Merocef 250 mg

Indication:

Merocef 250 mg is indicated for the treatment of-

• Respiratory Tract Infections: Acute and chronic bronchitis, infected bronchiectasis, bacterial pneumonia, lung abscess, and post-operative chest infections.
• ENT Infections: Otitis media, sinusitis, tonsillitis, and pharyngitis.
• Urinary Tract Infections: Pyelonephritis, cystitis, and asymptomatic bacteriuria.
• Skin and Soft Tissue Infections: Furunculosis, pyoderma, and impetigo.
• Lyme Disease: Treatment of early Lyme disease and subsequent prevention of late complications.
• Surgical Prophylaxis: Prevention of infection during abdominal, pelvic, orthopedic, cardiac, and vascular surgeries.

Dogase & Adminstration:

Adults (Oral):

• Most Infections: 250 mg twice daily.
• Severe Respiratory Tract Infections/Pneumonia: 500 mg twice daily.
• Urinary Tract Infections: 125–250 mg twice daily.
• Lyme Disease: 500 mg twice daily for 14–21 days.

Children (Oral – Based on BNFC):

• 3 months to 2 years: 10 mg/kg (max 125 mg) twice daily.
• 2 to 12 years: 15 mg/kg (max 250 mg) twice daily.
• Over 12 years: Adult dose (usually 250 mg twice daily).

Administration: For optimal absorption, Cefuroxime axetil tablets and suspension should be taken with or immediately after food. Tablets should not be crushed or chewed as the bitter taste may reduce compliance.

Injection Uses Doses For Adults (18 years and above):

• General Infections: 750 mg every 8 hours by IM or IV injection.
• Severe Infections: 1.5 g every 6–8 hours by IV injection or infusion.
• Surgical Prophylaxis: * 1.5 g by IV injection at the time of induction of anesthesia.
  • This may be followed by 750 mg IV/IM every 8 hours for up to 24 hours depending on the surgery type.
• Meningitis: 3 g every 8 hours by IV injection.

For Children (Based on BNFC 2022-2023):

• Neonates (up to 7 days): 30–60 mg/kg daily in 2 divided doses.
• Neonates (7–28 days): 30–60 mg/kg daily in 3 divided doses.
• Infants and Children (1 month to 18 years):
  • Standard Dose: 20 mg/kg every 8 hours (Max 750 mg per dose).
  • Severe Infections: 40–50 mg/kg every 8 hours (Max 1.5 g per dose).
  • Bone/Joint Infections: 50 mg/kg every 8 hours (Max 1.5 g per dose).
  • Meningitis: 60–80 mg/kg every 6–8 hours (Max 3 g per dose).

 Administration (Injection)

• IV Injection: Reconstitute with water for injections and administer slowly over 3 to 5 minutes.
• IV Infusion: Can be diluted in compatible fluids (like Normal Saline or 5% Dextrose) and infused over 30 minutes.
• IM Injection: 750 mg should be dissolved in 3 mL of water for injections. Shake gently to produce an opaque suspension.

”রেজিস্ট্রার চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন”

Pharmacology:

• Mechanism of Action: Cefuroxime is a bactericidal agent. It works by interfering with the bacterial cell wall synthesis. It binds to essential penicillin-binding proteins (PBPs) located in the bacterial cell wall. This binding inhibits the transpeptidation enzyme, preventing the cross-linking of peptidoglycan chains, which are vital for bacterial cell wall strength and rigidity. Consequently, the bacterial cell wall becomes unstable, leading to cell lysis and death.
• Pharmacodynamics: Cefuroxime is highly stable against many bacterial beta-lactamases, which makes it effective against many strains that are resistant to ampicillin or amoxicillin.
• Pharmacokinetics: After oral administration as Cefuroxime Axetil, it is absorbed from the gastrointestinal tract and rapidly hydrolyzed in the intestinal mucosa and blood to release cefuroxime. Absorption is enhanced when taken with food. It is widely distributed in body fluids and excreted unchanged in the urine.

Side Effects:

• Common: Diarrhea, nausea, vomiting, and temporary increase in liver enzymes.
• Hypersensitivity: Skin rashes, urticaria, and pruritus.
• Rare: Pseudomembranous colitis and eosinophilia.

Drug Interaction:

• Antacids/H2 Blockers: May reduce the bioavailability of cefuroxime axetil.
• Probenecid: Increases the plasma concentration of cefuroxime.
• Oral Contraceptives: May decrease the effectiveness of oral contraceptives.
• Warfarin: May increase the anticoagulant effect (INR level).

Pregnancy & Lactation:

• Pregnancy: Generally considered safe (Category B). Use only if strictly indicated.
• Lactation: Cefuroxime is excreted in breast milk in small amounts. Use with caution; monitor the infant for diarrhea or fungal infection.

Over Dosage:

Overdose can cause cerebral irritation resulting in convulsions. Treatment is supportive. Cefuroxime levels can be reduced by hemodialysis.

Therapeutic Class:

Second-generation Cephalosporin; Beta-lactam Antibiotic.

Storage Conditions:

Store tablets and dry powder at room temperature (below 30°C). Reconstituted oral suspension should be stored in a refrigerator (2–8°C) and used within 10 days.