Cefuroxime (Zinacef) is the first of a series of α-methoximinoacyl–substituted cephalosporins that constitute most of thethird-generation agents available for clinical use. A syn alkoximinosubstituent is associated with β-lactamase stability in these cephalosporins.78 Cefuroxime is classified as a secondgenerationcephalosporin because its spectrum of antibacterialactivity more closely resembles that of cefamandole. It is,however, active against β-lactamase–producing strains thatare resistant to cefamandole, such as E. coli, K. pneumoniae,N. gonorrhoeae, and H. influenzae. Other important Gramnegativepathogens, such as Serratia, indole-positive Proteusspp., P. aeruginosa, and B. fragilis, are resistant.Cefuroxime is distributed throughout the body. It penetratesinflamed meninges in high enough concentrations tobe effective in meningitis caused by susceptible organisms.Three-times-daily dosing is required to maintain effectiveplasma levels for most sensitive organisms, such asNeisseria meningitidis, Streptococcus pneumoniae, and H.influenzae. It has a plasma half-life of 1.4 hours.
