When to choose Cefuroxime over Azithromycin?

From the Guidelines

Choose Cefuroxime over Azithromycin for infections that require a broader spectrum of antibacterial coverage, such as skin and soft tissue infections, or for patients with a history of macrolide resistance, as seen in cases of Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis 1.

Key Considerations

• Cefuroxime is typically prescribed at a dose of 250-500mg twice daily for 5-10 days, whereas Azithromycin is usually given as a 5-day course of 500mg on the first day, followed by 250mg daily.
• The choice between Cefuroxime and Azithromycin should be based on the specific infection, patient factors, and local resistance patterns, as outlined in guidelines for the management of community-acquired pneumonia in adults 1.
• Cefuroxime has better coverage against Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis, making it a preferred choice for infections caused by these pathogens 1.
• However, Azithromycin may be preferred for patients with a history of allergy to cephalosporins or for infections caused by atypical pathogens, such as Mycoplasma pneumoniae or Chlamydophila pneumoniae 1.

Important Factors

• Local resistance patterns and patient factors, such as history of macrolide resistance or allergy to cephalosporins, should be considered when choosing between Cefuroxime and Azithromycin 1.
• The duration of treatment and assessment of response should be based on the specific infection and patient factors, as outlined in guidelines for the management of community-acquired lower respiratory tract infections 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Choosing Cefuroxime over Azithromycin

• Cefuroxime is a second-generation cephalosporin with broad antimicrobial activity against both Gram-positive and Gram-negative organisms 2.
• It has excellent in vitro activity against staphylococcal strains, streptococcal strains, N. gonorrhoeae, H. influenzae, and N. meningitidis, making it a suitable choice for infections caused by these pathogens 2.
• Cefuroxime axetil, a prodrug of cefuroxime, has proven effective in treating upper and lower respiratory tract infections, genitourinary infections, skin and soft-tissue infections, and erythema migrans associated with early stage Lyme disease 3.
• In contrast, azithromycin is a macrolide antibiotic with an expanded spectrum against gram-negative bacilli, but its use may be limited by resistance patterns 4.
• A study comparing ceftriaxone plus azithromycin with levofloxacin for the treatment of hospitalized patients with moderate to severe community-acquired pneumonia found that the combination of a third-generation cephalosporin and a macrolide was at least as efficacious as monotherapy with a fluoroquinolone 5.
• However, when considering the treatment of uncomplicated skin and skin structure infections, azithromycin may be as effective as cefadroxil, a first-generation cephalosporin 6.
• Cefuroxime may be preferred over azithromycin in cases where:
  • The infection is caused by a pathogen that is resistant to azithromycin
  • The patient has a history of allergic reactions to macrolides
  • The infection requires a broader spectrum of antimicrobial activity
  • The patient has a compromised renal function, as cefuroxime is primarily excreted unchanged in the urine 2