From the Guidelines
Cefuroxime is not the first-line treatment for cellulitis, especially when methicillin-resistant Staphylococcus aureus (MRSA) is suspected or confirmed. According to the most recent guidelines, for nonpurulent cellulitis, a 5- to 6-day course of antibiotics active against streptococci is recommended, particularly for patients able to self-monitor and who have close follow-up with primary care 1. For empirical coverage of CA-MRSA in outpatients with skin and soft tissue infections (SSTIs), oral antibiotic options include clindamycin, trimethoprim-sulfamethoxazole, a tetracycline (doxycycline or minocycline), and linezolid 1. Cefuroxime, a second-generation cephalosporin antibiotic, is effective against common cellulitis-causing organisms such as Streptococcus and Staphylococcus species, including some methicillin-sensitive Staphylococcus aureus (MSSA), but it is not effective against MRSA. The usual treatment duration for cellulitis is 5-10 days, depending on the severity and clinical response, and patients should complete the full course of antibiotics even if symptoms improve before completion to prevent recurrence and antibiotic resistance. Some key points to consider when treating cellulitis include:
- The use of rifampin as a single agent or as adjunctive therapy for the treatment of SSTI is not recommended 1.
- For hospitalized patients with complicated SSTI, empirical therapy for MRSA should be considered pending culture data, and options include intravenous vancomycin, linezolid, daptomycin, telavancin, and clindamycin 1.
- Cultures from abscesses and other purulent SSTIs are recommended in patients treated with antibiotic therapy, patients with severe local infection or signs of systemic illness, patients who have not responded adequately to initial treatment, and if there is concern for a cluster or outbreak 1. Given the potential for MRSA and the need for effective treatment, it is essential to choose an antibiotic that covers both streptococci and MRSA, such as clindamycin or trimethoprim-sulfamethoxazole, especially in cases where MRSA is suspected or confirmed.
From the FDA Drug Label
Skin and Skin-Structure Infections caused by Staphylococcus aureus (penicillinase- and non–penicillinase-producing strains), Streptococcus pyogenes, Escherichia coli, Klebsiella spp., and Enterobacter spp. Clinical microbiological studies in skin and skin-structure infections frequently reveal the growth of susceptible strains of both aerobic and anaerobic organisms Cefuroxime for Injection, USP has been used successfully in these mixed infections in which several organisms have been isolated
Cefuroxime is effective for treating cellulitis, which is a type of skin and skin-structure infection. The drug label indicates that cefuroxime is indicated for the treatment of skin and skin-structure infections caused by susceptible strains of various organisms, including Staphylococcus aureus and Streptococcus pyogenes, which are common causes of cellulitis 2.
From the Research
Effectiveness of Cefuroxime for Cellulitis
- Cefuroxime has a broad spectrum of in vitro antibacterial activity, including methicillin-sensitive staphylococci and common respiratory pathogens 3.
- However, there is limited direct evidence on the effectiveness of cefuroxime for treating cellulitis.
- A study on cefdinir vs. cephalexin for mild to moderate uncomplicated skin and skin structure infections, including cellulitis, found that both treatments had similar clinical cure rates, but the study did not specifically evaluate cefuroxime 4.
- Another study compared cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis and found no significant difference in treatment success rates, suggesting that coverage for CA-MRSA may not be necessary for non-purulent cellulitis 5, 6.
- A review of cefuroxime axetil's antibacterial activity, pharmacokinetic properties, and therapeutic efficacy found it to be effective for a wide range of infections, including skin infections, but did not specifically address cellulitis 3.
- A study on empiric outpatient therapy with trimethoprim-sulfamethoxazole, cephalexin, or clindamycin for cellulitis found that trimethoprim-sulfamethoxazole had a higher treatment success rate than cephalexin, but cefuroxime was not evaluated 7.
Spectrum of Activity
- Cefuroxime has activity against methicillin-sensitive staphylococci, but its effectiveness against CA-MRSA is unclear 3.
- The rise of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the empirical antimicrobial treatment of cellulitis, and cefuroxime's spectrum of activity may not be sufficient to cover CA-MRSA 5, 7.