Posology : מינונים

4.2       Posology and method of administration
Posology

Table 1. Adults and children ≥ 40 kg

Indication                             Dosage
Community acquired pneumonia and acute 750 mg every 8 hours exacerbations of chronic bronchitis    (intravenously or intramuscularly) Indication                                         Dosage
Soft-tissue infections: cellulitis, erysipelas and wound infections.

Intra-abdominal infections

Sinusitis, septic arthritis                     750 mg every 8 hours
(intravenously or intramuscularly). For more severe infections, this dose should be increased to 1.5g every 8 hours i.v. The frequency of i.m. or i.v. injections can be increased to six-hourly if necessary, giving total doses of
3g to 6g daily. Where clinically indicated, some infections respond to 750 mg or 1.5 g twice daily (i.v. or i.m.)
Complicated urinary tract infections, including 1.5 g every 8 hours pyelonephritis                                  (intravenously or intramuscularly) Severe infections                               750 mg every 6 hours (intravenously) 1.5 g every 8 hours (intravenously)

Surgical prophylaxis for gastrointestinal,           1.5 g with the induction of anaesthesia. This may be gynaecological surgery (including caesarean          supplemented with two 750 mg doses (intramuscularly) section) and orthopaedic operations                  after 8 hours and 16 hours Surgical prophylaxis for cardiovascular and          1.5 g with induction of anaesthesia followed by 750 mg oesophageal operations                               (intramuscularly) every 8 hours for a further 24 hours 
Table 2. Children < 40 kg

Infants and toddlers > 3           weeks Infants (birth to 3 weeks) and children < 40 kg
Community acquired pneumonia
Complicated         urinary    tract
30        to       100 mg/kg/day infections, including pyelonephritis
Soft-tissue infections: cellulitis,
(intravenously) given as 3 or 4 30        to      100 mg/kg/day erysipelas and wound infections      divided    doses;   a  dose   of (intravenously) given as 2 or 3 60 mg/kg/day is appropriate for divided doses (see section 5.2) most infections
Intra-abdominal infections

Sinusitis, septic arthritis           Doses of 30 to 100 mg/kg/day Doses of 30 to 100 mg/kg/day given as three or four divided given as two or three divided doses. A dose of 60mg/kg/day is doses.
appropriate for most infections.

Renal impairment
Cefuroxime is primarily excreted by the kidneys. Therefore, as with all such antibiotics, in patients with markedly impaired renal function it is recommended that the dosage of Zinacef should be reduced to compensate for its slower excretion.

Table 3. Recommended doses for Zinacef in renal impairment

Creatinine clearance                    T1/2 (hrs)               Dose (mg) > 20 mL/min/1.73 m2                     1.7–2.6                  It is not necessary to reduce the standard dose (750 mg to 1.5 g three times daily)

10-20 mL/min/1.73 m2                    4.3–6.5                  750 mg twice daily 
< 10 mL/min/1.73 m2                     14.8–22.3                750 mg once daily 

Patients on haemodialysis                3.75                   A further 750 mg dose should be given intravenously or intramuscularly at the end of each dialysis; in addition to parenteral use,
cefuroxime sodium can be incorporated into the peritoneal dialysis fluid (usually 250 mg for every 2 litres of dialysis fluid)

Patients   in   renal  failure   on      7.9–12.6               750 mg     twice  daily;    for    low-flux continuous            arteriovenous      (CAVH)                 haemofiltration  follow      the     dosage haemodialysis (CAVH) or high-flux        1.6 (HF)               recommended under impaired renal function haemofiltration (HF) in intensive therapy units

Hepatic impairment
Cefuroxime is primarily eliminated by the kidney. In patients with hepatic dysfunction this is not expected to affect the pharmacokinetics of cefuroxime.

Method of administration
Zinacef should be administered by intravenous injection over a period of 3 to 5 minutes directly into a vein or via a drip tube or infusion over 30 to 60 minutes, or by deep intramuscular injection. Intramuscular injections should be injected well within the bulk of a relatively large muscle and not more than 750 mg should be injected at one site. For doses greater than 1.5 g intravenous administration should be used. For instructions on reconstitution of the medicinal product before administration, see section 6.6.