Is Ceftin (cefuroxime) effective for treating acute bacterial sinusitis?

Cefuroxime (Ceftin) for Acute Bacterial Sinusitis

Cefuroxime axetil (Ceftin) is an effective and appropriate treatment option for acute bacterial sinusitis, particularly as an alternative first-line agent for penicillin-allergic patients or when β-lactamase-producing organisms are suspected. 1, 2

Position in Treatment Algorithm

For patients without recent antibiotic exposure and no penicillin allergy, amoxicillin remains the preferred first-line agent (500 mg twice daily for mild disease, 875 mg twice daily for moderate disease). 1, 2 However, cefuroxime axetil is explicitly recommended as an alternative first-line option in the following scenarios:

• Penicillin-allergic patients (non-Type I hypersensitivity): Cefuroxime axetil 250-500 mg twice daily for 10-14 days 1, 2
• Recent antibiotic exposure (within 4-6 weeks): Consider cefuroxime for broader coverage 1
• Areas with high prevalence of β-lactamase-producing organisms (H. influenzae, M. catarrhalis) 3, 4

Clinical Efficacy Data

Cefuroxime axetil demonstrates 83-88% predicted clinical efficacy for acute bacterial sinusitis in both adults and children. 1 This is comparable to amoxicillin but slightly lower than high-dose amoxicillin-clavulanate (90-92%) or respiratory fluoroquinolones (90-92%). 1

Key clinical trial data:

• Bacteriologic cure rates of 84-100% across multiple studies 4
• Clinical cure/improvement rates of 79-100% in comparative trials 4
• In head-to-head comparison with cefaclor, cefuroxime achieved 95% bacteriologic cure versus 71% for cefaclor 5
• Comparable efficacy to amoxicillin-clavulanate, cefaclor, cefixime, clarithromycin, and doxycycline 4

Microbiologic Coverage

Cefuroxime axetil is β-lactamase-stable, providing excellent coverage against the three primary pathogens in acute bacterial sinusitis:

• Streptococcus pneumoniae (33-41% of cases): Good activity against penicillin-susceptible strains, but limited activity against drug-resistant S. pneumoniae (DRSP) 1, 3
• Haemophilus influenzae (29-35% of cases): Enhanced activity against β-lactamase-producing strains (42% of H. influenzae produce β-lactamase) 1, 3, 5
• Moraxella catarrhalis (4-8% of cases): Excellent coverage against β-lactamase-producing strains (60-100% produce β-lactamase) 1, 3, 5

Cefuroxime penetrates sinus tissue in concentrations exceeding the MIC90 values for these pathogens. 4

Dosing Specifications

Adults: Cefuroxime axetil 250 mg twice daily for 10-14 days (standard dose recommended in guidelines) 1, 4, 5

Pediatrics: Cefuroxime axetil is an acceptable alternative for children with penicillin allergy, though specific pediatric dosing should follow standard cephalosporin guidelines 2

Treatment duration: Continue until symptom-free for 7 days, typically 10-14 days total 1, 2

Comparison with Other Cephalosporins

Cefuroxime axetil versus third-generation cephalosporins:

• Similar activity against S. pneumoniae compared to cefpodoxime and cefdinir 1
• Less active against H. influenzae than cefpodoxime proxetil 1
• More active than cefprozil against H. influenzae 1
• Superior to cefaclor and loracarbef, which have poor activity against H. influenzae and no activity against DRSP 1

When to Switch from Cefuroxime

Reassess at 72 hours (pediatrics) or 3-5 days (adults). 1, 2 If no improvement occurs, switch to:

• High-dose amoxicillin-clavulanate (4 g/250 mg per day for adults; 90 mg/kg/day for children) for enhanced DRSP coverage 1, 2
• Respiratory fluoroquinolone (levofloxacin 500 mg once daily or moxifloxacin 400 mg once daily) for treatment failures or multi-drug resistant organisms 1, 2
• Third-generation cephalosporin (cefpodoxime proxetil or cefdinir) if H. influenzae coverage is inadequate 1, 2

Critical Pitfalls to Avoid

• Do not use cefuroxime for severe disease with high suspicion of DRSP: Switch to high-dose amoxicillin-clavulanate or respiratory fluoroquinolone 1, 2
• Do not confuse with first-generation cephalosporins (cephalexin): These have inadequate H. influenzae coverage and should never be used for sinusitis 6
• Monitor for diarrhea: Cefuroxime was associated with more frequent diarrhea than cefaclor in comparative trials (though overall tolerability was similar) 5
• Ensure adequate treatment duration: Minimum 10 days to prevent relapse 1, 2

Adjunctive Therapies

Always recommend intranasal corticosteroids (mometasone, fluticasone, or budesonide twice daily) as adjunctive therapy to reduce mucosal inflammation and improve symptom resolution. 2

Consider short-term oral corticosteroids (5 days) for patients with marked mucosal edema or severe pain who fail initial treatment. 2