Cefuroxime in the Treatment of Neonates

The new broad spectrum cephalosporin, cefuroxime, was used to treat 28 neonates with suspected or proved infection. All of them had had complications at birth or in early neonatal life which were known to predispose to infection. The treatment regimen consisted of intramuscular or intravenous cefuroxime (50 mg/kg twice a day) for 5 days. Previously, such infants would have received gentamicin with penicillin or ampicillin. Pathogenic or potentially pathogenic bacteria were isolated from 7 (25%) of them. All of these organisms were sensitive to cefuroxime. None of the babies had meningitis, but blood cultures from 2 gave positive results. There was significant clinical improvement in 27 of them after 5 days of treatment and each was well on discharge from hospital. Serum urea, total protein, albumin, and alanine transaminase levels were estimated before, during, and after cefuroxime treatment. There were no changes attributable to cefuroxime nor were any changes in haemoglobin, packed cell volume, or total differential white cell counts observed. There were no adverse clinical side effects. One hundred and ninety-four samples of serum were assayed for cefuroxime. The mean peak level after intramuscular injection (42.7 mg/l) was reached in 0.8 hours, and the mean trough level was 10.5 mg/l. The mean half-life of cefuroxime in infants aged less than 4 days was 5.8 hours. In 4 infants older than 8 days, it ranged from 1.6-3.8 hours. Half-life was not associated with birthweight. Cefuroxime is a safe, well-tolerated, and rapidly absorbed drug for the treatment of neonates with suspected or proved infections; it is a useful alternative to gentamicin, if the use of an aminoglycoside is not clearly indicated.