Cefuroxime

PD Dialyzability: Likely

Pharmacokinetic Parameters [1] [2]

  Cefuroxime axetil Cefuroxime sodium
Molecular Weight (Da) 510.48 446.37
Plasma Protein Binding (%) 30-50 33
Volume of Distribution (L/Kg) 0.13-1.8 0.13-1.8
Hepatic Metabolism Partial metabolism in the liver. Axetil moiety is metabolized to acetic acid and acetaldehyde Partial metabolism in the liver
Excreted Unchanged (%) 90 90
Half-Life; Normal Renal Function (hours) 1.2 1.2
Half-Life; ESRD (hours) 17 17

CAPD Dosing: [3] [4] [5]

  • PO Dosing: Cefuroxime axetil 250-500mg PO Q12H
  • IV/IM Dosing: Cefuroxime sodium 0.75-1.5g IV/IM Q8H

CCPD Dosing:

  • No literature identified. Extrapolate dosing from CAPD dosing recommendations.

Indication Specific PD Dosing:

  • Peritonitis [6]
    • Intermittent Dosing: Cefuroxime 400mg PO/IV daily
    • Continuous Dosing: Cefuroxime 200mg/L exchange IP (LD), then 100-200mg/L exchange IP
  • Surgical Prophylaxis: Cefuroxime 1.5g IV (2) +/- 250mg IP (7,8) 30 minutes – 1 hours preoperatively
  • Exit-site/Tunnel Infection: Cefuroxime 2.25g PO initially, then 750mg PO Q12H x 4 weeks (Exit-site) or 6 weeks (Exit site + tunnel infection)

Literature Summary:

Title Patient Intervention Outcome Note
Exit-site infections by non-diphtheria corynebacteria in CAPD.
[9]
  • CAPD
  • 3 Patients with exit-site/tunnel Corynebacteria infection
 Cefuroxime 2.25g initially, then 0.75g Q12H PO
  • Exit site appearance
  • Ultrasound examination
  • Follow up exit-site culture.
  • No ADR noted
Prevention of peritonitis in newly placed peritoneal dialysis catheters: efficacy of oral prophylaxis with cefuroxime axetil- a preliminary study.
[10]
  • CAPD
  • 67 patients (32 female)
  • Mean age 46 years old
  • Undergoing percutaneous PD placement procedure
  • Cefuroxime axetil 750mg IV 30 minutes before catheter placement.
  • Cefuroxime 500mg PO 1 hour before catheter placement, then 500mg PO BID x 3 days
  • Emergence of peritonitis within 14 days of catheter placement.
  • 3 patients from IV group and 3 patients from PO group experienced peritonitis infection.
  • Abstract only

References

[1]Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. DrugBank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(suppl_1):D668–72.
[2]American Pharmacist Association. Drug information handbook: a comprehensive resource for all clinicians and healthcare professionals [Internet]. Hudson, Ohio: American Pharmacist association; 2012 [cited 2018 Jan 24]. Available from: http://online.lexi.com.login.ezproxy.library.ualberta.ca/lco/action/home?siteid=1
[3]Gilbert B, Robbins P, Livornese LL. Use of Antibacterial Agents in Renal Failure. Med Clin North Am. 2011;95:677–702.
[4]Aronoff GR. Drug prescribing in renal failure: dosing guidelines for adults and children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
[5]Adjusting oral antibiotics to estimated creatinine clearance [Internet]. [cited 2018 Jan 24]. Available from: http://www.vhpharmsci.com/VHFormulary/Tools/ADJUSTING%20ORAL%20ANTIBIOTICS.pdf
[6]Keane WF, Bailie GR, Boeschoten E, Gokal R, Golper T a, Holmes CJ, et al. ISPD Guidelines/Recommendations: Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 Update. Perit Dial Int. 2000;20(May):396–411.
[7]Gokal R, Alexander S, Ash S, Chen TW, Danielson A, Holmes C, et al. Peritoneal catheters and exit-site practices toward optimum peritoneal access: 1998 Update. Perit Dial Int. 1998;18:11–33.
[8]Wikdahl AM, Engman U, Stegmayr BG, Sörenssen JG. One-dose cefuroxime i.v. and i.p. reduces microbial growth in PD patients after catheter insertion. Nephrol Dial Transpl. 1997;12(1):157–160.
[9]Schiffl H, Mücke C, Lang SM. Exit-site infections by non-diphtheria corynebacteria in CAPD. Perit Dial Int J Int Soc Perit Dial. 2004;24(5):454–9.
[10]Velioglu A, Asicioglu E, Ari E, Arikan H, Tuglular S, Ozener C. Prevention of peritonitis in newly-placed peritoneal dialysis catheters: efficacy of oral prophylaxis with cefuroxime axetil - a preliminary study. Minerva Urol E Nefrol Ital J Urol Nephrol. 2016 Feb;68(1):27–31.