Can fever and diaphoresis be a result of cefuroxime (Cefuroxime) therapy?

Fever and Diaphoresis as Potential Side Effects of Cefuroxime

Yes, fever and diaphoresis can occur as adverse reactions to cefuroxime therapy, although they are not among the most common side effects. 1

Evidence on Cefuroxime and Fever

According to the European Position Paper on Rhinosinusitis and Nasal Polyps (2020), clinical trials comparing cefuroxime to other antibiotics have documented fever as a potential side effect:

• In a study by Namyslowski et al. involving 231 patients with chronic rhinosinusitis or acute exacerbation of CRS, fever was observed in some patients treated with cefuroxime, although the difference was not statistically significant compared to the amoxicillin/clavulanate group (0% vs. 11%) 1

• Adverse events were observed in 9.5% of patients in the cefuroxime-treated group, with diarrhea being the most common adverse event 1

Mechanism and Risk Factors

The mechanism behind cefuroxime-induced fever and diaphoresis likely involves:

• Hypersensitivity reactions - cephalosporins can trigger immune-mediated reactions that manifest as fever 2
• Direct effect on thermoregulatory centers - some antibiotics can affect central temperature regulation

Risk factors that may increase the likelihood of experiencing these symptoms include:

• History of drug allergies, particularly to beta-lactam antibiotics
• Prior adverse reactions to cephalosporins
• Concurrent medications that may interact with cefuroxime

Clinical Presentation and Management

When fever and diaphoresis occur as a reaction to cefuroxime, they typically:

• Develop within hours to days after initiating therapy
• May be accompanied by other hypersensitivity symptoms (rash, pruritus)
• Usually resolve after discontinuation of the medication

Management steps include:

1. Assess severity - determine if symptoms represent a mild reaction or a more serious hypersensitivity reaction
2. Consider discontinuation - if symptoms are severe or accompanied by other concerning signs
3. Provide supportive care - antipyretics for fever management
4. Consider alternative antibiotics - if treatment must continue, switch to a non-beta-lactam alternative

Cross-Reactivity Considerations

For patients with suspected cefuroxime hypersensitivity who need continued antibiotic therapy:

• Cross-reactivity between penicillins and cephalosporins is estimated at 2-5% in patients with true penicillin allergy 1
• Second and third-generation cephalosporins (like cefuroxime) have minimal cross-reactivity compared to first-generation cephalosporins 1
• When evaluating alternative options, consider antibiotics with different side chain structures to minimize cross-reactivity risk 1

Other Common Side Effects of Cefuroxime

While evaluating fever and diaphoresis, be aware of other potential adverse effects:

• Gastrointestinal disturbances (most common): diarrhea, nausea, vomiting 3, 4
• Neurological manifestations (rare but reported): headache, dizziness, and in severe cases, more prominent CNS symptoms 2
• Skin reactions: rash, urticaria 4

Clinical Pitfalls to Avoid

1. Misattribution of symptoms - Don't automatically assume fever is due to worsening infection rather than a drug reaction
2. Delayed recognition - Fever may be mistakenly attributed to the underlying infection being treated
3. Inappropriate continuation - Continuing cefuroxime despite signs of hypersensitivity could lead to more severe reactions
4. Inadequate documentation - Failing to document the reaction may lead to inappropriate future prescribing

Conclusion

When evaluating a patient with fever and diaphoresis during cefuroxime therapy, consider drug reaction in your differential diagnosis. While not the most common side effects, these symptoms can occur and may necessitate discontinuation of the medication and selection of an alternative antibiotic agent based on the clinical scenario and severity of the reaction.