Dosage of Tpoxim in details
Tablet: The usual course of therapy is seven days (range 5 to 10 days).
Tpoxim axetil (Tpoxim) should be taken after food for optimum absorption.
Sequential Therapy: Pneumonia: 1.5 g Tpoxim sodium (Tpoxim) three times a day or twice a day [intravenous (i.v.) or intramuscular (i.m.)] for 48 to 72 hours, followed by Tpoxim axetil (Tpoxim) oral therapy 500 mg twice a day for 7 to10 days.
Acute Exacerbations of Chronic Bronchitis: 750 mg Tpoxim sodium (Tpoxim) three times a day or twice a day (i.v. or i.m.) for 48 to 72 hours, followed by Tpoxim axetil (Tpoxim) oral therapy 500 mg twice a day for 5 to 10 days.
Duration of both parenteral and oral therapy is determined by the severity of the infection and the clinical status of the patient.
Tpoxim axetil (Tpoxim) tablets should not be crushed and are therefore unsuitable for treatment of patients, such as younger children, who cannot swallow tablets. In children Tpoxim axetil (Zinnat) oral suspension may be used.
There is no experience of using Tpoxim axetil (Zinnat) in children under the age of 3 months.
Injection: Tpoxim (as sodium) (Tpoxim) Injection is for intravenous (i.v.) and/or intramuscular (i.m.) administration. Tpoxim (as sodium) (Tpoxim) is also available as the axetil ester Tpoxim (as axetil) (Zinnat) for oral administration. This permits the use of sequential therapy with the same antibiotic, when a change from parenteral to oral therapy is clinically indicated.
No more than 750 mg should be injected at one intramuscular site.
General Dosing Recommendations: Adults: Many infections respond to 750 mg three times daily by i.m. or i.v. injection. For more severe infections the dose should be increased to 1.5 g three times daily given i.v. The frequency of administration may be increased to 6-hourly if necessary, giving total daily doses of 3 to 6 g. Where clinically indicated, some infections respond to 750 mg or 1.5 g twice daily (i.v. or i.m.) followed by oral therapy with Tpoxim (as axetil) (Zinnat).
Infants and Children: 30 to 100 mg/kg/day given as 3 or 4 divided doses. A dose of 60 mg/kg/day is appropriate for most infections.
Neonates: 30 to 100 mg/kg/day given as 2 or 3 divided doses..
Gonorrhea: Adults: 1.5 g as a single dose (as 2 x 750 mg injections given i.m. with different sites e.g. each buttock).
Meningitis: Tpoxim (as sodium) (Tpoxim) is suitable for sole therapy of bacterial meningitis due to sensitive strains.
Adults: 3 g given i.v. every 8 hours.
Infants and Children: 150 to 250 mg/kg/day given i.v. in 3 or 4 divided doses
Neonates: The dosage should be 100 mg/kg/day given i.v.
Prophylaxis: The usual dose is 1.5 g given i.v. with induction of anaesthesia for abdominal, pelvic and orthopaedic operations. This may be supplemented with two 750 mg i.m. doses 8 and 16 hours later.
In cardiac, pulmonary, oesophageal and vascular operations, the usual dose is 1.5 g given i.v. with induction of anaesthesia, continuing with 750 mg given i.m. three times daily for a further 24 to 48 hours.
In total joint replacement, 1.5 g Tpoxim (as sodium) (Tpoxim) powder may be mixed dry with each pack of methyl methacrylate cement polymer before adding the liquid monomer.
Sequential Therapy: Adults: Duration of both parenteral and oral therapy is determined by the severity of the infection and the clinical status of the patient.
Pneumonia: 1.5 g Tpoxim (as sodium) (Tpoxim) three times daily or twice daily (given i.v. or i.m.) for 48 to 72 hours, followed by 500 mg twice daily Tpoxim (as axetil) (Zinnat) (Tpoxim axetil) oral therapy for 7 to 10 days.
Acute Exacerbations of Chronic Bronchitis: 750 mg Tpoxim (as sodium) (Tpoxim) three times daily or twice daily (given i.v. or i.m.) for 48 to 72 hours, followed by 500 mg twice daily Tpoxim (as axetil) (Zinnat) (Tpoxim axetil) oral therapy for 5 to 10 days.
Renal Impairment: Tablet: Tpoxim is primarily excreted by the kidneys. In patients with markedly impaired renal function it is recommended that the dosage of Tpoxim be reduced to compensate for its slower excretion.
Tpoxim is also available as the axetil ester for oral administration. This permits parenteral therapy with Tpoxim to be followed by oral therapy in situations where a change from parenteral to oral is clinically indicated.
Injection: Tpoxim is excreted by the kidneys. Therefore, as with all such antibiotics, in patients with markedly impaired renal function it is recommended that the dosage of Tpoxim (as sodium) (Tpoxim) should be reduced to compensate for its slower excretion.
It is not necessary to reduce the standard dose (750 mg to 1.5 g three times daily) until the creatinine clearance falls to 20 mL/min or below.
In adults with marked impairment (creatinine clearance 10 to 20 mL/min) 750 mg twice daily is recommended and with severe impairment (creatinine clearance <10 mL/min) 750 mg once daily is adequate.
For patients on haemodialysis a further 750 mg dose should be given i.v. or i.m. at the end of each dialysis. In addition to parenteral use, Tpoxim (as sodium) (Tpoxim) can be incorporated into the peritoneal dialysis fluid (usually 250 mg for every 2 litres of dialysis fluid).
For patients in renal failure on continuous arteriovenous haemodialysis or high-flux haemofiltration in intensive therapy units a suitable dosage is 750 mg twice daily. For low-flux haemofiltration follow the dosage recommended under impaired renal function.
What other drugs will affect Tpoxim?
Tell your doctor about all your other medicines, especially:
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probenecid;
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a diuretic or "water pill";
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a blood thinner--warfarin, Coumadin, Jantoven; or
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a stomach acid reducer--esomeprazole, famotidine, Nexium, Pepcid, Prevacid, Prilosec, Tagamet, Zantac, and others.
This list is not complete. Other drugs may affect Tpoxim, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Tpoxim drug interactions (more detail)
Tpoxim interactions
Probenecid: Probenecid, when given together or right before administration with Tpoxim, slows down tubular secretion of Tpoxim and produces higher and more prolonged serum Tpoxim concentrations. This drug interaction is usually used beneficially in treating gonorrhea.
Tpoxim's peak serum concentrations and t½ are increased by up to 30% with concomitant administration of probenecid. Area under the concentration-time curve of Tpoxim is also increased by 50%. A decrease in Tpoxim's apparent volume of distribution by about 20% has been reported with concurrent administration of probenecid.
Aminoglycosides: The risk of nephrotoxicity may increase when aminoglycosides and cephalosphorins are given concomitantly. This has not been reported with Tpoxim use to date. Monitoring of the patient's renal function is advisable when these drugs are given together.
Diuretics: Studies suggest that the concomitant use of potent diuretics, including furosemide and ethacrynic acid, may increase the risk of renal toxicity with cephalosphorins. Renal impairment has been reported with concurrent treatment with potent diuretics eg, furosemide or aminoglycosides.
Oral Antacids:
These drugs may result in lower bioavailability of Tpoxim compared with that of the fasting state and tend to cancel the effect of enhanced postprandial absorption.Oral Contraceptives:
As with other antibacterial agents, Tpoxim may affect the gut flora, leading to lower estrogen reabsorption and reduced efficacy of combined oral contraceptives.Interference with Laboratory Tests: A false-positive reaction for glucose in the urine may occur with copper reduction tests (Benedict's or Fehling's solution, or with Clinitest tablets) but not with enzyme-based tests for glycosuria. As a false-negative result may occur in the ferricyanide test, it is recommended that either the glucose oxidase or hexokinase method be used to determine blood plasma glucose levels in patients receiving Tpoxim.
Positive direct antiglobulin (Coombs') test results have also been reported in a few patients receiving oral Tpoxim, however, it is not clear whether the mechanism of this reaction is immunologic in nature. This phenomenon can interfere with cross matching of blood.
References
- FDA/SPL Indexing Data. "O1R9FJ93ED: The UNique Ingredient Identifier (UNII) is an alphanumeric substance identifier from the joint FDA/USP Substance Registration System (SRS).". https://www.fda.gov/ForIndustry/Data... (accessed September 17, 2018).
- MeSH. "Anti-Bacterial Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
- European Chemicals Agency - ECHA. "Cefuroxime: The information provided here is aggregated from the "Notified classification and labelling" from ECHA's C&L Inventory. ". https://echa.europa.eu/information-o... (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Tpoxim are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Tpoxim. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
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Information checked by Dr. Sachin Kumar, MD Pharmacology
