Cefuroxime Disease Interactions

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Most beta-lactam antibacterial agents are eliminated by the kidney as unchanged drug and, in some cases, also as metabolites. The serum concentrations of beta-lactam antibacterial agents and their metabolites may be increased, and the half-lives prolonged, in patients with impaired renal function. Neurotoxic reactions (e.g., encephalopathy, aphasia, asterixis, myoclonus, seizures, nonconvulsive status epilepticus, coma) have been reported in such patients treated parenterally with these agents. Dosage adjustments may be necessary, and modifications should be based on the degree of renal function as well as severity of infection in accordance with the individual manufacturer product information. Renal function tests should be performed periodically during prolonged and/or high-dose therapy since nephrotoxicity and alterations in renal function have occasionally been associated with the use of these drugs.

Cefuroxime serum levels can be reduced by hemodialysis and peritoneal dialysis. A supplemental dose should be given at the end of each hemodialysis session. There is not enough information regarding the use of cefuroxime in patients on peritoneal dialysis.

A false-negative result for blood/plasma glucose may occur with ferricyanide tests in patients receiving cefuroxime; either the glucose oxidase or hexokinase method should be used to determine blood/plasma glucose levels during cefuroxime therapy. Clinicians should consider the interaction with the ferricyanide test when prescribing or administering cefuroxime to patients with diabetes.

Several cephalosporins (including cefuroxime) have been implicated in triggering seizures, especially in patients with renal dysfunction when the dosage was not reduced. If seizures associated with drug therapy occur, cefuroxime should be discontinued. Anticonvulsant therapy can be administered if clinically indicated.

Parenteral cefuroxime sodium contains approximately 54.2 mg (2.4 mEq) of sodium per gram of cefuroxime activity. The sodium content should be considered in patients with conditions that may require sodium restriction, such as congestive heart failure, hypertension, and fluid retention.

Use of cephalosporins may result in a false-positive reaction for glucose in urine with certain methods (e.g., Clinitest tablets). Glucose tests based on enzymatic glucose oxidase reactions are recommended for patients receiving cephalosporins.

Cases of hepatitis have been reported with the use of certain cephalosporins. Transient rise in AST, ALT, and alkaline phosphatase levels have also been observed. Caution and monitoring are recommended when these agents are prescribed to patients with hepatic disorders.

Cephalosporins may be associated with reduced prothrombin activity/prolonged prothrombin time. Risk factors include renal or liver dysfunction, poor nutritional state, prolonged antimicrobial therapy, and previously stabilized on/receiving anticoagulant therapy. Prothrombin time should be monitored in at-risk patients and managed as indicated (e.g., exogenous vitamin K administered).