Ceftin Tablets and Ceftin for Oral Suspension contain cefuroxime as cefuroxime axetil. Ceftin is a semisynthetic, broad-spectrum cephalosporin antibiotic for oral administration.
Chemically, cefuroxime axetil, the 1-(acetyloxy) ethyl ester of cefuroxime, is (RS)-1-hydroxyethyl (6R ,7R) - 7 - [2 - (2 - furyl)glyoxyl - amido] - 3 - (hydroxymethyl) - 8 - oxo - 5 - thia - 1 - azabicyclo[4.2.0] - oct - 2 - ene - 2 - carboxylate, 72-(Z)-(O -methyl-oxime), 1-acetate 3-carbamate. Its molecular formula is C20H22N4O10S, and it has a molecular weight of 510.48.
Cefuroxime axetil is in the amorphous form and has the following structural formula:
Ceftin Tablets are film-coated and contain the equivalent of 250 or 500 mg of cefuroxime as cefuroxime axetil. Ceftin Tablets contain the inactive ingredients colloidal silicon dioxide, croscarmellose sodium, hydrogenated vegetable oil, hypromellose, methylparaben, microcrystalline cellulose, propylene glycol, propylparaben, sodium benzoate, sodium lauryl sulfate, and titanium dioxide.
Ceftin for Oral Suspension, when reconstituted with water, provides the equivalent of 125 mg or 250 mg of cefuroxime (as cefuroxime axetil) per 5 mL of suspension. Ceftin for Oral Suspension contains the inactive ingredients acesulfame potassium, aspartame, povidone K30, stearic acid, sucrose, tutti-frutti flavoring, and xanthan gum.
Ceftin - Clinical Pharmacology
Absorption and Metabolism
After oral administration, cefuroxime axetil is absorbed from the gastrointestinal tract and rapidly hydrolyzed by nonspecific esterases in the intestinal mucosa and blood to cefuroxime. Cefuroxime is subsequently distributed throughout the extracellular fluids. The axetil moiety is metabolized to acetaldehyde and acetic acid.
Pharmacokinetics
Approximately 50% of serum cefuroxime is bound to protein. Serum pharmacokinetic parameters for Ceftin Tablets and Ceftin for Oral Suspension are shown in Tables 1 and 2.
Table 1. Postprandial Pharmacokinetics of Cefuroxime Administered as Ceftin Tablets to Adultsa
Doseb
(Cefuroxime
Equivalent)
|
Peak Plasma Concentration
(mcg/mL)
|
Time of Peak Plasma Concentration (hr)
|
Mean
Elimination
Half-life (hr)
|
AUC
(mcg•hr/mL)
|
125 mg
|
2.1
|
2.2
|
1.2
|
6.7
|
250 mg
|
4.1
|
2.5
|
1.2
|
12.9
|
500 mg
|
7.0
|
3.0
|
1.2
|
27.4
|
1,000 mg
|
13.6
|
2.5
|
1.3
|
50.0
|
a Mean values of 12 healthy adult volunteers.
b Drug administered immediately after a meal.
Table 2. Postprandial Pharmacokinetics of Cefuroxime Administered as Ceftin for Oral Suspension to Pediatric Patientsa
Doseb
(Cefuroxime
Equivalent)
|
n
|
Peak Plasma
Concentration
(mcg/mL)
|
Time of Peak
Plasma
Concentration (hr)
|
Mean
Elimination
Half-life
(hr)
|
AUC
(mcg•hr/mL)
|
10 mg/kg
|
8
|
3.3
|
3.6
|
1.4
|
12.4
|
15 mg/kg
|
12
|
5.1
|
2.7
|
1.9
|
22.5
|
20 mg/kg
|
8
|
7.0
|
3.1
|
1.9
|
32.8
|
a Mean age = 23 months.
b Drug administered with milk or milk products.
Comparative Pharmacokinetic Properties
A 250 mg/5 mL-dose of Ceftin Suspension is bioequivalent to 2 times 125 mg/5 mL-dose of Ceftin Suspension when administered with food (see Table 3). Ceftin for Oral Suspension was not bioequivalent to Ceftin Tablets when tested in healthy adults. The tablet and powder for oral suspension formulations are NOT substitutable on a milligram-per-milligram basis. The area under the curve for the suspension averaged 91% of that for the tablet, and the peak plasma concentration for the suspension averaged 71% of the peak plasma concentration of the tablets. Therefore, the safety and effectiveness of both the tablet and oral suspension formulations had to be established in separate clinical trials.
Table 3. Pharmacokinetics of Cefuroxime Administered as 250 mg/5 mL or 2 x 125 mg/5 mL Ceftin for Oral Suspension to Adultsa With Food
Dose
(Cefuroxime
Equivalent)
|
Peak Plasma Concentration
(mcg/mL)
|
Time of Peak
Plasma
Concentration (hr)
|
Mean Elimination
Half-life (hr)
|
AUC
(mcg•hr/mL)
|
250 mg/5 mL
|
2.23
|
3
|
1.40
|
8.92
|
2 x 125 mg/5 mL
|
2.37
|
3
|
1.44
|
9.75
|
a Mean values of 18 healthy adult volunteers.
Food Effect on Pharmacokinetics
Absorption of the tablet is greater when taken after food (absolute bioavailability of Ceftin Tablets increases from 37% to 52%). Despite this difference in absorption, the clinical and bacteriologic responses of patients were independent of food intake at the time of tablet administration in 2 studies where this was assessed.
All pharmacokinetic and clinical effectiveness and safety studies in pediatric patients using the suspension formulation were conducted in the fed state. No data are available on the absorption kinetics of the suspension formulation when administered to fasted pediatric patients.
Renal Excretion
Cefuroxime is excreted unchanged in the urine; in adults, approximately 50% of the administered dose is recovered in the urine within 12 hours. The pharmacokinetics of cefuroxime in the urine of pediatric patients have not been studied at this time. Until further data are available, the renal pharmacokinetic properties of cefuroxime axetil established in adults should not be extrapolated to pediatric patients.
Because cefuroxime is renally excreted, the serum half-life is prolonged in patients with reduced renal function. In a study of 20 elderly patients (mean age = 83.9 years) having a mean creatinine clearance of 34.9 mL/min, the mean serum elimination half-life was 3.5 hours. Despite the lower elimination of cefuroxime in geriatric patients, dosage adjustment based on age is not necessary (see PRECAUTIONS: Geriatric Use).
Microbiology
The in vivo bactericidal activity of cefuroxime axetil is due to cefuroxime's binding to essential target proteins and the resultant inhibition of cell-wall synthesis.
Cefuroxime has bactericidal activity against a wide range of common pathogens, including many beta-lactamase−producing strains. Cefuroxime is stable to many bacterial beta-lactamases, especially plasmid-mediated enzymes that are commonly found in enterobacteriaceae.
Cefuroxime has been demonstrated to be active against most strains of the following microorganisms both in vitro and in clinical infections as described in the INDICATIONS AND USAGE (see INDICATIONS AND USAGE).
Aerobic Gram-Positive MicroorganismsStaphylococcus aureus (including betalactamase−producing strains)
Streptococcus pneumoniae
Streptococcus pyogenes
Aerobic Gram-Negative MicroorganismsEscherichia coli
Haemophilus influenzae (including betalactamase−producing strains)
Haemophilus parainfluenzae
Klebsiella pneumoniae
Moraxella catarrhalis (including betalactamase−producing strains)
Neisseria gonorrhoeae (including betalactamase−producing strains)
SpirochetesBorrelia burgdorferi
Cefuroxime has been shown to be active in vitro against most strains of the following microorganisms; however, the clinical significance of these findings is unknown.
Cefuroxime exhibits in vitro minimum inhibitory concentrations (MICs) of 4.0 mcg/mL or less (systemic susceptible breakpoint) against most (≥90%) strains of the following microorganisms; however, the safety and effectiveness of cefuroxime in treating clinical infections due to these microorganisms have not been established in adequate and well-controlled trials.
Aerobic Gram-Positive MicroorganismsStaphylococcus epidermidis
Staphylococcus saprophyticus
Streptococcus agalactiae
NOTE: Listeria monocytogenes and certain strains of enterococci, e.g., Enterococcus faecalis (formerly Streptococcus faecalis), are resistant to cefuroxime. Methicillin-resistant staphylococci are resistant to cefuroxime.
Aerobic Gram-Negative MicroorganismsMorganella morganii
Proteus inconstans
Proteus mirabilis
Providencia rettgeri
NOTE: Pseudomonas spp., Campylobacter spp., Acinetobacter calcoaceticus, Legionella spp., and most strains of Serratia spp. and Proteus vulgaris are resistant to most first- and second-generation cephalosporins. Some strains of Morganella morganii, Enterobacter cloacae, and Citrobacter spp. have been shown by in vitro tests to be resistant to cefuroxime and other cephalosporins.
Anaerobic MicroorganismsPeptococcus niger
NOTE: Most strains of Clostridium difficile and Bacteroides fragilis are resistant to cefuroxime.
Susceptibility Tests
Dilution TechniquesQuantitative methods that are used to determine MICs provide reproducible estimates of the susceptibility of bacteria to antimicrobial compounds. One such standardized procedure uses a standardized dilution method1 (broth, agar, or microdilution) or equivalent with cefuroxime powder. The MIC values obtained should be interpreted according to the following criteria:
MIC (mcg/mL)
|
Interpretation
|
≤4
|
(S) Susceptible
|
8-16
|
(I) Intermediate
|
≥32
|
(R) Resistant
|
A report of "Susceptible" indicates that the pathogen, if in the blood, is likely to be inhibited by usually achievable concentrations of the antimicrobial compound in blood. A report of "Intermediate" indicates that inhibitory concentrations of the antibiotic may be achieved if high dosage is used or if the infection is confined to tissues or fluids in which high antibiotic concentrations are attained. This category also provides a buffer zone that prevents small, uncontrolled technical factors from causing major discrepancies in interpretation. A report of "Resistant" indicates that usually achievable concentrations of the antimicrobial compound in the blood are unlikely to be inhibitory and that other therapy should be selected.
Standardized susceptibility test procedures require the use of laboratory control microorganisms. Standard cefuroxime powder should give the following MIC values:
Microorganism
|
MIC (mcg/mL)
|
Escherichia coli ATCC 25922
|
2-8
|
Staphylococcus aureus ATCC 29213
|
0.5-2
|
Diffusion TechniquesQuantitative methods that require measurement of zone diameters provide estimates of the susceptibility of bacteria to antimicrobial compounds. One such standardized procedure2 that has been recommended (for use with disks) to test the susceptibility of microorganisms to cefuroxime uses the 30-mcg cefuroxime disk. Interpretation involves correlation of the diameter obtained in the disk test with the MIC for cefuroxime.
Reports from the laboratory providing results of the standard single-disk susceptibility test with a 30-mcg cefuroxime disk should be interpreted according to the following criteria:
Zone Diameter (mm)
|
Interpretation
|
≥23
|
(S) Susceptible
|
15-22
|
(I) Intermediate
|
≤14
|
(R) Resistant
|
Interpretation should be as stated above for results using dilution techniques.
As with standard dilution techniques, diffusion methods require the use of laboratory control microorganisms. The 30-mcg cefuroxime disk provides the following zone diameters in these laboratory test quality control strains:
Microorganism
|
Zone Diameter (mm)
|
Escherichia coli ATCC 25922
|
20-26
|
Staphylococcus aureus ATCC 25923
|
27-35
|
Indications and Usage for Ceftin
NOTE: Ceftin TABLETS AND Ceftin FOR ORAL SUSPENSION ARE NOT BIOEQUIVALENT AND ARE NOT SUBSTITUTABLE ON A MILLIGRAM-PER-MILLIGRAM BASIS (SEE CLINICAL PHARMACOLOGY).
Ceftin Tablets
Ceftin Tablets are indicated for the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms in the conditions listed below:
- Pharyngitis/Tonsillitis caused by Streptococcus pyogenes.
NOTE: The usual drug of choice in the treatment and prevention of streptococcal infections, including the prophylaxis of rheumatic fever, is penicillin given by the intramuscular route. Ceftin Tablets are generally effective in the eradication of streptococci from the nasopharynx; however, substantial data establishing the efficacy of cefuroxime in the subsequent prevention of rheumatic fever are not available. Please also note that in all clinical trials, all isolates had to be sensitive to both penicillin and cefuroxime. There are no data from adequate and well-controlled trials to demonstrate the effectiveness of cefuroxime in the treatment of penicillin-resistant strains of 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 (non-beta-lactamase−producing strains only) (see CLINICAL STUDIES).
NOTE: In view of the insufficient numbers of isolates of beta-lactamase−producing strains of Haemophilus influenzae and Moraxella catarrhalis that were obtained from clinical trials with Ceftin Tablets for patients with acute bacterial maxillary sinusitis, it was not possible to adequately evaluate the effectiveness of Ceftin Tablets for sinus infections known, suspected, or considered potentially to be caused by beta-lactamase−producing Haemophilus influenzae or Moraxella catarrhalis.
- Acute Bacterial Exacerbations of Chronic Bronchitis and Secondary Bacterial Infections of Acute Bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae (beta-lactamase negative strains), or Haemophilus parainfluenzae (betalactamase negative strains) (see DOSAGE AND ADMINISTRATION and CLINICAL STUDIES).
- Uncomplicated Skin and Skin-Structure Infections caused by Staphylococcus aureus (including beta-lactamase−producing strains) or Streptococcus pyogenes.
- Uncomplicated Urinary Tract Infections caused by Escherichia coli or Klebsiella pneumoniae.
- Uncomplicated Gonorrhea, urethral and endocervical, caused by penicillinase-producing and non-penicillinase−producing strains of Neisseria gonorrhoeae and uncomplicated gonorrhea, rectal, in females, caused by non-penicillinase−producing strains of Neisseria gonorrhoeae.
- Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi.
Ceftin for Oral Suspension
Ceftin for Oral Suspension is indicated for the treatment of pediatric patients 3 months to 12 years of age with mild to moderate infections caused by susceptible strains of the designated microorganisms in the conditions listed below. The safety and effectiveness of Ceftin for Oral Suspension in the treatment of infections other than those specifically listed below have not been established either by adequate and wellcontrolled trials or by pharmacokinetic data with which to determine an effective and safe dosing regimen.
- Pharyngitis/Tonsillitis caused by Streptococcus pyogenes.
NOTE: The usual drug of choice in the treatment and prevention of streptococcal infections, including the prophylaxis of rheumatic fever, is penicillin given by the intramuscular route. Ceftin for Oral Suspension is generally effective in the eradication of streptococci from the nasopharynx; however, substantial data establishing the efficacy of cefuroxime in the subsequent prevention of rheumatic fever are not available. Please also note that in all clinical trials, all isolates had to be sensitive to both penicillin and cefuroxime. There are no data from adequate and well-controlled trials to demonstrate the effectiveness of cefuroxime in the treatment of penicillin-resistant strains of 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.
- Impetigo caused by Staphylococcus aureus (including beta-lactamase−producing strains) or Streptococcus pyogenes.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Ceftin and other antibacterial drugs, Ceftin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
Contraindications
Ceftin products are contraindicated in patients with known allergy to the cephalosporin group of antibiotics.
Warnings
Ceftin TABLETS AND Ceftin FOR ORAL SUSPENSION ARE NOT BIOEQUIVALENT AND ARE THEREFORE NOT SUBSTITUTABLE ON A MILLIGRAM-PER-MILLIGRAM BASIS (SEE CLINICAL PHARMACOLOGY).
BEFORE THERAPY WITH Ceftin PRODUCTS IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO Ceftin PRODUCTS, OTHER CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN-SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS-HYPERSENSITIVITY AMONG BETALACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY. IF A CLINICALLY SIGNIFICANT ALLERGIC REACTION TO Ceftin PRODUCTS OCCURS, DISCONTINUE THE DRUG AND INSTITUTE APPROPRIATE THERAPY. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE TREATMENT WITH EPINEPHRINE AND OTHER EMERGENCY MEASURES, INCLUDING OXYGEN, INTRAVENOUS FLUIDS, INTRAVENOUS ANTIHISTAMINES, CORTICOSTEROIDS, PRESSOR AMINES, AND AIRWAY MANAGEMENT, AS CLINICALLY INDICATED.
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Ceftin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
Precautions
General
As with other broad-spectrum antibiotics, prolonged administration of cefuroxime axetil may result in overgrowth of nonsusceptible microorganisms. If superinfection occurs during therapy, appropriate measures should be taken.
Cephalosporins, including cefuroxime axetil, should be given with caution to patients receiving concurrent treatment with potent diuretics because these diuretics are suspected of adversely affecting renal function.
Cefuroxime axetil, as with other broad-spectrum antibiotics, should be prescribed with caution in individuals with a history of colitis. The safety and effectiveness of cefuroxime axetil have not been established in patients with gastrointestinal malabsorption. Patients with gastrointestinal malabsorption were excluded from participating in clinical trials of cefuroxime axetil.
Cephalosporins may be associated with a fall in prothrombin activity. Those at risk include patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy. Prothrombin time should be monitored in patients at risk and exogenous Vitamin K administered as indicated.
Prescribing Ceftin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as 2 or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.
Information for Patients/Caregivers (Pediatric)
PhenylketonuricsCeftin for Oral Suspension 125 mg/5 mL contains phenylalanine 11.8 mg per 5 mL (1 teaspoonful) constituted suspension. Ceftin for Oral Suspension 250 mg/5 mL contains phenylalanine 25.2 mg per 5 mL (1 teaspoonful) constituted suspension.
- During clinical trials, the tablet was tolerated by pediatric patients old enough to swallow the cefuroxime axetil tablet whole. The crushed tablet has a strong, persistent, bitter taste and should not be administered to pediatric patients in this manner. Pediatric patients who cannot swallow the tablet whole should receive the oral suspension.
- Discontinuation of therapy due to taste and/or problems of administering this drug occurred in 1.4% of pediatric patients given the oral suspension. Complaints about taste (which may impair compliance) occurred in 5% of pediatric patients.
- Patients should be counseled that antibacterial drugs, including Ceftin, should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When Ceftin is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Ceftin or other antibacterial drugs in the future.
Drug/Laboratory Test Interactions
A false-positive reaction for glucose in the urine may occur with copper reduction tests (Benedict's or Fehling's solution or with CLINITEST® tablets), but not with enzyme-based tests for glycosuria (e.g., CLINISTIX®). As a false-negative result may occur in the ferricyanide test, it is recommended that either the glucose oxidase or hexokinase method be used to determine blood/plasma glucose levels in patients receiving cefuroxime axetil. The presence of cefuroxime does not interfere with the assay of serum and urine creatinine by the alkaline picrate method.
Drug/Drug Interactions
Concomitant administration of probenecid with cefuroxime axetil tablets increases the area under the serum concentration versus time curve by 50%. The peak serum cefuroxime concentration after a 1.5-g single dose is greater when taken with 1 g of probenecid (mean = 14.8 mcg/mL) than without probenecid (mean = 12.2 mcg/mL).
Drugs that reduce gastric acidity may result in a lower bioavailability of Ceftin compared with that of fasting state and tend to cancel the effect of postprandial absorption.
In common with other antibiotics, cefuroxime axetil may affect the gut flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral estrogen/progesterone contraceptives.
Carcinogenesis, Mutagenesis, Impairment of Fertility
Although lifetime studies in animals have not been performed to evaluate carcinogenic potential, no mutagenic activity was found for cefuroxime axetil in a battery of bacterial mutation tests. Positive results were obtained in an in vitro chromosome aberration assay; however, negative results were found in an in vivo micronucleus test at doses up to 1.5 g/kg. Reproduction studies in rats at doses up to 1,000 mg/kg/day (9 times the recommended maximum human dose based on mg/m2) have revealed no impairment of fertility.
Pregnancy
Teratogenic EffectsPregnancy Category B. Reproduction studies have been performed in mice at doses up to 3,200 mg/kg/day (14 times the recommended maximum human dose based on mg/m2) and in rats at doses up to 1,000 mg/kg/day (9 times the recommended maximum human dose based on mg/m2) and have revealed no evidence of impaired fertility or harm to the fetus due to cefuroxime axetil. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Labor and Delivery
Cefuroxime axetil has not been studied for use during labor and delivery.
Nursing Mothers
Because cefuroxime is excreted in human milk, consideration should be given to discontinuing nursing temporarily during treatment with cefuroxime axetil.
Pediatric Use
The safety and effectiveness of Ceftin have been established for pediatric patients aged 3 months to 12 years for acute bacterial maxillary sinusitis based upon its approval in adults. Use of Ceftin in pediatric patients is supported by pharmacokinetic and safety data in adults and pediatric patients, and by clinical and microbiological data from adequate and well-controlled studies of the treatment of acute bacterial maxillary sinusitis in adults and of acute otitis media with effusion in pediatric patients. It is also supported by postmarketing adverse events surveillance (see CLINICAL PHARMACOLOGY, INDICATIONS AND USAGE, ADVERSE REACTIONS, DOSAGE AND ADMINISTRATION, and CLINICAL STUDIES).
Geriatric Use
Of the total number of subjects who received cefuroxime axetil in 20 clinical studies of Ceftin, 375 were 65 and older while 151 were 75 and older. No overall differences in safety or effectiveness were observed between these subjects and younger adult subjects.The geriatric patients reported somewhat fewer gastrointestinal events and less frequent vaginal candidiasis compared with patients aged 12 to 64 years old; however, no clinically significant differences were reported between the elderly and younger adult patients. Other reported clinical experience has not identified differences in responses between the elderly and younger adult patients.
Adverse Reactions
Ceftin TABLETS IN CLINICAL TRIALS
Multiple-Dose Dosing Regimens 7 to 10 Days DosingUsing multiple doses of cefuroxime axetil tablets, 912 patients were treated with cefuroxime axetil (125 to 500 mg twice daily). There were no deaths or permanent disabilities thought related to drug toxicity. Twenty (2.2%) patients discontinued medication due to adverse events thought by the investigators to be possibly, probably, or almost certainly related to drug toxicity. Seventeen (85%) of the 20 patients who discontinued therapy did so because of gastrointestinal disturbances, including diarrhea, nausea, vomiting, and abdominal pain. The percentage of cefuroxime axetil tablet-treated patients who discontinued study drug because of adverse events was very similar at daily doses of 1,000, 500, and 250 mg (2.3%, 2.1%, and 2.2%, respectively). However, the incidence of gastrointestinal adverse events increased with the higher recommended doses.
The following adverse events were thought by the investigators to be possibly, probably, or almost certainly related to cefuroxime axetil tablets in multiple-dose clinical trials (n = 912 cefuroxime axetil-treated patients).
Table 4. Adverse Reactions--Ceftin Tablets
Multiple-Dose Dosing Regimens--Clinical Trials
Incidence ≥1%
|
Diarrhea/loose stools 3.7%
Nausea/vomiting 3.0%
Transient elevation in AST 2.0%
Transient elevation in ALT 1.6%
Eosinophilia 1.1%
Transient elevation in LDH 1.0%
|
Incidence
<1% but >0.1%
|
Abdominal pain
Abdominal cramps
Flatulence
Indigestion
Headache
Vaginitis
Vulvar itch
Rash
Hives
Itch
Dysuria
Chills
Chest pain
Shortness of breath
Mouth ulcers
Swollen tongue
Sleepiness
Thirst
Anorexia
Positive Coombs test
|
5-Day Experience (see CLINICAL STUDIES)In clinical trials using Ceftin in a dose of 250 mg twice daily in the treatment of secondary bacterial infections of acute bronchitis, 399 patients were treated for 5 days and 402 patients were treated for 10 days. No difference in the occurrence of adverse events was found between the 2 regimens.
In Clinical Trials for Early Lyme Disease With 20 Days DosingTwo multicenter trials assessed cefuroxime axetil tablets 500 mg twice a day for 20 days. The most common drug-related adverse experiences were diarrhea (10.6% of patients), Jarisch-Herxheimer reaction (5.6%), and vaginitis (5.4%). Other adverse experiences occurred with frequencies comparable to those reported with 7 to 10 days dosing.
Single-Dose Regimen for Uncomplicated Gonorrhea
In clinical trials using a single dose of cefuroxime axetil tablets, 1,061 patients were treated with the recommended dosage of cefuroxime axetil (1,000 mg) for the treatment of uncomplicated gonorrhea. There were no deaths or permanent disabilities thought related to drug toxicity in these studies.
The following adverse events were thought by the investigators to be possibly, probably, or almost certainly related to cefuroxime axetil in 1,000-mg single-dose clinical trials of cefuroxime axetil tablets in the treatment of uncomplicated gonorrhea conducted in the United States.
Table 5. Adverse Reactions--Ceftin Tablets
1-g Single-Dose Regimen for Uncomplicated Gonorrhea—Clinical Trials
Incidence ≥1%
|
Nausea/vomiting 6.8%
Diarrhea 4.2%
|
Incidence
<1% but >0.1%
|
Abdominal pain
Dyspepsia
Erythema
Rash
Pruritus
Vaginal candidiasis
Vaginal itch
Vaginal discharge
Headache
Dizziness
Somnolence
Muscle cramps
Muscle stiffness
Muscle spasm of neck
Tightness/pain in chest
Bleeding/pain in urethra
Kidney pain
Tachycardia
Lockjaw-type reaction
|
Ceftin FOR ORAL SUSPENSION IN CLINICAL TRIALS
In clinical trials using multiple doses of cefuroxime axetil powder for oral suspension, pediatric patients (96.7% of whom were younger than 12 years of age) were treated with the recommended dosages of cefuroxime axetil (20 to 30 mg/kg/day divided twice a day up to a maximum dose of 500 or 1,000 mg/day, respectively). There were no deaths or permanent disabilities in any of the patients in these studies. Eleven US patients (1.2%) discontinued medication due to adverse events thought by the investigators to be possibly, probably, or almost certainly related to drug toxicity. The discontinuations were primarily for gastrointestinal disturbances, usually diarrhea or vomiting. During clinical trials, discontinuation of therapy due to the taste and/or problems with administering this drug occurred in 13 (1.4%) pediatric patients enrolled at centers in the United States.
The following adverse events were thought by the investigators to be possibly, probably, or almost certainly related to cefuroxime axetil for oral suspension in multiple-dose clinical trials (n = 931 cefuroxime axetil-treated US patients).
Table 6. Adverse Reactions—Ceftin for Oral Suspension
Multiple-Dose Dosing Regimens—Clinical Trials
Incidence ≥1%
|
Diarrhea/loose stools 8.6%
Dislike of taste 5.0%
Diaper rash 3.4%
Nausea/vomiting 2.6%
|
Incidence
<1% but >0.1%
|
Abdominal pain
Flatulence
Gastrointestinal infection
Candidiasis
Vaginal irritation
Rash
Hyperactivity
Irritable behavior
Eosinophilia
Positive direct Coombs test
Elevated liver enzymes
Viral illness
Upper respiratory infection
Sinusitis
Cough
Urinary tract infection
Joint swelling
Arthralgia
Fever
Ptyalism
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POSTMARKETING EXPERIENCE WITH Ceftin
In addition to adverse events reported during clinical trials, the following events have been identified during clinical practice in patients treated with Ceftin Tablets or with Ceftin for Oral Suspension and were reported spontaneously. Data are generally insufficient to allow an estimate of incidence or to establish causation.
GeneralThe following hypersensitivity reactions have been reported: Anaphylaxis, angioedema, pruritus, rash, serum sickness-like reaction, urticaria.
GastrointestinalPseudomembranous colitis (see WARNINGS).
HematologicHemolytic anemia, leukopenia, pancytopenia, thrombocytopenia, and increased prothrombin time.
HepaticHepatic impairment including hepatitis and cholestasis, jaundice.
NeurologicSeizure.
SkinErythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis.
UrologicRenal dysfunction.
CEPHALOSPORIN-CLASS ADVERSE REACTIONS
In addition to the adverse reactions listed above that have been observed in patients treated with cefuroxime axetil, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics: Toxic nephropathy, aplastic anemia, hemorrhage, increased BUN, increased creatinine, false-positive test for urinary glucose, increased alkaline phosphatase, neutropenia, elevated bilirubin, and agranulocytosis.
Several cephalosporins have been implicated in triggering seizures, particularly in patients with renal impairment when the dosage was not reduced (see DOSAGE AND ADMINISTRATION and OVERDOSAGE). If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated.
Overdosage
Overdosage of cephalosporins can cause cerebral irritation leading to convulsions. Serum levels of cefuroxime can be reduced by hemodialysis and peritoneal dialysis.
Ceftin Dosage and Administration
NOTE: Ceftin TABLETS AND Ceftin FOR ORAL SUSPENSION ARE NOT BIOEQUIVALENT AND ARE NOT SUBSTITUTABLE ON A MILLIGRAM-PER-MILLIGRAM BASIS (SEE CLINICAL PHARMACOLOGY).
Table 7. Ceftin Tablets
(May be administered without regard to meals.)
Population/Infection
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