the elderly and younger adults. However, since elderly patients have increased risk of renal impairment, dose adjustment and renal function monitoring may be necessary.