Can cefuroxime be used to treat urinary tract infections (UTIs)?

Can Cefuroxime Be Used for UTI?

Yes, cefuroxime can be used for urinary tract infections, as it is FDA-approved for UTIs caused by E. coli and Klebsiella species, but it should be considered a second-line option rather than first-line therapy for uncomplicated UTIs. 1

FDA-Approved Indications

Cefuroxime is specifically indicated for urinary tract infections caused by:

• Escherichia coli 1
• Klebsiella species 1

The FDA-approved dosing for uncomplicated UTIs is 750 mg every 8 hours (intravenous formulation), typically for 5-10 days 1. The oral formulation (cefuroxime axetil) can be given at 250 mg twice daily 2, 3.

Position in Treatment Guidelines

While cefuroxime is FDA-approved for UTIs, current guidelines position it as a second-line agent:

• β-lactams (including cephalosporins like cefuroxime) are considered second-line agents for uncomplicated UTIs by the Infectious Diseases Society of America 4
• β-lactams have inferior efficacy compared to first-line agents for uncomplicated UTIs 4
• β-lactams have more adverse effects than other UTI antimicrobials 4
• β-lactam antibiotics may promote more rapid recurrence of UTI 4

Recommended First-Line Alternatives

For uncomplicated cystitis, prefer these options before cefuroxime:

• Nitrofurantoin 100 mg twice daily for 5 days 5
• Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days (if local resistance <20%) 4, 5
• Amoxicillin-clavulanic acid 4

For pyelonephritis (mild to moderate):

• Ciprofloxacin (if local resistance <10%) 4
• Ceftriaxone or cefotaxime are preferred third-generation cephalosporins over cefuroxime 4

Clinical Evidence for Cefuroxime in UTIs

When cefuroxime has been studied, it demonstrates reasonable efficacy:

• In uncomplicated UTIs, oral cefuroxime axetil 250 mg twice daily achieved 97% clinical success rates 3
• A 10-day course of cefuroxime axetil 250 mg daily achieved 86% overall cure rate (including reinfections) 6
• Cefuroxime was comparable to trimethoprim-sulfamethoxazole in clinical cure (100% for both), though bacteriological cure was only 75% 2
• Cefotaxime (a third-generation cephalosporin) was shown to be superior to cefuroxime in complicated UTIs 7

When to Consider Cefuroxime

Cefuroxime may be appropriate in these specific scenarios:

• Documented susceptibility to cefuroxime with resistance to first-line agents 2
• Allergy to fluoroquinolones and contraindications to nitrofurantoin (e.g., renal impairment) 5
• Complicated UTIs when culture shows susceptibility and other options are unavailable 1
• Pregnancy where fluoroquinolones and trimethoprim are contraindicated (though other β-lactams may be preferred)

Important Caveats

• Always obtain urine culture before starting antibiotics for suspected pyelonephritis 4
• Check local resistance patterns before empiric use 4, 5
• Cefuroxime has no activity against enterococci 7
• Adverse effects include diarrhea (4-5%) and candida superinfection (8%) 6, 3
• Cephalosporins are more likely to alter fecal microbiota and cause collateral damage compared to nitrofurantoin 4
• In complicated UTIs, 42.5% resistance to trimethoprim-sulfamethoxazole was found in one study, while all isolates were susceptible to cefuroxime, highlighting the importance of local antibiograms 2

Dosing Adjustments

For renal impairment, reduce dosing based on creatinine clearance 1:

• CrCl >20 mL/min: 750 mg-1.5 g every 8 hours
• CrCl 10-20 mL/min: 750 mg every 12 hours
• CrCl <10 mL/min: 750 mg every 24 hours
• Post-hemodialysis: Give additional dose after dialysis 1