Pharmacokinetics of intravenous and intraperitoneal cefuroxime in patients undergoing peritoneal dialysis

The pharmacokinetics of cefuroxime sodium, a parenteral beta-lactam antibiotic, were investigated in 9 patients during peritoneal dialysis. In 6 patients cefuroxime 500 mg was administered intravenously. Mean plasma levels of cefuroxime thereafter fell from 28.0 +/- 5.0 mg/l at 1 hr to 6.0 +/- 1.6 mg/l at 24 hr. Mean peak levels 4.6 +/- 1.9 mg/l in peritoneal effluent were found 7 hr after dosing and clearance of the drug by peritoneal dialysis averaged 4.7 ml/min. There was no evidence of net tubular secretion or of increased non-renal elimination. In 5 patients, the administration of cefuroxime, 100 mg/2 l dialyzate, in each cycle of dialysis maintained mean cefuroxime levels of 25.4 +/- 13 mg/l in the dialysis effluent. An average of 44% of the dose was not recovered in the effluent, and was presumably absorbed by the patient, and mean plasma levels of cefuroxime increased from 1.1 +/- 0.4 mg/l at 1 hr to 14.0 +/- 8.1 mg/l at 24 hr. If cefuroxime is used to treat peritoneal infections associated with peritoneal dialysis it should be given by both intraperitoneal and intravenous routes and followed up with parenteral therapy alone.

The evaluation of cefuroxime in the prevention of postoperative infection

Patients undergoing biliary surgery received either 750 mg cefuroxime i.m. with the premedication and then 8 hourly for 3 days ((group A) or 1.5 g cefuroxime i.v. at the time of induction of anaesthesia (group B) or not treatment (group C). Wound infections occurred in 3 out of 35 patients in group A, 1 out of 40 patients in group B and 11 out of 39 patients in group C (group B significantly different than group C, P less than 0.05). Eight patients (23%) in group C had chest complications. Cefuroxime was effective in the reduction of wound sepsis following biliary surgery and 1.5 g i.v. administered during induction of anaesthesia is the dosage of choice. The incidence of chest infection tended to be lower in patients receiving cefuroxime but many more patients would have to be studied for a conclusive result.

Penetration of a prophylactic antibiotic into peritoneal fluid

The ability of an antibiotic, given for prophylaxis, to enter the peritoneal fluid was measured in 40 patients having abdominal operations. Cefuroxime, the antibiotic studied, attained a satisfactory level (4 mg/1) in the peritoneal fluid of 34 of the 40 patients (85 per cent). There was no difference between emergency and elective operations, suggesting that peritoneal inflammation does not enhance the penetration of cefuroxime into peritoneal fluid.

A controlled trial to compare systemic and intra-incisional cefuroxime prophylaxis in high risk gastric surgery

A prospective randomized controlled trial has compared single dose systemic cefuroxime (n = 27) or intra-incisional cefuroxime (n = 26) with a control group (n = 28) in 81 patients undergoing gastric resection, revision gastric surgery or operation for gastro-oesophageal malignancy. In the controls the incidence of sepsis was: 35 per cent wound infection, 29 per cent abscess, 21 per cent septicaemia. After intra-incisional cefuroxime the incidence was: 4 per cent wound sepsis, 19 per cent abscess and 4 per cent septicaemia. After systemic cefuroxime only 2 patients developed wound sepsis (7 per cent) with no cases of abscess or septicaemia. Excluded from this high risk group were 36 patients who had a vagotomy with or without drainage during the trial where antibiotics were not given, 4 of whom developed wound sepsis only (11 per cent). There was a poor correlation between the individual species isolated from the gastric aspirate and the organisms responsible for postoperative infection in the controls, but there was a good correlation between fasting gastric pH and the risk of sepsis in the controls.

[Fundamental and clinical studies of cefuroxime in pediatric purulent meningitis (author's transl)]

The following results were obtained from the fundamental and clinical studies of cefuroxime, a new synthetic cephalosporin, in pediatric patients with purulent meningitis. This drug was administered to 2 pediatric patients with purulent meningitis at the dose to 50 mg/kg, by intravenous drip infusion over 30 minutes and one shot intravenous injection respectively. When spinal fluid levels were determined, about 15 approximately 30% of the drug concentration in blood was found to transfer to spinal fluid at acute stage. Spinal fluid levels were about 4 approximately 7 micrograms/ml. When 4 pediatric patients with purulent meningitis were treated with the drug, the good results were obtained in all of them. The dose given was 200 approximately 300 mg/kg/day and the dosing duration was 14 approximately 22 days. No adverse reaction was noted, nor abnormal laboratory test values were noted.

Cefuroxime-tobramycin Therapy in Cancer Patients with Bacterial Infections

Twenty-five patients with different metastatic tumors, and often with other diseases which may have further compromised their organic defenses (such as diabetes, anemia and neutropenia), had a simultaneous bacterial complication. This was regarded as documented (i.e., proved by positive culture) in 12 of 25 patients, and probable if subjective and objective symptoms, X-ray, laboratory tests and the clinical picture agreed with bacterial infection in progress, even though the culture was negative, in 13 of 25 patients. Antibiotic therapy with cefuroxime-tobramycin gave good results in 19 of 25 patients, i.e., in 10 of 12 with a documented infection and in 9 of 13 with a probable infection. Fever of unknow origin and urinary infections were the most responsive to the therapy. Three of 25 patients had nephrotoxicity, with a very small rise in BUN and creatinine, which was easily reversible. According to our experience, antibiotic therapy with cefuroxime-tobramycin would be useful in cancer patients with bacterial complications because of its effectiveness and tolerability.

Cefuroxime in soft tissue infections and septicaemia

Data are presented on the absorption, antibacterial activity, clinical efficacy and side effects of cefuroxime in 33 cases with proven bacterial infection in soft tissues and in patients with septicaemia. The drug was administered mainly intramuscularly (i.m.) but also intravenously (i.v.). Peak serum concentrations 1 h after an injection of 750 mg cefuroxime i.m. were between 16-25 mug/ml. After 8 h the levels were mostly < 4 mug/ml in patients with normal renal function. I.v. injection gave only slightly higher maximum serum level obtained was approximately 40 mug/ml. No accumulation of the drug occurred in patients with normal renal function. Cefuroxime was active against all the gram-positive bacteria isolated from our patients as well as most of the gram-negatives. The clinical effect was satisfactory in 96%. The drug was well tolerated. Side effects were slight and relatively few.

The pharmacokinetics of cefuroxime lysine in the elderly

Single doses of 750 mg of cefuroxime lysine were given to eight elderly patients. The mean plasma half life was 124 minutes and the mean time to peak was 82 minutes. When compared with previous studies in young healthy volunteers, while peak plasma concentrations are similar, there is prolongation of half life and delay of excretion of the drug in the elderly. In our group studied, no local discomfort was noted following injection.

[Fractures with loss of substance of the middle and upper third of the face: nosographic classification, surgical indications and the prevention of meningeal infections with the new antibiotic, cefuroxime]

Reference is made to considerable personal experience acquired in the treatment of craniofacial fractures, particularly those affecting the upper third of the face. An account is given of the anatomical and surgical features of the naso-ethmoid-frontal and temporo-orbito-sphenoid areas--now recognised as within the domain of maxillofacial surgery--and their symptomatologies. Particular attention is directed to the question of liquorrhoea and the possibility of ascendent infections of the meninges. Reduction is favoured with respect to the former, since forward and upward repositioning often leads to the regression of ethmoidal liquorrhoea. Exclusion of the frontal sinus is regarded as a "categorical imperative" as far as meningeal infection is concerned, and support is also given for its prevention with antibiotics. A personal preference is expressed for cefuroxim, a new antibiotic with particular potency and marked diffusibility within the cerebrospinal fluid.

Antibacterial activity of cefuroxime in human bone

Bone samples were taken at orthopaedic surgery from 12 patients, who had been treated with 2 doses of 750 mg cefuroxime by intravenous infusion. After grinding, extraction and assay by the agar diffusion method the levels of cefuroxime ranged between 0.4--1.9 micrograms/g bone. Using an electrophoretic method followed by microbiological assay, higher levels of cefuroxime were measured, possibly because of a diminution in the binding capacity of the bone.

Effect of timing of cefuroxime dosage on its protection of rats against gentamicin nephrotoxicity

The neophrotoxic effect on rats of once daily treatment with 40 or 45 mg gentamicin/kg/day for ten days was substantially reduced by administration of 4 g cefuroxime/kg/day, either at the same time or eight hours later. This dosage of cefuroxime was protective when given for only two consecutive days starting on the first to third days of gentamicin treatment, but enhanced gentamicin nephrotoxocity when started on the sixth or subsequent days.

Guidelines for adequate chemotherapeutic dosage in newborns and infants with septicaemia and meningitis

The chemotherapy of septicaemia in newborns differs fundamentally from that in older children or adults because, although newborns have a fully developed immunological system, the system has not yet "learned" to operate completely. Ultimately, optimal chemotherapy can only be found empirically. In this respect a few basic guidelines can be given however: 1. The initial therapy must bring the pathogen under control with a high degree of certainty, since a correction in therapy following pathogen indentification is usually too late. 2. Since the pharmacokinetics of antibiotics in newborns vary considerably, the minimal peak serum concentration observed should exceed the MIC of the pathogen. 3. In rapidly maturing newborns and premature babies the pharmacokinetics of each antibiotic must be known precisely. 4. Since in the individual case there can never be absolute certainty with respect to the three above-mentioned problems, combination therapy should be given at all times.

Clinical study of cefuroxime in the treatment of lower respiratory tract infections

Twenty-three hospital in-patients with severe lower respiratory tract infections were treated with cefuroxime sodium. The drug was given intramuscularly in a dose of either 750 mg or 1000 mg at 8-hourly intervals for 5 days. Of the 21 patients who could be assessed, the response to treatment was highly satisfactory and there were no treatment failures. Eight patients had failed to respond to a course of oral antibiotics before being seen. Most of the patients were elderly and all were very ill. The sputum became mucoid in all but 1 patient. There was no change in tests of liver or renal function. Cefuroxime appears to be an effective and well-tolerated drug for the treatment of patients with severe chest infections.

Experience with cefuroxime in 190 patients with severe respiratory infections

Cefuroxime is a very effective agent for the treatment of severe purulent respiratory infections. 190 patients with purulent exacerbations of bronchitis or bronchiectasis, pneumonia or secondarily infected lung cancer received 2.25--3.0 g cefuroxime daily for an average of 9 days. A good clinical response was seen in 91% of 184 assessable patients. A remarkable improvement in sputum purulence was observed and side-effects to cefuroxime were minimal.

Local and Gastrointestinal reactions to intravenously administered cefoxitin and cefuroxime

Side effects of cefoxitin and cefuroxime were noted in 2 different studies during intravenous treatment for at least 14 days. In the cefoxitin group of 33 patients thrombophlebitis was observed in 3 cases and diarrhoea in 4 cases. In the cefuroxime group of 31 patients 1 case of thrombophlebitis was noted and 5 cases of diarrhoea occurred. Most patients with diarrhoea had decreased renal function or received higher dosage of the antibodies than the other patients.

[Study of cefuroxime in pediatric field (author's transl)]

1. Cefuroxime (CXM) was studied for absorption and excretion in 4 pediatric patients given one shot intravenous injection of 20 approximately 25 mg/kg. The following serum levels were determined: 24.5 approximately 38.0 micrograms/ml at 30 minutes (mean 33.3 +/- 6.1 micrograms/ml), 10.0 approximately 17.0 micrograms/ml at 1 hours (mean 13.9 +/- 3.3 micrograms/ml), 3.4 approximately 7.6 micrograms/ml at 2 hours (mean 5.2 +/- 1.9 micrograms/ml, 0.7 approximately 2.1 micrograms/ml at 4 hours (mean 1.3 +/- 0.6 micrograms/ml, 0.1 approximately 0.3 microgram/ml at 6 hours (mean 0.2 +/- 0.1 microgram microgram/ml). Half-life (T 1/2) was 0.65 approximately 0.88 hour (mean 0.75 +/- 0.10 hour). Urinary levels were 1,280 approximately 7,100 micrograms/ml at 0 approximately 2 hours, 96 approximately 3,400 micrograms/ml at 2 approximately 4 hours, 68 approximately 250 micrograms/ml at 4 approximately 6 hours. Urinary recovery rate at 0 approximately 6 hours was 54.1 approximately 74.4% (mean 61.8 +/- 9.4%). 2. From the study on spinal fluid concentration in pediatric patients with Haemophilus influenzae-induced meningitis, the dose of CXM 52.2 mg/kg was given to 1 pediatric case with this disease by one shot intravenous injection. Spinal fluid levels were presumed as 9.0 micrograms/ml at 30 minutes, 6.8 micrograms/ml at 1 hour, 3.8 micrograms/ml at 2 hours and 1.2 micrograms/ml at 4 hours. 3. CXM was studied in 19 pediatric patients with bacterial infection for clinical efficacy, bacteriological effect and side effect. Clinical result was found good in 1 with purulent meningitis; excellent in 9 out of 15 with acute lobar pneumonia or acute bronchopneumonia, and good in remaining 6 cases; good in 2 with acute bronchitis; excellent in 1 with acute pyelonephritis. This represents efficacy ("excellent" plus "good") rate of 100%. Of 5 strains of H. influenzae presumed as causative organisms, 4 were disappeared and 1 was reduced. Two strains of Streptococcus pneumoniae and 1 strain of Escherichia coli were disappeared. No side effect was noted in terms of clinical symptom. Laboratory examination showed elevation of GOT and GPT in 1 case, but these elevated values returned to normal after the end of the CXM treatment.

[Fundamental and clinical studies of cefuroxime, a new cephalosporin antibiotic, in pediatric field (author's transl)]

A series of studies on cefuroxime (CXM) were carried out and the following results were obtained. 1) Most of MICs to recent clinical isolates of Group A hemolytic Streptococcus were less than 0.0125 micrograms/ml. 2) A single intravenous bolus dose of 36.5 mg/kg of CXM was given to two children, and the peak blood levels of 30 and 40 micrograms/ml were obtained at 30 minutres after injection; mean half-life in blood was 1.02 hours. The doses of 25 approximately 50 mg/kg were given over 1 hour by intravenous instillation to six children. The peak blood level appeared at the end of instillation, and half-life in blood was distributed between 0.56 and 0.81 hour. With both of these administrations, measurable blood levels were maintained up to 6 hours, and urinary excretion rate in active form up to 6 hours was distributed between 40.5 and 96%. 3) Serious upper respiratory tract inflammations, low respiratory tract inflammations (acute bronchitis and bronchopneumonia), staphylococcal exanthema and acute urinary tract infections mostly responded well to CXM intravenous administration (one shot injection, or instillation at dose of 50 approximately mg/kg/day in 2 approximately 3 daily divided doses. 4) Staphylococcal pyothorax was completely cured by 17 day-long CXM intravenous instillation at dose of about 150 mg/kg/day. 5) No difference in CXM therapy result was seen between the two administration forms used, i.e., one shot injection and instillation. 6) Clinical efficacy rate in 48 patients was 100% (excluding 1 unassessable case). As for side effect, transitory elevation of GPT and Al-P were seen in only 1 case each. The summary of this paper was reported on June 9, 1979 at 27th General Meeting of Japan Society of Chemotherapy (Fukuoka).

[Experience with cefuroxime in pediatric field (author's transl)]

Having resistance to beta-lactamase-producing strains and showing resistance to not only cephalosporin resistant strains of E. coli and Klebsiella but also to Citrobacter, Proteus and Enterobacter, Cefuroxime (CXM) was used in pediatric field for both fundamental and clinical studies. CXM was found to be a useful antibiotic in views of high clinical efficacy rate obtained and no side effect noted. As for the dose, the single dose of 25 mg/kg achieved sufficient blood levels. Also in view of good clinical effect, the dose of 25 mg/kg three or four times daily seems appropriate for treatment of children.

The intraocular penetration of cefuroxime after parenteral administration

Cefuroxime (Zinacef) is a new second generation cephalosporin which is resistant to beta-lactamases produced by both Gram-negative and Gram-positive organisms, with an antibacterial spectrum that includes practically all likely ocular pathogens except pseudomonas. It is shown to penetrate into the eye after intravenous (1.5g) or intramuscular (1 g) injection and achieve therapeutic concentrations, with absence of side effects. Cefuroxime is therefore a useful antibiotic for ophthalimic infections and should have a role in combination with gentamicin in intraocular infections, particularly those of unknown aetiology.

Cefuroxime in severe respiratory infections: a double-blind comparison of two doses

Cefuroxime, a new cephalosporin, was given in doses of 750 mg and 1000 mg three times daily for 10 days to 99 patients in a double-blind comparison. Patients were moderately or severely ill with exacerbations of chronic bronchitis, often accompanied by pneumonia. Both doses were equally efficacious in improving the clinical state and sputum purulence and in maintaining the improvement.

Toxicological studies on cefuroxime sodium

The intravenous LD50 of cefuroxime sodium for mice was 10.4 g/kg. The maximum dosage administered in other acute toxicity tests was well tolerated by mice (10 g/kg, subcutaneous), by rats (4 g/kg, intravenous, 5 g/kg, subcutaneous) and by cats, dogs and monkeys (2 g/kg, intramuscularly). Cefuroxime sodium was administered subcutaneously (s.c.) or intramuscularly (i.m.) for 3 months to rats (100, 300 or 900 mg/kg/day) followed by a recovery period, and also for 6 months to rats and dogs (50, 150 or 450 mg/kg/day) and for 1 month to monkeys (150 or 450 mg/kg/day). In all these tests there were no serious toxic effects. Minor haematological changes were attributable in part if not entirely to haemorrhage and tissue reaction at the site of injection of large doses. In rats large doses caused some increase in urine volume and electrolyte excretion, and slightly aggravated an age related nephropathy. Administration to rats intravenously (i.v.) for1 month of up to 400 mg/kg/day had no toxic effects. In reproduction studies on mice and rabbits there were no adverse effects on fertility, organogenesis or the rearing of young.