Alkem

Patient No *

Patient Initials *

Date of Enrollment *

Investigator *

Site *

Patient ID *

Gender *

Male Female

Age (in Years) *

Gender *

Male Female

Comorbidities (Specify) *

Diagnosis at Admission *

Upper Respiratory Tract Infection (URTI) Lower Respiratory Tract Infection (LRTI) Skin and Soft Tissue Infection (SSTI) Urinary Tract Infection (UTI) Intra-Abdominal Infection (IAI) Bone Infection

Clinical Presentation *

Symptoms at Admission (Specify) *

Severity of Symptoms *

Mild Moderate Severe

Microbiology Results

Pathogen(s) Identified (if available)

Susceptibility Patterns (if available)

Treatment Regimen *

Cefuroxime Dose *

Route of Administration *

Oral IV

Duration of Treatment *

Clinical Response to Cefuroxime Therapy*

Resolution of Symptoms *

Yes No

Time to Symptom Improvement*

Need for Additional Therapy *

Yes No

Adverse Events

Any Adverse Events *

Yes No

Description of Adverse Events

Mortality (If any)

Additional Comments

CEF

Demographic Information