Can I also give cefuroxime (Cefuroxime) for urinary tract infections (UTIs)?

Cefuroxime for UTIs: Reserve as Second-Line Only

Cefuroxime should NOT be used as first-line therapy for urinary tract infections due to inferior efficacy, suboptimal tissue penetration, and greater collateral damage to protective microbiota compared to recommended first-line agents. 1

First-Line Agents You Should Use Instead

The European Association of Urology recommends the following as first-line oral agents for uncomplicated cystitis: 2

• Fosfomycin trometamol 3g single dose (women only)
• Nitrofurantoin 100mg twice daily for 5 days
• Pivmecillinam 400mg three times daily for 3-5 days

These agents demonstrate superior efficacy and lower risk of disrupting protective microbiota compared to cefuroxime. 1

When Cefuroxime Can Be Used

Cefuroxime is acceptable only in specific circumstances: 1, 3

• Documented allergies to ALL first-line agents
• Culture-confirmed susceptibility when first-line agents are contraindicated or ineffective 3
• Complicated UTIs requiring parenteral therapy when fluoroquinolones are contraindicated 1
• Second-generation cephalosporins like cefuroxime should be combined with an aminoglycoside for complicated UTIs with systemic symptoms 3

Critical Limitations of Cefuroxime

Spectrum gaps that make empiric use dangerous: 1, 3

• Does NOT cover Enterococcus species
• Does NOT cover Pseudomonas aeruginosa (common in complicated UTIs and catheter-associated infections)
• Variable activity against resistant gram-negatives
• Should NEVER be used empirically without culture confirmation 1

Efficacy concerns: 1

• CDC guidelines note cefuroxime axetil achieves only 95.9% cure rates (CI 94.5%-97.3%) for urogenital infections due to poor mucosal penetration
• This falls below minimum efficacy criteria for first-line UTI treatment

FDA-Approved Dosing When You Must Use It

For uncomplicated UTIs: 4

• 750mg every 8 hours for 5-10 days (IV/IM formulation)

Renal dose adjustments are mandatory: 1

• CrCl >20 mL/min: 750mg-1.5g every 8 hours
• CrCl 10-20 mL/min: 750mg every 12 hours
• CrCl <10 mL/min: 750mg every 24 hours
• Give additional dose after hemodialysis 4

Alternative Second-Line Options (If First-Line Fails)

The European Association of Urology lists these alternatives when local E. coli resistance is <20%: 2

• Cephalosporins (e.g., cefadroxil) 500mg twice daily for 3 days
• Trimethoprim 200mg twice daily for 5 days (avoid first trimester pregnancy)
• Trimethoprim-sulfamethoxazole 160/800mg twice daily for 3 days (avoid last trimester pregnancy)

Common Pitfalls to Avoid

Do NOT use cefuroxime when: 3

• Empiric treatment is needed for uncomplicated cystitis (use first-line agents instead)
• Complicated UTI with systemic symptoms requires treatment (use third-generation cephalosporins or combination therapy)
• Patient has catheter-associated infection (Pseudomonas and Enterococcus coverage needed)

Always obtain culture before starting therapy when considering cefuroxime, as its spectrum limitations require documented susceptibility. 1, 3