What is Cefuroxime (Cefuroxime axetil, a second-generation Cephalosporin antibiotic)?

From the Guidelines

Cefuroxime is a second-generation cephalosporin antibiotic used to treat various bacterial infections, with a recommended dose of 500 mg twice daily for 14 days in the treatment of early localized or early disseminated Lyme disease associated with erythema migrans, as stated in the guidelines by the Infectious Diseases Society of America 1.

Key Points

• Cefuroxime axetil is the oral form of cefuroxime, with a dosage of 500 mg twice daily for adults and 30 mg/kg per day in 2 divided doses for children, as outlined in the guidelines 1.
• The treatment duration for Lyme disease is usually 14 days, but may vary depending on the infection type and severity, with some cases requiring up to 28 days of treatment 1.
• Cefuroxime works by inhibiting bacterial cell wall synthesis, making it effective against many gram-positive and some gram-negative bacteria, including those that cause Lyme disease 1.
• Common side effects of cefuroxime include diarrhea, nausea, and skin rash, and patients should complete the full course of treatment even if symptoms improve before completion 1.
• Those with penicillin allergies should use caution as cross-reactivity can occur, and cefuroxime should be taken with food to enhance absorption and reduce stomach upset 1.

Important Considerations

• Cefuroxime is ineffective against viral infections like the common cold or flu, and should only be used to treat bacterial infections 1.
• First-generation cephalosporins, such as cephalexin, are ineffective for treatment of Lyme disease and should not be used, as stated in the guidelines 1.
• Macrolide antibiotics are not recommended as first-line therapy for early Lyme disease, but may be used in patients who are intolerant of or should not take amoxicillin, doxycycline, and cefuroxime axetil 1.

From the FDA Drug Label

Cefuroxime is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis. Cefuroxime has activity in the presence of some beta-lactamases, both penicillinases and cephalosporinases, of Gram-negative and Gram-positive bacteria Cefuroxime, USP is a sterile semisynthetic, broad-spectrum, cephalosporin antibiotic for parenteral administration.

Cefuroxime (Cefuroxime axetil, a second-generation Cephalosporin antibiotic) is a bactericidal agent that works by inhibiting bacterial cell wall synthesis. It is a semisynthetic, broad-spectrum, cephalosporin antibiotic effective against Gram-negative and Gram-positive bacteria 2 2.

• Key characteristics:
  • Mechanism of action: inhibition of bacterial cell wall synthesis
  • Antibacterial spectrum: broad-spectrum, effective against Gram-negative and Gram-positive bacteria
  • Classification: second-generation Cephalosporin antibiotic

From the Research

Definition and Classification of Cefuroxime

• Cefuroxime is a second-generation cephalosporin antibiotic, obtained from the 7-cephalosporanic acid nucleus of cephalosporin C 3.
• It is a semi-synthetic cephalosporin with a broad spectrum of antimicrobial activity against both Gram-positive and Gram-negative organisms 4.

Mechanism of Action and Antimicrobial Activity

• Cefuroxime has excellent in vitro activity against staphylococcal strains, streptococcal strains (other than enterococci), N. gonorrhoeae, H. influenzae, and N. meningitidis 4.
• It is active against members of the Enterobacteriaceae, with the exception of Serratia and indole-positive Proteus, but Ps. aeruginosa and B. fragilis are resistant 4.
• Cefuroxime axetil, the acetoxyethyl ester of cefuroxime, has proven in vitro antibacterial activity against several Gram-positive and Gram-negative organisms, including those most frequently associated with various common community-acquired infections 5.

Pharmacokinetic Properties

• The maximum plasma concentration of cefuroxime after oral administration of 250 mg and 500 mg of cefuroxime axetil after a meal are respectively 4.6 and 7.9 mg/l 3.
• The absolute bioavailability of tablets is 68% (extremes 63-73%) after oral administration of 500 mg cefuroxime axetil 3.
• Cefuroxime is metabolically stable, and most of it is excreted unchanged in the urine, with three fourths of it distributed in the extravascular compartment 4.

Therapeutic Efficacy and Indications

• Cefuroxime axetil is indicated for the treatment of infections caused by susceptible bacteria, including lower respiratory tract infections, upper respiratory tract infections, genito-urinary tract infections, and skin and soft tissue infections 3.
• It has been shown to be effective in the treatment of community-acquired pneumonia, otitis media, pharyngitis, sinusitis, and acute exacerbations of chronic bronchitis 5, 6.
• Cefuroxime axetil may be considered as an empirical therapy for a range of community-acquired infections, including those in which beta-lactamase-producing strains of common respiratory pathogens are identified as the causative organisms 5.

Adverse Reactions and Safety

• Adverse reactions to cefuroxime have generally been mild and transient in nature, including gastrointestinal disturbances, such as diarrhea, nausea, and vomiting 3, 5.
• Cefuroxime axetil is well tolerated by adult and pediatric patients, with adverse effects that are consistent with those of other cephalosporins 5.