What are the risk factors associated with Ceftin (cefuroxime)?

Risk Factors Associated with Cefuroxime (Ceftin)

Cefuroxime (Ceftin) carries several important risk factors that should be considered before prescribing, with allergic reactions, renal impairment, and certain drug interactions being the most significant concerns.

Allergic Reactions

• Hypersensitivity reactions occur in fewer than 1% of patients treated with cefuroxime and include rash (1 in 125 patients), pruritus, urticaria, and positive Coombs' test (each in fewer than 1 in 250 patients) 1
• Rare but serious hypersensitivity reactions include anaphylaxis, drug fever, erythema multiforme, interstitial nephritis, toxic epidermal necrolysis, and Stevens-Johnson syndrome 1
• History of penicillin allergy may increase risk of cross-reactivity with certain cephalosporins, though this risk is lower with cefuroxime than with first-generation cephalosporins 2
• Patients with previous history of allergic reactions to cephalosporins or penicillins are at increased risk of adverse reactions 3

Renal Impairment

• Patients with transient or persistent renal insufficiency require dose adjustment as high and prolonged serum antibiotic concentrations can occur from usual doses 1
• Cefuroxime may be associated with elevations in serum creatinine and/or blood urea nitrogen and decreased creatinine clearance 1
• Nephrotoxicity has been reported following concomitant administration of aminoglycoside antibiotics and cephalosporins 1

Gastrointestinal Effects

• Gastrointestinal symptoms occur in approximately 1 in 150 patients and include diarrhea (1 in 220 patients) and nausea (1 in 440 patients) 1
• Pseudomembranous colitis may occur during or after treatment with cefuroxime 1
• Individuals with a history of gastrointestinal disease, particularly colitis, should receive broad-spectrum antibiotics like cefuroxime with caution 1

Hematologic Effects

• Decreases in hemoglobin and hematocrit have been observed in 1 in 10 patients 1
• Transient eosinophilia occurs in 1 in 14 patients 1
• Less common reactions include transient neutropenia (fewer than 1 in 100 patients) and leukopenia (1 in 750 patients) 1
• Rare reports of thrombocytopenia have been documented 1
• Cephalosporins may be associated with a fall in prothrombin activity, particularly in patients with renal or hepatic impairment, poor nutritional state, or those receiving protracted courses of antimicrobial therapy 1

Hepatic Effects

• Transient elevations in liver enzymes may occur, including SGOT and SGPT (1 in 25 patients), alkaline phosphatase (1 in 50 patients), LDH (1 in 75 patients), and bilirubin (1 in 500 patients) 1

Pregnancy and Breastfeeding Considerations

• While animal studies show no evidence of impaired fertility or harm to the fetus, adequate and well-controlled studies in pregnant women are lacking 1
• Cefuroxime is classified as pregnancy category B1 (Australia) or B (FDA), indicating it is probably safe during pregnancy 4
• Cefuroxime is considered compatible with breastfeeding 4

Drug Interactions

• Concurrent treatment with potent diuretics may adversely affect renal function 1
• Prolonged prothrombin time may occur in patients previously stabilized on anticoagulant therapy 1
• False-positive reactions for glucose in urine may occur with copper reduction tests (Benedict's or Fehling's solution or with CLINITEST tablets) 1

Administration-Related Risks

• Thrombophlebitis has occurred with IV administration in 1 in 60 patients 1
• Rapid intravenous injection has been identified as a risk factor for adverse events 3

Special Populations at Risk

• Patients with a history of seizures or renal impairment may be at increased risk of seizures if dosage is not appropriately reduced 1
• Elderly patients may require dose adjustment due to age-related decline in renal function 1

Superinfection Risk

• Prolonged use may result in overgrowth of non-susceptible organisms requiring careful observation of the patient 1
• Superinfections with Pseudomonas aeruginosa and enterococcal strains may present a problem during treatment 5

Understanding these risk factors is essential for safe prescribing of cefuroxime and minimizing potential adverse outcomes in patients requiring this antibiotic therapy.