Can cefuroxime (Cefuroxime) cause aseptic meningitis?

Cefuroxime and Aseptic Meningitis

There is no evidence that cefuroxime causes aseptic meningitis based on the available guidelines and research. In fact, cefuroxime is used as a treatment option for bacterial meningitis, though it is not the preferred first-line agent.

Cefuroxime's Role in Meningitis Treatment

• Cefuroxime (a second-generation cephalosporin) has been studied for treating bacterial meningitis, but third-generation cephalosporins are superior and preferred as first-line agents 1
• Clinical trials have found third-generation cephalosporins to be superior to cefuroxime for the treatment of childhood bacterial meningitis 1
• In a comparative study, ceftriaxone (a third-generation cephalosporin) was found to be superior to cefuroxime for treating acute bacterial meningitis in children, with better cerebrospinal fluid sterilization and less hearing impairment 2

Preferred Antibiotics for Bacterial Meningitis

• Current guidelines recommend third-generation cephalosporins (ceftriaxone or cefotaxime) as first-line empiric therapy for suspected bacterial meningitis 1
• For adults with suspected bacterial meningitis, the recommended empiric treatment is ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours 1
• For patients aged 60 years or older, ampicillin/amoxicillin should be added to cover Listeria monocytogenes 1

Cefuroxime Penetration into CSF

• Studies have shown that cefuroxime does penetrate the cerebrospinal fluid (CSF) in patients with bacterial meningitis 3
• In adults with bacterial meningitis, CSF levels of cefuroxime ranged from 1.5 to 13.5 mg/L (mean 6.0 mg/L) in the acute stage of the disease 3
• Despite achieving adequate CSF levels in most cases, cefuroxime is not preferred for meningitis treatment due to the superior efficacy of third-generation cephalosporins 4

Limitations of Cefuroxime for Meningitis

• While cefuroxime can be used to treat meningitis due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis in children, it is not the preferred agent 4
• The efficacy of cefuroxime in treating bacterial meningitis has been demonstrated in some studies, with an 83% clinical and bacteriological effectiveness rate in one study of infants and children 5
• However, third-generation cephalosporins (ceftriaxone, cefotaxime) have consistently shown better outcomes and are now considered standard of care 1, 2

Duration of Treatment for Bacterial Meningitis

• For pneumococcal meningitis, treatment should continue for 10 days if the patient is clinically stable (up to 14 days if taking longer to respond) 1
• For meningococcal meningitis, treatment can be discontinued after 5 days if the patient has clinically recovered 1
• If no pathogen has been found, antibiotics can be stopped after 10 days if the patient has clinically recovered 1

In conclusion, while cefuroxime has been used to treat bacterial meningitis, there is no evidence in the provided literature suggesting it causes aseptic meningitis. The current standard of care for bacterial meningitis favors third-generation cephalosporins over cefuroxime due to their superior efficacy and better clinical outcomes.