What is the recommended dosing of Ceftin (Cefuroxime Axetil) for acute cystitis?

Cefuroxime Axetil Dosing for Acute Cystitis

For acute uncomplicated cystitis, cefuroxime axetil (Ceftin) should be dosed at 250 mg orally twice daily for 3-7 days when other recommended first-line agents cannot be used. 1, 2

Recommended Treatment Algorithm for Acute Cystitis

First-Line Options (Preferred over Cefuroxime)

• Nitrofurantoin 100 mg twice daily for 5 days due to minimal resistance and limited collateral damage 1
• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days if local resistance rates are <20% 1
• Fosfomycin trometamol 3 g single dose where available 1

Second-Line Options (When First-Line Cannot Be Used)

• β-Lactams including cefuroxime axetil 250 mg twice daily for 3-7 days 1, 2, 3
• Other β-lactams such as cefpodoxime proxetil 100 mg twice daily for 3 days 1, 4
• Fluoroquinolones (e.g., ciprofloxacin 250 mg twice daily for 3 days) should be reserved due to concerns about resistance and collateral damage 1

Rationale for Cefuroxime Axetil Recommendation

• β-Lactams generally have inferior efficacy and more adverse effects compared to first-line agents for uncomplicated cystitis 1
• Clinical studies show cefuroxime axetil can be effective for uncomplicated UTIs with cure rates of 93-95% 3
• The FDA-approved dosing for cefuroxime in uncomplicated urinary tract infections is consistent with the recommendation of 250 mg twice daily 2

Important Considerations

• β-Lactams should be used with caution for uncomplicated cystitis due to:

  • Lower efficacy compared to other UTI antimicrobials 1
  • Higher rates of adverse effects 1
  • Potential for promoting resistance 1

• Obtain urine culture before starting therapy if:

  • Patient has risk factors for resistant organisms
  • Previous treatment failure
  • Recurrent UTI 1

• Common adverse effects of cefuroxime axetil include:

  • Gastrointestinal disturbances (diarrhea, nausea, vomiting) 5
  • Candida vaginitis (reported in some patients) 3

Clinical Pitfalls to Avoid

• Do not use amoxicillin or ampicillin for empirical treatment due to poor efficacy and high resistance rates 1
• Do not extend treatment beyond 7 days for uncomplicated cystitis as longer durations increase risk of adverse effects without improving outcomes 1
• Avoid fluoroquinolones as first-line therapy despite high efficacy due to concerns about promoting resistance and potential association with MRSA 1
• Remember that cefuroxime and other β-lactams should only be used when first-line agents cannot be used (e.g., allergy, resistance, or unavailability) 1