Can Cefuroxime (Cefuroxime) cause hypotension?

Can Cefuroxime Cause Hypotension?

Yes, cefuroxime can cause hypotension, though it is not among the most commonly reported adverse effects of this second-generation cephalosporin antibiotic.

Evidence for Hypotension with Cefuroxime

The American College of Cardiology/American Heart Association guidelines specifically mention "perioperative hypotension" as a potential complication that can occur during surgical procedures, including when antibiotics like cefuroxime are used 1. Cefuroxime is listed in these guidelines as one of the cephalosporins used for prophylaxis in surgical settings.

In clinical practice, hypotension with cefuroxime may occur through several mechanisms:

1. Direct cardiovascular effects: While less common than with some other antibiotics, cephalosporins can occasionally cause cardiovascular effects including hypotension.

2. Hypersensitivity reactions: Severe allergic reactions to cephalosporins, though rare, can manifest as hypotension as part of anaphylaxis.

3. Administration-related factors: Rapid intravenous administration of cefuroxime may increase the risk of hypotension, particularly in critically ill patients.

Incidence and Risk Factors

The incidence of hypotension with cefuroxime appears to be low. Most studies and guidelines focus on other adverse effects such as:

• Gastrointestinal disturbances (diarrhea, nausea, vomiting) 2
• Hypersensitivity reactions (primarily skin manifestations)
• Clostridioides difficile infections

Risk factors that may increase the likelihood of hypotension with cefuroxime include:

• History of allergic reactions to beta-lactam antibiotics
• Rapid intravenous administration
• Pre-existing cardiovascular instability
• Concurrent use of other medications that can cause hypotension
• Critically ill patients, particularly those on continuous renal replacement therapy 3

Clinical Management

If hypotension occurs during cefuroxime administration:

1. Immediately stop the infusion
2. Assess for signs of anaphylaxis (urticaria, bronchospasm, angioedema)
3. Provide supportive care:
   • IV fluids
   • Vasopressors if needed
   • Antihistamines and corticosteroids if hypersensitivity is suspected
4. Consider alternative antibiotics from a different class if hypersensitivity is confirmed

Comparison to Other Cephalosporins

Cefuroxime's adverse effect profile is generally similar to other second-generation cephalosporins. The French Society of Anesthesia and Intensive Care Medicine includes cefuroxime among recommended prophylactic antibiotics for various surgical procedures, suggesting its cardiovascular safety profile is acceptable for most patients 1.

Conclusion

While hypotension is a potential adverse effect of cefuroxime, it is relatively uncommon compared to other side effects. Clinicians should be aware of this possibility, particularly when administering the drug intravenously to patients with pre-existing cardiovascular compromise or a history of drug allergies. Monitoring vital signs during initial administration is prudent, especially in high-risk patients.