Usage
Cefuroxime + Clavulanic Acid is prescribed for a variety of bacterial infections, including:
- Pharyngitis/Tonsillitis
- Otitis Media
- Sinusitis
- Gonorrhea
- Lyme Disease
- Lower Respiratory Tract Infections (e.g., bronchitis, pneumonia)
- Skin and Soft Tissue Infections (e.g., impetigo)
- Urinary Tract Infections (e.g., cystitis, pyelonephritis)
- Bone and Joint Infections
- Septicemia
- Meningitis
Pharmacological Classification: Antibiotic (Combination of a second-generation cephalosporin and a beta-lactamase inhibitor).
Mechanism of Action: Cefuroxime inhibits bacterial cell wall synthesis, leading to bacterial cell death. Clavulanic acid inhibits beta-lactamase enzymes produced by bacteria, which would otherwise break down cefuroxime, thus enhancing cefuroxime’s effectiveness against resistant strains.
Alternate Names
Cefuroxime Axetil + Clavulanic Acid (axetil is an ester of cefuroxime that improves oral absorption), Cefuroxime and Clavulanate Potassium, Cefuroxime/Clavulanic Acid, Cefuroxime-Clavulanate
Brand Names: Cefotil Plus, Cefaprime CV, Bigcef (and others; brand names vary by region).
How It Works
Pharmacodynamics: Cefuroxime exerts bactericidal activity by binding to penicillin-binding proteins (PBPs), crucial enzymes for bacterial cell wall synthesis. Clavulanic acid, while having weak antibacterial activity itself, binds irreversibly to beta-lactamases, protecting cefuroxime from degradation and extending its spectrum of activity.
Pharmacokinetics: Cefuroxime axetil is orally administered and readily absorbed from the gastrointestinal tract. It is hydrolyzed to cefuroxime in the intestinal mucosa and blood. Food enhances the bioavailability of cefuroxime axetil. Clavulanic acid is also well-absorbed orally. Both components reach therapeutic concentrations in various tissues and fluids, including cerebrospinal fluid (important for treating meningitis). They are primarily excreted by the kidneys, with minor excretion in bile. Cefuroxime’s half-life is approximately 1.2 hours.
Elimination pathways: Primarily renal excretion, with some biliary excretion.
Dosage
Standard Dosage
Adults:
- Most infections: 250-500 mg twice daily for 7-10 days.
- Gonorrhea: 1 g as a single dose.
- Lyme Disease: 500 mg twice daily for 14-21 days.
Children (3 months and older):
- Most infections: 10-15 mg/kg twice daily (maximum 1 g/day) for 7-10 days.
- Otitis Media: 15 mg/kg twice daily (maximum 500 mg/day) for 10 days.
Special Cases:
- Elderly Patients: No specific dosage adjustment is generally recommended, but monitor renal function.
- Patients with Renal Impairment: Dose adjustment is necessary based on creatinine clearance.
- Patients with Hepatic Dysfunction: No specific adjustment is typically needed.
- Patients with Comorbid Conditions: Evaluate based on the specific comorbidity.
Clinical Use Cases
Dosages for these situations follow standard adult recommendations unless renal adjustments are required. Serum levels may be monitored in critically ill patients to ensure therapeutic levels.
Dosage Adjustments
Dose adjustments are based on creatinine clearance.
Side Effects
Common Side Effects:
- Diarrhea
- Nausea
- Vomiting
- Abdominal pain
Rare but Serious Side Effects:
- Pseudomembranous colitis
- Severe allergic reactions (anaphylaxis)
- Serum sickness-like reaction
- Seizures (in patients with renal impairment)
Adverse Drug Reactions (ADR):
- Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis)
- Drug-induced liver injury
- Hematological abnormalities (e.g., neutropenia, thrombocytopenia)
Contraindications
- Hypersensitivity to cephalosporins or penicillins.
- History of severe allergic reaction (anaphylaxis) to beta-lactam antibiotics.
Drug Interactions
- Probenecid: Increases serum levels of cefuroxime by interfering with renal excretion.
- Oral Contraceptives: Cefuroxime may reduce the efficacy of oral contraceptives.
- Antacids: May reduce the absorption of cefuroxime.
- Anticoagulants (e.g., warfarin): Cefuroxime may enhance the anticoagulant effect.
Pregnancy and Breastfeeding
- Pregnancy: Cefuroxime is generally considered safe to use during pregnancy, particularly after the first trimester. No strong evidence suggests harm to the fetus.
- Breastfeeding: Cefuroxime is excreted in breast milk in low concentrations. While usually considered compatible with breastfeeding, monitor for diarrhea or rash in the infant.
Drug Profile Summary
- Mechanism of Action: Cefuroxime: Inhibits bacterial cell wall synthesis. Clavulanic acid: Inhibits beta-lactamases.
- Side Effects: Diarrhea, nausea, vomiting, abdominal pain. Rarely: severe allergic reactions, pseudomembranous colitis, seizures.
- Contraindications: Hypersensitivity to cephalosporins or penicillins.
- Drug Interactions: Probenecid, oral contraceptives, antacids, anticoagulants.
- Pregnancy & Breastfeeding: Generally safe in both. Monitor infant for diarrhea/rash if breastfeeding.
- Dosage: Adults: 250-500 mg BID. Children: 10-15mg/kg BID. Adjust for renal impairment.
- Monitoring Parameters: Renal function (especially in patients with pre-existing renal impairment), signs of superinfection (e.g., oral/vaginal candidiasis).
Popular Combinations Not applicable.
Precautions
- Monitor for signs of allergic reactions.
- Assess renal function, particularly in elderly patients and those with pre-existing renal impairment.
- Caution in patients with a history of colitis.
- Advise patients to complete the full course of therapy, even if symptoms improve.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefuroxime + Clavulanic Acid?
A: Adults: 250-500 mg twice daily. Children: 10-15 mg/kg twice daily. Dose adjustments are needed for patients with renal impairment.
Q2: Can Cefuroxime + Clavulanic Acid be used during pregnancy?
A: Yes, it’s generally considered safe, particularly after the first trimester. However, always weigh the benefits against potential risks with the patient.
Q3: What are the most common side effects?
A: Diarrhea, nausea, vomiting, and abdominal pain are the most common side effects.
Q4: What are the signs of a serious allergic reaction?
A: Hives, difficulty breathing, swelling of the face, lips, or tongue, rapid heartbeat, dizziness, and loss of consciousness. Seek immediate medical attention.
Q5: Does this medication interact with birth control pills?
A: It might reduce the efficacy of oral contraceptives. Advise patients to use additional barrier methods.
Q6: Should this drug be taken with food?
A: Cefuroxime axetil is better absorbed when taken with food. It’s recommended to administer it with food to improve bioavailability and reduce gastrointestinal side effects.
Q7: Can this drug be used to treat viral infections like the flu?
A: No, Cefuroxime + Clavulanic Acid is only effective against bacterial infections. It won’t work for viral infections such as the flu or common cold.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. However, if it’s almost time for the next dose, skip the missed dose and continue with your regular dosing schedule. Don’t double the dose to catch up.
Q9: Can I drink alcohol while taking this medication?
A: Although no direct interaction is noted, it’s generally advised to limit alcohol consumption while taking antibiotics, as it can sometimes worsen side effects like nausea or diarrhea.
