Cefuroxime for Upper Respiratory Tract Infections
Cefuroxime-axetil is an appropriate and effective second-generation cephalosporin for treating bacterial upper respiratory tract infections, specifically recommended as first-line therapy for acute bacterial sinusitis (maxillary, frontal, ethmoidal, and sphenoidal) when amoxicillin-clavulanate is not suitable. 1
Primary Indications for Cefuroxime in URTI
Cefuroxime-axetil is specifically recommended for:
- Acute bacterial sinusitis (all sites: maxillary, frontal, fronto-ethmoidal, sphenoidal) as first-line therapy alongside amoxicillin-clavulanate and select third-generation cephalosporins 1
- Acute otitis media, pharyngitis, and tonsillitis in both adults and children when beta-lactamase-producing organisms are suspected 2, 3
- Treatment duration: 7-10 days for most infections, though cefuroxime-axetil has demonstrated efficacy in 5-day regimens 1
Clinical Efficacy Evidence
Cefuroxime-axetil demonstrates:
- 97% clinical success rate in treating upper respiratory tract infections (tonsillitis, pharyngitis, sinusitis, otitis media) with 250 mg twice daily for 5 days 4
- 89% overall clinical improvement rate across various URTIs with 7-day treatment courses 5
- Comparable efficacy to amoxicillin-clavulanate, with similar bacteriological eradication rates (73% vs 72%) 4
- Broad spectrum activity against common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and beta-lactamase-producing strains 6, 3
Dosing Recommendations
Standard adult dosing:
- 250 mg twice daily for most upper respiratory tract infections 4, 5
- 500 mg twice daily for more severe infections or when pneumonia is suspected 6
- Administer with food to optimize bioavailability (68% absolute bioavailability after meals) 6
Position in Treatment Algorithm
First-line options for acute bacterial sinusitis include: 1
- Amoxicillin-clavulanate
- Cefuroxime-axetil (second-generation cephalosporin)
- Cefpodoxime-proxetil or cefotiam-hexetil (third-generation cephalosporins)
- Pristinamycin (particularly for beta-lactam allergies)
Reserve fluoroquinolones (levofloxacin, moxifloxacin) for complicated sinusitis (frontal, fronto-ethmoidal, sphenoidal) or first-line treatment failure 1, 7
Important Clinical Considerations
Cefuroxime is appropriate when:
- Beta-lactamase-producing organisms (H. influenzae, M. catarrhalis) are suspected 3
- Patient has non-immediate penicillin allergy (avoid in immediate hypersensitivity reactions) 8
- Empirical therapy is needed for community-acquired URTIs 2
Safety profile:
- Low incidence of adverse events: 7% drug-related adverse events, primarily mild gastrointestinal disturbances (4% diarrhea) 4
- Better tolerability than amoxicillin-clavulanate (7% vs 12% adverse events) 4
- Most adverse effects are mild, transient, and reversible upon discontinuation 6, 2
Critical Pitfalls to Avoid
Do NOT use cefuroxime for:
- Patients with immediate-type hypersensitivity to beta-lactam antibiotics (cross-reactivity up to 10%) 8
- Situations where cefixime might be considered—cefixime is specifically NOT recommended for respiratory infections due to inactivity against pneumococci with decreased penicillin susceptibility 9
Escalate to hospitalization and IV antibiotics if: 7
- Meningeal signs (neck stiffness, photophobia)
- Orbital involvement (exophthalmos, palpebral edema, ocular mobility disorders)
- Severe pain preventing sleep
- Systemic signs (fever with altered mental status)
If no improvement after 3 days: Consider switching antibiotics or investigating for complications 7