Which is better, cefuroxime or cefadroxil?

Which Cephalosporin is Better: Cefuroxime or Cefadroxil?

Cefuroxime is superior to cefadroxil for most clinical infections due to its broader spectrum of activity, particularly against beta-lactamase-producing organisms and respiratory pathogens. 1, 2

Antimicrobial Spectrum Comparison

Cefuroxime's Advantages

• Cefuroxime demonstrates significantly broader activity against respiratory pathogens including Streptococcus pneumoniae (75-85% coverage), Haemophilus influenzae (70-85% coverage), and Moraxella catarrhalis (50% coverage), making it superior for respiratory tract infections 2
• Cefuroxime is resistant to beta-lactamases produced by staphylococci and most Gram-negative aerobic bacteria, giving it activity against organisms resistant to first-generation cephalosporins like cefadroxil 3, 4
• Cefuroxime has excellent activity against beta-lactamase-producing Haemophilus influenzae and Neisseria gonorrhoeae, which cefadroxil cannot reliably cover 4

Cefadroxil's Limitations

• Cefadroxil is a first-generation cephalosporin with narrower spectrum, primarily covering Gram-positive cocci and limited Gram-negative activity 5
• Cefadroxil lacks reliable activity against beta-lactamase-producing organisms that are increasingly common in clinical practice 5

Clinical Evidence

Head-to-Head Comparison

• In a randomized trial of 1,685 patients with uncomplicated skin and skin-structure infections, cefuroxime 250 mg BID achieved an 88% clinical cure rate compared to 85% for cefadroxil 500 mg BID (not statistically different for skin infections specifically) 6
• However, cefditoren 200 mg demonstrated significantly higher pathogen eradication rates than cefadroxil (P = 0.018), suggesting cefadroxil's microbiologic activity is inferior to newer agents 6

Guideline-Supported Uses

• French and European guidelines recommend cefuroxime as first-line therapy for acute sinusitis, alongside amoxicillin-clavulanate and third-generation cephalosporins, with no mention of cefadroxil 1
• Cefuroxime is specifically recommended for maxillary, frontal, fronto-ethmoidal, and sphenoidal sinusitis with proven 5-day efficacy 1
• For chronic rhinosinusitis, a study showed cefuroxime achieved 86-88% clinical cure rates in patients with confirmed sinus infections 1

Pharmacokinetic Considerations

• Older first-generation cephalosporins like cefadroxil have better pharmacokinetic profiles with higher free serum concentrations, but this advantage is offset by inferior antimicrobial activity 5
• Cefuroxime achieves blood levels that exceed minimum inhibitory concentrations for many important Gram-negative pathogens despite lower serum concentrations than cefadroxil 3, 5

Clinical Algorithm for Selection

Choose cefuroxime for:

• Respiratory tract infections (pneumonia, bronchitis, sinusitis) 1, 7
• Infections where beta-lactamase-producing organisms are suspected 4
• Soft tissue infections requiring broader Gram-negative coverage 3
• Urinary tract infections caused by Enterobacteriaceae 3
• Gonorrhea (parenteral cefuroxime only) 1

Cefadroxil may be considered for:

• Simple skin infections caused by confirmed methicillin-susceptible Staphylococcus aureus or Streptococcus pyogenes where cost is a major concern 6
• Uncomplicated urinary tract infections in areas with low resistance rates 5

Critical Caveats

• Neither cefuroxime nor cefadroxil has activity against Pseudomonas aeruginosa, enterococci, or Bacteroides fragilis 3
• Cefuroxime has limited activity against drug-resistant S. pneumoniae (DRSP), which is a consideration in areas with high DRSP prevalence 2
• Both agents are ineffective against methicillin-resistant Staphylococcus aureus (MRSA) 2
• Superinfections with Pseudomonas and enterococci may occur during cefuroxime therapy 3