Cefuroxime
Ceftin · Zinacef
2nd-generation cephalosporin
β-lactam — inhibits cell-wall synthesis (PBP binding). 2nd-gen: gram-positive + expanded gram-negative.
Indications
- •Surgical prophylaxis (alternative)
- •Respiratory/UTI infections
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| Surgical prophylaxis | 1.5 g IV within 60 min of incision; redose q4h intraop | — |
Pharmacokinetics
Half-life ~1–2 h → intraoperative redose q4h. Renally cleared.
Side effects
- !Allergy
- !C. difficile
- !Rare seizures (high dose/renal failure)
Contraindications
- ×Severe (anaphylactic) penicillin/cephalosporin allergy
Clinical pearls
- ★Cross-reactivity with penicillin allergy is LOW (~1–2%, mainly shared side-chains) — most penicillin-allergic patients tolerate cephalosporins; true anaphylaxis history is the exception.
- ★Redose intraop q4h (or after large blood loss).
Other drugs in Antibiotics
- Cefazolin
β-lactam — inhibits bacterial cell wall PBPs.
- Vancomycin
Inhibits cell wall synthesis (binds D-Ala-D-Ala). Active against MRSA + gram-positives.
- Clindamycin
Binds 50S ribosomal subunit, blocks peptide-bond formation. Bacteriostatic against most organisms; bactericidal against susceptible streptococci. Excellent activity against anaerobes and gram-positive cocci including community-acquired MRSA.
- Gentamicin
Binds 30S ribosomal subunit, causes misreading of mRNA → defective bacterial protein synthesis. Bactericidal, concentration-dependent killing. Synergy with cell-wall agents (β-lactams, vancomycin) for gram-positive endocarditis.
- Cefepime
β-lactam cell-wall inhibitor. Broad gram-negative (incl. Pseudomonas) + gram-positive coverage.
- Cefotetan
β-lactam; adds anaerobic (B. fragilis) coverage → colorectal/gynecologic prophylaxis.
- Cefotaxime
β-lactam cell-wall inhibitor. Broad gram-negative + CNS penetration.
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
