Cefuroxime Axetil 500 mg for Tooth Infection
Cefuroxime axetil 500 mg is NOT a first-line antibiotic for tooth infections, but it can be effective when used at 250 mg three times daily for 3-7 days based on available evidence for acute dental infections. 1
Evidence for Dental Infections
The only direct evidence for cefuroxime in dental infections comes from a double-blind comparative study that evaluated cefuroxime axetil specifically for acute dental infections (periodontitis, pericoronitis, and gnathitis). 1
Key findings from this dental infection study:
- Cefuroxime axetil achieved an 81.6% clinical efficacy rate in acute dental infections 1
- The dosing regimen used was 250 mg three times daily (not 500 mg twice daily) for 3-7 days 1
- Efficacy was comparable to cefaclor, with bacteriological elimination rates of 73.7% 1
- The drug was well tolerated with only 0.8% adverse reaction rate 1
Important Dosing Discrepancy
The standard adult dose of cefuroxime axetil for most infections is 500 mg twice daily, but the specific dental infection study used 250 mg three times daily. 2, 1 For more severe infections, 500 mg twice daily is typically recommended, though this specific regimen has not been formally studied in dental infections. 2
Why Not First-Line?
Cefuroxime axetil is not mentioned in standard guidelines for odontogenic infections. The French guidelines for respiratory infections list cefuroxime axetil as a first-line option for sinusitis (including maxillary sinusitis of dental origin), but do not specifically address primary tooth infections. 3
For maxillary sinusitis of dental origin specifically, French guidelines recommend cefuroxime axetil 500 mg twice daily as a first-line option alongside amoxicillin-clavulanate. 3
Clinical Considerations
If using cefuroxime axetil for a tooth infection:
- Consider 250 mg three times daily for 3-7 days based on the dental infection study 1
- Alternatively, 500 mg twice daily could be used for more severe infections, extrapolating from other infection types 2
- Take with food to increase absorption 2
- Maximum adult daily dose is 4000 mg/day 2
Spectrum of Activity
Cefuroxime has appropriate coverage for common oral pathogens, being active against methicillin-sensitive staphylococci and streptococci (excluding group D), which are frequently involved in dental infections. 4, 5 However, it lacks activity against anaerobes like Bacteroides fragilis, which are often present in odontogenic infections. 6
Critical caveat: The lack of anaerobic coverage is a significant limitation for many dental infections, where mixed aerobic-anaerobic flora is common. This is why amoxicillin-clavulanate is typically preferred for dental infections, as it provides both aerobic and anaerobic coverage.