Zinnat^™

Presentation

Zinnat Tablets 125mg are white, film-coated, capsule-shaped tablets engraved GXES5 on one side and plain on the other. Each tablet contains cefuroxime 125mg (as cefuroxime axetil).

Zinnat Tablets 250mg are white, film-coated, capsule-shaped tablets engraved GXES7 on one side and plain on the other. Each tablet contains cefuroxime 250mg (as cefuroxime axetil).

Uses

Zinnat is an oral prodrug of the bactericidal cephalosporin antibiotic cefuroxime, which is resistant to most - lactamases and is active against a wide range of Gram-positive and Gram-negative organisms.

It is indicated for the treatment of infections caused by sensitive bacteria.

Indications include:
Upper respiratory tract infections for example, ear, nose and throat infections, such as otitis media, sinusitis, tonsillitis and pharyngitis.
Lower respiratory tract infections for example, pneumonia, acute bronchitis, and acute exacerbations of chronic bronchitis.
Genito-urinary tract infections for example, pyelonephritis, cystitis and urethritis.

Skin and soft-tissue infections for example, furunculosis, pyoderma, and impetigo.

Gonorrhoea, acute uncomplicated gonococcal urethritis and cervicitis.

Cefuroxime is also available as the sodium salt (Zinacef) for parenteral administration. This permits the use of sequential therapy with the same antibiotic, when a change from parenteral to oral therapy is clinically indicated.

Where appropriate Zinnat is effective when used following initial parenteral Zinacef (cefuroxime sodium) in the treatment of pneumonia and acute exacerbations of chronic bronchitis.

Dosage and administration
The usual course of therapy is 7 days (Range 5 - 10 days).
Zinnat should be taken after food for optimum absorption.

Adults:
Most infections - 250mg twice daily

Urinary tract infections - 125mg twice daily

Mild to moderate lower tract infections e.g. bronchitis - 250mg twice daily

More severe lower tract infections, or if pneumonia is suspected - 500mg twice daily

Pyelonephritis - 250mg twice daily

Uncomplicated gonorrhoea - single dose of 1g

Sequential therapy:
Pneumonia:
1.5g Zinacef tds or bd (IV or IM) for 48 - 72 hours followed by 500 mg bd Zinnat (cefuroxime axetil) oral therapy for 7 - 10 days.

Acute exacerbations of chronic bronchitis:
750mg Zinacef tds or bd (IV or IM) for 48 - 72 hours, followed by 500mg bd Zinnat (cefuroxime axetil) oral therapy for 5 - 10 days.

Duration of both parenteral and oral therapy is determined by the severity of the infection and the clinical status of the patient.

Children:
Most infections - 125mg (1 x 125mg tablet) twice daily, to a maximum of 250mg daily.

Children aged two years or older with otitis media or where appropriate, with more severe infections250mg (1 x 250mg tablet or 2 x 125mg tablets) twice daily, to a maximum of 500mg daily.

Zinnat Tablets should not be crushed and are therefore unsuitable for treatment of patients, such as younger children, who cannot swallow tablets. In children Zinnat Oral suspension may be used.

There is no experience of using Zinnat in children under the age of 3 months.

Contra-indications
Patients with known hypersensitivity to cephalosporin antibiotics.

Warnings and precautions
Special care is indicated in patients who have experienced an allergic reaction to penicillins or other betalactams.

As with other antibiotics, prolonged use of cefuroxime axetil may result in the overgrowth of nonsusceptible organisms (eg. Candida, Enterococci, Clostridium difficile), which may require interruption of treatment.

Pseudomembranous colitis has been reported with the use of broad-spectrum antibiotics, therefore, it is important to consider its diagnosis in patients who develop serious diarrhoea during or after antibiotic use. With a sequential therapy regime the timing of change to oral therapy is determined by the severity of the infection, clinical status of the patient and susceptibility of the pathogens involved. If there is no clinical improvement within 72 hours, then the parenteral course of treatment must be continued.

Please refer to the relevant prescribing information for Zinacef before initiating sequential therapy.

Pregnancy and lactation.
There is no experimental evidence of embryopathic or teratogenic effects attributable to Zinnat but, as with all drugs, it should be administered with caution during the early months of pregnancy.

Cefuroxime is excreted in human milk, and consequently caution should be exercised when Zinnat is administered to a nursing mother.

Effects on ability to drive and operate machinery

None reported.

Drug interactions
Drugs which reduce gastric acidity may result in a lower bioavailability of Zinnat compared with that of the fasting state and tend to cancel the effect of enhanced post-prandial absorption.

As a false negative result may occur in the ferricyanide test, it is recommended that either the glucose oxidase or hexokinase methods are used to determine blood/plasma glucose levels in patients receiving Zinnat. This antibiotic does not interfere in the alkaline picrate assay for creatinine.

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