Is cefuroxime (Cefuroxime) safe to use in patients with liver injury (hepatic impairment)?

Cefuroxime Safety in Liver Injury

Cefuroxime can be safely used in patients with hepatic impairment without dose adjustment, as it demonstrates minimal hepatotoxicity and is well-tolerated even in patients with impaired liver function. 1

Evidence for Safety

Pharmacokinetic Profile

• Cefuroxime, like other cephalosporins, exhibits little hepatotoxicity and does not require hepatic dose adjustment 2
• A prospective study of 15 patients demonstrated that cefuroxime treatment was well-tolerated even in patients with signs of impaired metabolic liver function at treatment initiation 1
• Four elderly patients with prolonged galactose half-life (indicating impaired hepatic function) showed declining values during cefuroxime treatment, suggesting the drug does not worsen liver function 1

Comparison with Other Cephalosporins

• Third-generation cephalosporins like cefixime show only modest kinetic modifications in severe hepatic impairment (cirrhosis with ascites and hypoalbuminemia), with no specific dosage adjustment required 3
• While ceftriaxone has been associated with rare cases of acute drug-induced liver injury, cephalosporins as a class have minimal hepatotoxicity 2

Important Caveats

Rare Hepatotoxicity Risk

• Extremely rare cases of cefuroxime-induced cholestatic liver injury have been reported 4
• One documented case involved paradoxical worsening of jaundice with intrahepatic cholestasis following cefuroxime administration, though the patient recovered completely after drug withdrawal 4
• The overall incidence remains exceptionally low, making cefuroxime one of the safer antibiotics for hepatic impairment 2, 4

Monitoring Recommendations

• In patients with pre-existing abnormal liver function tests, baseline liver enzymes should be documented 5
• If jaundice worsens or new hepatic symptoms develop during treatment, consider cefuroxime as a potential (though unlikely) cause and evaluate for alternative etiologies first 4
• Clinical judgment should focus on the timing of medication use relative to any liver abnormality development 5

Practical Algorithm

For patients with stable chronic liver disease or cirrhosis:

• Use standard cefuroxime dosing without modification 1
• No routine liver function monitoring is required beyond standard clinical assessment 1

For patients with acute liver injury or decompensated cirrhosis:

• Cefuroxime remains safe, but consider the narrow therapeutic index principle for drugs in advanced liver disease 5
• Monitor clinical response and watch for unexpected deterioration 4

If liver function worsens during treatment:

• Exclude other causes (disease progression, biliary obstruction, other medications) first 4
• Consider discontinuation only if cefuroxime is the most likely culprit based on temporal relationship 4