Cefuroxime for E. coli UTI
Yes, cefuroxime is effective for treating E. coli urinary tract infections and is FDA-approved for this indication, though it is not recommended as first-line therapy due to concerns about collateral damage and resistance patterns. 1
FDA-Approved Indication
Cefuroxime is specifically indicated for urinary tract infections caused by Escherichia coli and Klebsiella species 1. The drug achieves high urinary concentrations, with levels averaging 1,300 mcg/mL during the first 8 hours following a 750-mg intramuscular dose and 1,150-2,500 mcg/mL following intravenous doses 1.
Guideline Recommendations Position
Cefuroxime is not listed as a first-choice antibiotic for lower urinary tract infections in current guidelines 2. The WHO 2024 recommendations specify amoxicillin-clavulanate, nitrofurantoin, and trimethoprim-sulfamethoxazole as first-choice options for lower UTIs 2.
For complicated intra-abdominal infections, cefuroxime combined with metronidazole is listed as an acceptable option for mild-to-moderate community-acquired infections 2. However, for uncomplicated UTIs, beta-lactam antibiotics including cephalosporins are not considered first-line therapy due to collateral damage effects and their propensity to promote more rapid UTI recurrence 2.
Clinical Efficacy Data
Clinical studies demonstrate cefuroxime's effectiveness against E. coli UTIs:
- Bacteriological cure rates of 72-96% have been documented in clinical trials 3
- In a comparative study, cefuroxime 250 mg twice daily achieved clinical cure in 100% of patients and bacteriological cure in 75%, with E. coli accounting for 85% of isolates 4
- A single daily 250-mg dose for 10 days achieved a 93% clearance rate of the original infecting organism, with an overall cure rate of 86% 5
- Cefuroxime demonstrated 97% clinical success rates in trials comparing it to cefaclor and amoxicillin-clavulanate 3
Resistance Considerations
The major limitation is increasing resistance patterns 2. While all E. coli isolates in one study were susceptible to cefuroxime, 42.5% were resistant to trimethoprim-sulfamethoxazole 4. However, fluoroquinolones and cephalosporins are more likely than other antibiotic classes to alter fecal microbiota and cause Clostridium difficile infection 2.
Practical Dosing
For uncomplicated UTIs, cefuroxime axetil 250 mg twice daily for 7 days is the standard oral regimen 6, 4, 3. For more severe infections or when oral therapy is not feasible, parenteral cefuroxime 750 mg can be administered 1.
Important Caveats
- Cefuroxime should not be used empirically as first-line therapy given guideline recommendations favoring nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin 2
- It is particularly valuable when beta-lactamase-producing E. coli strains are suspected or documented 5, 7
- Local resistance patterns must be reviewed before empiric use 2
- The drug is relatively free of serious side effects, with diarrhea (4%) and gastrointestinal disturbances being most common 6, 3