What is the preferred treatment between cefixime (Cefixime) and cefuroxime (Cefuroxime) for bacterial pharyngitis?

Cefixime vs Cefuroxime for Bacterial Pharyngitis

For bacterial pharyngitis caused by Group A Streptococcus (GAS), narrow-spectrum cephalosporins such as cephalexin or cefadroxil are preferred over broad-spectrum cephalosporins like cefixime and cefuroxime when penicillin cannot be used. 1

First-line Treatment Options

• Penicillin or amoxicillin remains the treatment of choice for GAS pharyngitis due to proven efficacy, safety, narrow spectrum, and low cost 1
• Penicillin-resistant GAS has never been documented 1
• Amoxicillin once daily (50 mg/kg, maximum 1000 mg) for 10 days is equally effective and may enhance adherence due to once-daily dosing 1

For Penicillin-Allergic Patients

• A 10-day course of an oral cephalosporin is recommended for most penicillin-allergic individuals (except those with immediate/anaphylactic hypersensitivity) 1
• Narrow-spectrum cephalosporins (cefadroxil, cephalexin) are much preferred over broad-spectrum cephalosporins (cefaclor, cefuroxime, cefixime, cefdinir, cefpodoxime) 1
• Broad-spectrum cephalosporins like cefixime and cefuroxime:
  • Are considerably more expensive than penicillin or amoxicillin 1
  • Are more likely to select for antibiotic-resistant flora 1
  • Have unnecessarily broad antimicrobial spectrum 1

Comparing Cefixime vs Cefuroxime

When comparing these two specific agents:

• Both cefixime and cefuroxime are FDA-approved for pharyngitis caused by Streptococcus pyogenes 2
• Cefixime requires once or twice daily dosing (8 mg/kg/day) 2
• Cefuroxime is typically given twice daily 3, 4
• Both should be given for 10 days in GAS pharyngitis to prevent rheumatic fever 2
• Some studies show cefuroxime may have higher bacteriological cure rates compared to penicillin in certain age groups 5, 4

Important Considerations

• Up to 10% of penicillin-allergic persons are also allergic to cephalosporins, and these agents should not be used in patients with immediate (anaphylactic-type) hypersensitivity to penicillin 1
• For patients with true penicillin allergy who cannot take cephalosporins, alternatives include:
  • Clindamycin (resistance rate approximately 1% in the US) 1
  • Macrolides (erythromycin, clarithromycin) or azithromycin, though macrolide resistance rates in the US are around 5-8% 1

Duration of Therapy

• Standard duration for GAS pharyngitis treatment is 10 days for most antibiotics 1
• Shorter courses (5 days) with certain cephalosporins have been studied but cannot be broadly endorsed at this time 1, 5
• In the treatment of infections due to Streptococcus pyogenes, a therapeutic dosage should be administered for at least 10 days to prevent rheumatic fever 2

Conclusion

While both cefixime and cefuroxime can be effective for GAS pharyngitis, neither is preferred when other options are available. If a cephalosporin must be used in a penicillin-allergic patient, narrow-spectrum agents like cephalexin or cefadroxil are preferred over either cefixime or cefuroxime to minimize antimicrobial resistance and unnecessary broad-spectrum coverage 1.