C-2

Uses

- Pharyngitis/tonsillitis caused by Streptococcus pyogenes

- Acute bacterial otitis media caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta lactamase-producing strains), Moraxella Catarrhalis (including beta-lactamase-producing strains) or Streptococcus pyogenes.

- Acute bacterial maxillary sinusitis caused by Streptococcus pneumoniae, or Haemophilus influenzae (nonbeta-lactamase-producing strains only)

- Lower respiratory tract infections including pneumoniae, caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta lactamase-producing strains), Klebsiella spp., Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains), Streptococcus pyogenes, Escherichia coli.

- Acute bacterial exacerbations of chronic bronchitis and secondary bacterial infections of acute bronchitis caused by Streptococcus penumoniae, Haemophilus influenzae (beta-lactamase negative strains), or Haemophilus parainfluenzae (beta-lactamase negative strains).

- Skin and Skin-Structure Infections caused by Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains), Streptococcus pyogenes, Escherichia coli, Klebsiella spp., and Enterobacter spp.

- Urinary tract infections caused by Escherichia coli or Klebsiella pneumoniae.

- Bone and Joint Infections caused by Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains).

- Gonorrhea : Uncomplicated and disseminated gonococcal infections due to Neiseria gonorrhoeae (penicillinase- and non-penicillinase-producing strains) in both males and females.

- Early Lyme disease (erythema migrans) caused by Borrelia burgdorferi.

- Septicemia caused by Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains), Streptococcus pneumoniae, Escherichia coli, Haemophilus influenzae (including ampicillin-resistant strains), and Klebsiella spp.

- Meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), Neisseira menintitidis, and Staphylococcus aureus (penicillinase- and non-penicillinase-producing strains).

- Surgical Prophylaxis: Prophylaxis against infections in abdominal, pelvic, orthopedic, cardiac, pulmonary, esophageal and vascular surgery where there is increased risk for infection.

C-2 is also used to associated treatment for these conditions: Acute Bacterial Exacerbation of Chronic Bronchitis (ABECB), Animal bite, Bacterial Infections, Bloodstream Infections, Bone and Joint Infections, Gonorrhea, Impetigo, Lower Respiratory Tract Infection (LRTI), Lyme Disease, Maxillary Sinusitis, Meningitis, Skin and Subcutaneous Tissue Bacterial Infections, Urinary Tract Infection, Bacterial otitis media, Mild Streptococcal pharyngitis, Mild Streptococcal tonsillitis, Moderate Streptococcal pharyngitis, Moderate Streptococcal tonsillitis

How C-2 works

C-2, like the penicillins, is a beta-lactam antibiotic. By binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, it inhibits the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins; it is possible that cefuroxime interferes with an autolysin inhibitor.

Dosage

C-2 dosage

Oral :

INFECTIONS DOSAGE DURATION

Tablet

(May be administered without regard to meals)

Adolescents & adults(13 years & above)

Pharyngitis or Tonsillitis 250 mg twice daily 5-10 days

Acute bacterial maxillary sinusitis 250 mg twice daily 10 days

Acute bacterial exacerbation of chronic bronchitis 250-500 mg twice daily 10 days

Secondary bacterial infections of acute bronchitis 250-500 mg twice daily 5-10 days

Uncomplicated skin & skin-structure infections 250-500 mg twice daily 10 days

Uncomplicated urinary tract infection 125-250 mg twice daily 7-10 days

Uncomplicated gonorrhea 1000 mg single dose - - -

Lyme disease 500 mg twice daily 20 days

Paediatric patients (Upto12 years)

(Who can swallow tablets whole)

Pharyngitis or Tonsillitis 125 mg twice daily 5-10 days Acute otitis media 250 mg twice daily 10 days

Acute bacterial maxillary sinusitis 250 mg twice daily 10 days

Suspension

(Must be administered with food. Shake the bottle

well before each use)

Paediatric patients (3 months to 12 years)

Pharyngitis or Tonsillitis 20 mg/kg/day in two divided doses 5-10 days Acute otitis media 30 mg/kg/day in two divided doses 10 days

Acute bacterial maxillary sinusitis 30 mg/kg/day in two divided doses 10 days

Injection :

Adult: 750 mg three times daily by IM or IV injection. In severe infections, dose can be increased upto 1.5 gm three times daily by IV injection. The frequency may be increased to four times daily, if necessary, giving total daily doses of 3 to 6 gms.

Children (above 3 months of age): 30 - 100 mg/kg/day given in 3 or 4 equally divided doses. A dose of 60mg/kg/day is appropriate for most infections.

Neonate: 30 - 100 mg/kg/day given in 2 or 3 equally divided doses.

Surgical prophylaxis: 1.5 gm by IV injection at induction of anaesthesia; up to 3 further doses of 750 mg may be given by IV/IM injection every 8 hours for high risk procedures.

Sequential therapy in adults

Pneumonia: 1.5 gm IV injection twice daily for 2-3 days, followed by 500 mg twice daily (oral) for 7-10 days.

Acute exacerbations of chronic bronchitis: 750 mg twice daily (IM or IV injection) for 2-3 days, followed by 500 mg twice daily (oral) for 5-10 days. (Duration of both parenteral and oral therapy is determined by the severity of the infection and the clinical status of the patient.)

Other recommendations

In Gonorrhoea: Adult: 1.5g as a single dose (as 2 x 750mg injections intramuscularly with different sites, e.g. each buttock).

In Meningitis: Adults: 3gm IV injection three times daily. Children (above 3 months of age): 200-240 mg/kg/day by IV injection in 3 or 4 divided doses reduced to 100 mg/kg/day after 3 days or on clinical improvement. Neonate: 100 mg/kg/day by IV injection reduced to 50 mg /kg/day.

In bone and joint infections: Adult: 1.5 gm IV injection four times daily. Children (above 3 months of age): 150 mg/kg/day (not to exceed the maximum adult dose) in equally divided doses every 8 hours.

In impaired renal function: A reduced dose must be employed when renal function is impaired. Dosage in adults should be determined by the degree of renal impairment and the susceptibility of the causative organism according to the table below -

Creatinine clearance (ml/min) Dose Frequency

> 20 750 mg - 1.5 gm q8h

10-20 750 mg q12h

< 10 750 mg q24h*

* Since C-2 is dialyzable, patients on hemodialysis should be given a further dose at the end of the dialysis.

In paediatric patients with renal insufficiency, the frequency of dosing should be modified consistent with the recommendations for adults.

Directions for reconstitution:

Shake the bottle well to loosen the powder. Add required amount (with the help of supplied measuring cup) of boiled and cooled water to the dry mixture in the bottle. Shake the bottle vigorously until all the powder is in suspension.

Note: Shake the bottle vigorously before each use. Keep the bottle tightly closed. The reconstituted suspension should be stored in a cool and dry place, preferably in a refrigerator and used within 10 days after reconstitution.

Kilbac 250 IM/IV Injection :

Intramuscular injection : Add 1 ml of supplied water for injection BP to the vial and shake.

Intravenous injection: Add 2 ml of supplied water for injection BP to the vial and shake. The solution should be slowly injected directly into a vein over a 3 to 5 minute period.

Kilbac 750 IM/IV Injection :

Intramuscular injection : Add 3 ml of supplied water for injection BP to the vial and shake.

Intravenous injection: Add 8 ml of supplied water for injection BP to the vial and shake. The solution should be slowly injected directly into a vein over a 3 to 5 minute period.

Kilbac 1.5 IV Injection :

Intravenous injection: Add 16 ml of supplied water for injection BP to the vial and shake. The solution should be slowly injected directly into a vein over a 3 to 5 minute period.

Pharmaceutical precaution

C-2 tablet, powder for suspension and vial (for injection) should be kept in a cool (15° - 30°C) and dry place and protected from light.

Side Effects

Generally C-2 is well tolerated. However, a few side effects like nausea, vomiting, diarrhea, abdominal discomfort or pain may occur. As with other broad-spectrum antibiotics, prolonged administration of C-2 may result in overgrowth of nonsusceptible microorganisms. Rarely (<0.2%) renal dysfunction, anaphylaxis, angioedema, pruritis, rash and serum sickness like urticaria may appear.

Toxicity

Allergic reactions might be expected, including rash, nasal congestion, cough, dry throat, eye irritation, or anaphylactic shock. Overdosage of cephalosporins can cause cerebral irritation leading to convulsions.

Precaution

C-2 should be given with care to patients receiving concurrent treatment with potent diuretics & who have history of colitis.

Interaction

No potentially hazardous interactions have been reported.

Food Interaction

• Take with food. Food increases absorption.

C-2 Hypertension interaction

[Moderate] 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.

C-2 Drug Interaction

Unknown: amoxicillin / clavulanate, amoxicillin / clavulanate, omega-3 polyunsaturated fatty acids, omega-3 polyunsaturated fatty acids, acetaminophen, acetaminophen, montelukast, montelukast, budesonide / formoterol, budesonide / formoterol, acetaminophen, acetaminophen, cyanocobalamin, cyanocobalamin, ascorbic acid, ascorbic acid, cholecalciferol, cholecalciferol, cetirizine, cetirizine

C-2 Disease Interaction

Major: colitisModerate: renal dysfunction, dialysis, ferricyanide tests, seizure disorders, sodium, liver disease, prolonged PT

Elimination Route

Absorbed from the gastrointestinal tract. Absorption is greater when taken after food (absolute bioavailability increases from 37% to 52%).

Half Life

Approximately 80 minutes following intramuscular or intravenous injection.

Pregnancy & Breastfeeding use

Pregnancy: While all antibiotics should be avoided in the first trimester if possible. However, C-2 has been safely used in later pregnancy to treat urinary and other infections.

Nursing mothers: C-2 is excreted into the breast milk in small quantities. However, the possibility of sensitizing the infant should be kept in mind

Contraindication

C-2 is contraindicated in patients with known allergy to Cephalosporins.

Acute Overdose

Excessively large doses of all Cephalosporins can cause cerebral irritation and may cause convulsions. This complication is unlikely to occur in routine practice unless the patient is in renal failure. Hemodialysis or peritoneal dialysis can remove C-2.

Interaction with other Medicine

Concomitant administration of probenecid with C-2 increases the area under the serum concentration versus time curve by 50%. Drug that reduces gastric acidity may result in a lower bioavailability of C-2 and tend to cancel the effect of postprandial absorption.

Storage Condition

Tablet: Store below 30° C, protected from light and moisture.

Suspension: Store below 25° C, protected from light and moisture.

Injection: Store below 25° C, protected from light and moisture. Use reconstituted solution immediately. The reconstituted solution is stable for 2 hours at room temperature and for 12 hours when refrigerated at 2° - 8° C.

Innovators Monograph

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