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Brand Name: Zinnat
Generic Name: Cefuroxime axetil
ZINNAT works by killing
bacteria that cause
ZINNAT belongs to a group
of medicines called
Cefuroxime is indicated for the treatment of the following mild to moderately severe infections
in adults caused by sensitive bacteria.
Acute upper respiratory infections: otitis media, sinusitis, tonsillitis and pharyngitis.
Acute exacerbations of chronic bronchitis, or acute bronchitis .
Skin and skin structure infections for example, furunculosis, pyoderma and impetigo.
Acute uncomplicated gonococcal urethritis, and cervicitis due to non-penicillinase producing
Patients with known hypersensitivity to cephalosporin antibiotics or who have experienced a
major allergy to penicillin (anaphylaxis, angioneurotic oedema, urticaria).
Serious and occasionally fatal hypersensitivity (anaphylactic/ anaphylactoid) reactions have
been reported in patients on penicillin/cephalosporin therapy. Although anaphylaxis is more
frequent following parenteral therapy, it has occurred in patients on oral
penicillins/cephalosporins. These reactions are more likely to occur in individuals with a history
of penicillin hypersensitivity and/or a history of sensitivity to multiple allergens. There have
been reports of individuals with a history of penicillin/cephalosporin hypersensitivity who have
experienced severe reactions when treated with a penicillin/cephalosporins. Past history of a
severe allergic reaction to penicillin/cephalosporin is a contraindication to the use of cefuroxime
axetil. Before initiating therapy with any penicillin/cephalosporin careful inquiry should be made
concerning previous hypersensitivity reactions to penicillins, cephalosporins, or other allergens.
If an allergic reaction occurs, cefuroxime axetil should be discontinued and the appropriate
therapy instituted. Serious anaphylactoid reactions require immediate emergency treatment
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with adrenaline. Oxygen, intravenous steroids, and airway management, including intubation,
should also be administered as indicated.
As with other antibiotics, prolonged use of cefuroxime axetil may result in the overgrowth of
non-susceptible organisms (eg Candida, Enterococci, Clostridium), which may require
interruption of treatment.
Antibiotic associated pseudomembranous colitis has been reported with many antibiotics
including cefuroxime axetil. A toxin produced by Clostridium difficile appears to be the primary
cause. The severity of the colitis may range from mild to life threatening. It is important to
consider this diagnosis in patients who develop diarrhoea or colitis in association with antibiotic
use (this may occur up to several weeks after cessation of antibiotic therapy). Mild cases
usually respond to drug discontinuation alone although cholestyramine may help by binding
the toxin in the colonic lumen. However, in moderate to severe cases appropriate therapy
with a suitable oral antibacterial agent effective against Clostridium difficile should be
considered. Fluids, electrolytes and protein replacement should be provided when indicated.
Drugs which delay peristalsis eg opiates and diphenoxylate with atropine (Lomotil) may
prolong and/or worsen the condition and should not be used.
Patients with Severe Renal Impairment: Dosage of cefuroxime should not exceed
500 mg per day and should be repeated after dialysis.
Use in the Elderly: The serum half life of cefuroxime is increased and pla sma levels raised
in elderly patients with declining renal function. No dosage reduction is necessary in such
patients at recommended dosages.
Use in Pregnancy: Pregnancy Category: B1
There is no experimental evidence of embryopathic or teratogenic effects attributable to
cefuroxime axetil. However, there is no clinical data on the use of cefuroxime axetil during
pregnancy. Therefore it should be administered during pregnancy only if such use is
Use in Lactation: Cefuroxime is excreted in human milk, and consequently caution should
be exercised when cefuroxime axetil is administered to a nursing mother.
It is recommended that either the glucose oxidase or hexokinase methods are used to
determine blood/plasma glucose levels in patients receiving cefuroxime axetil. This antibiotic
does not interfere in the alkaline picrate assay for creatinine.
Drugs such as ranitidine may result in a lower bioavailability of cefuroxime axetil compared
with that of the fasting state.
DOSAGE AND ADMINISTRATION:
The usual course of therapy with Zinnat tablets is 5 to 7 days for treatment of bronchitis, and
7 to 10 days for other infections.
Cefuroxime axetil should be taken after a light meal for optimum absorption.
Acute exacerbations of
chronic bronchitis - 250 mg to 500 mg twice daily
Acute bronchitis - 250 mg to 500 mg twice daily
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urethritis or cervicitis - single dose of 1 g
Other infections - 250 mg twice daily
Adverse reactions to cefuroxime axetil have been generally mild and transient in nature. The
drug was discontinued in 2.1% of cases, mainly due to diarrhoea/nausea.
The following adverse reactions to cefuroxime axetil have been reported in clinical trials.
However, the possibility of the occurrence of other adverse reactions, seen with the
cephalosporin class of antibiotics, should be borne in mind.
Diarrhoea, nausea, vomiting, abdominal discomfort, abdominal pain, flatulence, indigestion,
dry mouth, mouth ulcers, pseudomembranous colitis.
Transient elevations of AST, ALT and LDH
Eosinophilia, positive Coomb's test, increased coagulation time.
Rash, pruritus, urticaria
Patients with a history of delayed hypersensitivity to penicillin (but not a cephalosporin)
experienced delayed hypersensitivity reaction to cefuroxime axetil in 2.9% cases.
As with other cephalosporins, rare cases of severe hypersensitivity reactions, including
Stevens Johnsons Syndrome, erythema multiforme, toxic epidermal necrosis, drug fever,
serum sickness-like reaction and anaphylaxis have been reported with cefuroxime axetil.
Overdosage of cephalosporins can cause cerebral irritation leading to convulsions.
Serum levels of cefuroxime can be reduced by haemodialysis.
SHELF LIFE AND STORAGE CONDITIONS:
When stored below 30°C Zinnat tablets have a 3 year shelf life.