Is Cefuroxime effective for pneumonia coverage?

From the Guidelines

Cefuroxime is effective for pneumonia coverage, particularly for community-acquired pneumonia, as it is listed as a preferred or alternative treatment option in several guidelines, including those from the British Infection Society and the Infectious Diseases Society of America 1. Cefuroxime is typically given at a dose of 500 mg orally twice daily for 7-14 days for outpatient treatment of pneumonia. For more severe cases requiring hospitalization, intravenous dosing of 750 mg to 1.5 g every 8 hours may be used. Some key points to consider when using cefuroxime for pneumonia coverage include:

• Cefuroxime is effective against many common pneumonia-causing bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
• Cefuroxime may not cover atypical pathogens like Mycoplasma pneumoniae or Legionella, and may need to be combined with a macrolide antibiotic for broader coverage.
• Cefuroxime is not effective against methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa, which can cause pneumonia in certain populations.
• Local resistance patterns and patient risk factors should always be considered when selecting antibiotics for pneumonia. It's worth noting that the most recent and highest quality study, published in 2007 by the Infectious Diseases Society of America and the American Thoracic Society, recommends cefuroxime as a treatment option for community-acquired pneumonia, particularly for patients with non-severe disease and no risk factors for infection with drug-resistant Streptococcus pneumoniae (DRSP) or gram-negative pathogens 1.

From the FDA Drug Label

Cefuroxime for Injection, USP is indicated for the treatment of patients with infections caused by susceptible strains of the designated organisms in the following diseases: Lower Respiratory Tract Infections, including pneumonia, caused by Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), Klebsiella spp., Staphylococcus aureus (penicillinase- and non–penicillinase-producing strains), Streptococcus pyogenes, and Escherichia coli.

Cefuroxime is effective for pneumonia coverage against certain organisms, including:

• Streptococcus pneumoniae
• Haemophilus influenzae (including ampicillin-resistant strains)
• Klebsiella spp.
• Staphylococcus aureus (penicillinase- and non–penicillinase-producing strains)
• Streptococcus pyogenes
• Escherichia coli 2 2

From the Research

Efficacy of Cefuroxime for Pneumonia Coverage

• Cefuroxime has been recommended as a component of treatment for community-acquired pneumonia (CAP) in guidelines produced by several groups, including the US and British Thoracic Societies 3.
• It is effective in vitro against the major bacterial pathogens in CAP, but it needs to be given with an agent that is active against Mycoplasma, Chlamydia or Legionella spp. if the presence of any of these organisms is suspected 3.
• Cefuroxime penetrates respiratory tissue effectively after either parenteral or oral administration, and it has a pharmacodynamic profile which suggests that adequate cover can be achieved with oral therapy for respiratory pathogens susceptible to cefuroxime concentrations of 4 mg/L or less 3.

Clinical Experience with Cefuroxime

• Clinical experience in the treatment of bacterial pneumonia, of varying severity, in children has shown that cefuroxime can be used either orally or parenterally, and it is approved in many countries for the treatment of adult pneumonia by either route 3.
• Studies have demonstrated the efficacy of cefuroxime axetil in the treatment of community-acquired pneumonia or acute bronchitis in adults 4, 5.
• Cefuroxime axetil has been shown to be as effective as amoxicillin/clavulanic acid in the treatment of outpatients with mild to moderate community-acquired pneumonia 5.

Comparison with Other Antibiotics

• A study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in the treatment of adults with community-acquired pneumonia found that levofloxacin was superior to ceftriaxone and/or cefuroxime axetil in terms of clinical success and bacteriologic eradication rates 6.
• However, other studies have found that cefuroxime axetil is as effective as other antibiotics, such as amoxicillin/clavulanic acid, in the treatment of community-acquired pneumonia 4, 5.