Indications: surgical prophylaxis; more active against Haemophilus influenzae; Lyme disease mild to moderate lower respiratory-tract infections (e.g. bronchitis); doubled for more severe lower respiratory-tract infections or if pneumonia suspected Urinary-tract infection Open fractures, prophylaxis.

Cautions: sensitivity to beta-lactam antibacterial (avoid if history of immediate hypersensitivity reaction); false positive urinary glucose (if tested for reducing substances) and false positive Coombs' test.

Contra-indications: cephalosporin hypersensitivity Renal impairment no dose adjustment required— manufacturer advises caution.

Pregnancy not known to be harmful.

Breast-feeding present in milk in low concentration, but appropriate to use.

Side Effects: diarrhoea (rarely antibiotic-associated colitis), nausea and vomiting, abdominal discomfort, headache; allergic reactions including rashes, pruritus, urticaria, serum sickness-like reactions with rashes, fever and arthralgia, and anaphylaxis; Stevens-Johnson syndrome, toxic epidermal necrolysis reported; disturbances in liver enzymes, transient hepatitis and cholestatic jaundice; other side effects reported include eosinophilia and blood disorders (including thrombocytopenia, leucopenia, agranulocytosis, aplastic anaemia and haemolytic anaemia); reversible interstitial nephritis, hyperactivity, nervousness, sleep disturbances, hallucinations, confusion, hypertonia, and dizziness Dose: By mouth (as cefuroxime axetil), 250 mg twice daily in most infections including mild to moderate lower respiratory-tract infections (e.g. bronchitis); doubled for more severe lower respiratory-tract infections or if pneumonia suspected Urinary-tract infection, 125 mg twice daily, doubled in pyelonephritis child over 3 months, 125 mg twice daily, if necessary doubled in child over 2 years with otitis media Lyme disease, adult and child over 12 years, 500 mg twice daily for 14–21 days (for 28 days in Lyme arthritis) [unlicensed duration] By intramuscular injection or intravenous injection or infusion, 750 mg every 6–8 hours; 1.5 g every 6–8 hours in severe infections; single doses over 750 mg intravenous route only child usual dose 60 mg/kg daily (range 30–100 mg/kg daily) in 3–4 divided doses (2–3 divided doses in neonates) Surgical prophylaxis, 1.5 g by intravenous injection up to 30 minutes before the procedure; up to 3 further doses of 750 mg may be given by intramuscular or intravenous injection every 8 hours for high-risk procedures Open fractures, prophylaxis, by intravenous injection or infusion, 1.5 g every 8 hours until soft-tissue closure (max. duration 72 hours).