Can Cefuroxime Be Used for UTI?
Yes, cefuroxime can be used for UTIs, but it is considered a second-line agent that should only be used when first-line antibiotics cannot be used. 1
Position in Treatment Guidelines
Cefuroxime, like other β-lactam cephalosporins, has inferior efficacy compared to first-line agents and causes more adverse effects than other UTI antimicrobials. 1 The Infectious Diseases Society of America classifies β-lactams as appropriate choices only when other recommended agents cannot be used. 1
First-Line Agents to Consider Before Cefuroxime
- Nitrofurantoin is recommended as a first-choice option for uncomplicated cystitis 1
- Amoxicillin-clavulanic acid is recommended as a first-choice option for uncomplicated cystitis 1
- Sulfamethoxazole-trimethoprim is recommended if local resistance is less than 20% 1
- Ciprofloxacin is recommended for mild to moderate pyelonephritis if local resistance is less than 10% 1
When Cefuroxime May Be Appropriate
Cefuroxime may be considered when:
- First-line agents are contraindicated or unavailable 1
- The causative organism is confirmed susceptible to cefuroxime 2
- For uncomplicated UTIs when other recommended agents cannot be used 1
FDA-Approved Dosing for UTI
According to the FDA label, for uncomplicated urinary tract infections, 750 mg every 8 hours is recommended (parenteral formulation). 2 For oral cefuroxime axetil, 125 mg twice daily has been shown to be effective for some urinary tract infections, while 250 mg twice daily is appropriate for most infections. 3
Clinical Evidence Supporting Use
- In clinical trials, cefuroxime achieved 80.3% bacteriological cure rates in acute uncomplicated lower UTIs when given as 125 mg twice daily for 3 days 4
- Cefuroxime demonstrated 97% clinical success rates (cure plus improvement) in uncomplicated UTIs at 250 mg twice daily 5
- Cefuroxime showed activity against 90.2% of gram-negative organisms in complicated UTIs 6
Important Caveats and Limitations
- Cefuroxime is NOT effective against Pseudomonas - antipseudomonal agents like ceftazidime-avibactam or aminoglycosides are required for Pseudomonas UTIs 7
- Cefuroxime is NOT effective against enterococci 6
- β-lactam antibiotics like cefuroxime may promote more rapid recurrence of UTI 1
- Cephalosporins are more likely to alter fecal microbiota and cause collateral damage compared to first-line agents 1
Antimicrobial Stewardship Considerations
For complicated UTIs caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCephRE), cotrimoxazole may be considered for non-severe complicated UTI as good practice. 8 However, for severe infections, carbapenems are recommended. 8
Always obtain urine culture before starting antibiotics for suspected pyelonephritis or complicated UTIs to guide targeted therapy. 1