Can Cefuroxime (Cephalosporin antibiotic) cause diarrhea?

Cefuroxime and Diarrhea

Yes, cefuroxime can cause diarrhea as a common side effect, occurring in approximately 1 in 220 patients (0.45%) according to FDA labeling. 1

Mechanism and Risk

Cefuroxime, like other cephalosporin antibiotics, can disrupt the normal intestinal microbiota, which may lead to:

1. Simple antibiotic-associated diarrhea: Due to disruption of normal gut flora
2. Clostridioides difficile infection (CDI): A more serious form of diarrhea

The FDA drug label specifically notes that gastrointestinal symptoms, including diarrhea, occur in approximately 1 in 150 patients taking cefuroxime, with diarrhea specifically occurring in about 1 in 220 patients. 1

Clinical Significance

Diarrhea associated with cefuroxime can range from:

• Mild and self-limiting: Most common presentation
• Severe and potentially life-threatening: When associated with C. difficile infection

Risk Factors for Antibiotic-Associated Diarrhea

• Duration of antibiotic therapy
• Previous episodes of antibiotic-associated diarrhea
• Hospitalization
• Advanced age
• Comorbidities

Clostridioides difficile Risk

Cephalosporins as a class are associated with C. difficile infection. According to the Infectious Diseases Society of America (IDSA) guidelines:

• Third and fourth-generation cephalosporins pose a high risk for CDI development 2
• While cefuroxime is a second-generation cephalosporin, all cephalosporins can disrupt normal bowel microbiota, providing a "niche" for C. difficile to flourish 2

Management of Antibiotic-Associated Diarrhea

If diarrhea develops while taking cefuroxime:

1. For mild diarrhea:

   • Supportive care with fluid and electrolyte replacement
   • Consider probiotics (though evidence is mixed)

2. For severe diarrhea or suspected C. difficile infection:

   • Stop cefuroxime if possible
   • Test for C. difficile toxins
   • If C. difficile is confirmed, treat with oral vancomycin 125 mg four times daily for 10 days 3
   • Avoid anti-motility agents like loperamide in suspected CDI 3

Prevention

To reduce the risk of diarrhea when taking cefuroxime:

• Use the shortest effective duration of antibiotic therapy
• Consider taking with food (may reduce gastrointestinal side effects)
• Avoid unnecessary antibiotic use

Comparative Risk

In comparative studies, cefuroxime has shown a more favorable gastrointestinal side effect profile compared to some other antibiotics:

• In a direct comparison with cefixime for treating acute bronchitis, cefuroxime axetil was associated with significantly fewer gastrointestinal adverse events (10% vs 18%, p=0.01) and specifically less diarrhea (5% vs 15%, p=0.001) 4

Important Considerations

• Diarrhea can occur during treatment or up to two months after completing the antibiotic course 1
• If severe or bloody diarrhea develops, patients should contact their healthcare provider immediately
• The risk of C. difficile-associated diarrhea increases both during therapy and in the 3-month period following cessation of therapy 2

Remember that while diarrhea is a recognized side effect of cefuroxime, it is generally mild and transient in most cases. However, monitoring for more severe symptoms is important to identify potential C. difficile infection early.