What is Cefuroxime (Cefuroxime axetil) used for?

Cefuroxime Axetil: Clinical Indications

Cefuroxime axetil is a broad-spectrum second-generation oral cephalosporin used primarily for respiratory tract infections (including pneumonia, bronchitis, sinusitis, otitis media, pharyngitis), urinary tract infections, skin and soft tissue infections, uncomplicated gonorrhea, and early Lyme disease. 1

Primary Respiratory Tract Infections

Lower Respiratory Tract Infections

• Community-acquired pneumonia caused by Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), Klebsiella spp., Staphylococcus aureus, Streptococcus pyogenes, and E. coli 1
• Acute bronchitis and chronic bronchitis exacerbations with typical dosing of 250-500 mg twice daily for 5-10 days 2, 3
• For suspected pneumonia or severe lower respiratory infections, use 500 mg twice daily rather than 250 mg 4

Upper Respiratory Tract Infections

• Acute sinusitis: French and European guidelines specifically recommend cefuroxime axetil as first-line therapy for maxillary, frontal, fronto-ethmoidal, and sphenoidal sinusitis with proven 5-day efficacy 5
• Acute otitis media: Particularly effective when H. influenzae or M. catarrhalis are suspected; 5-day courses are as effective as 10-day courses 3
• Pharyngitis and tonsillitis: At least as effective as penicillin V for group A beta-hemolytic streptococcal infections 3

Pediatric Respiratory Infections

• Acute bronchiolitis with complications: Use only when fever ≥38.5°C persists >3 days, purulent acute otitis media is present, or pneumonia/atelectasis is confirmed on chest X-ray 6
• In children <3 years with pneumonia, amoxicillin remains first-line, but cefuroxime axetil is appropriate when insufficient H. influenzae type b vaccination (<3 injections) or coexisting purulent otitis media 6
• Dosing in children: 20-30 mg/kg/day divided twice daily 6

Urinary Tract Infections

• Uncomplicated UTI: 250 mg twice daily has proven effective, with 97% clinical success rates 7
• Pyelonephritis and complicated UTI: Caused by E. coli and Klebsiella spp. 1
• Predominantly effective against E. coli, which accounts for 61% of UTI isolates 7

Skin and Soft Tissue Infections

• Furunculosis, pyoderma, impetigo: Caused by S. aureus (penicillinase and non-penicillinase-producing), S. pyogenes, E. coli, Klebsiella spp., and Enterobacter spp. 1, 4
• When erythema migrans cannot be distinguished from bacterial cellulitis, cefuroxime axetil or amoxicillin-clavulanate are reasonable choices 6

Early Lyme Disease

• Erythema migrans without neurologic manifestations: 500 mg twice daily for 14-21 days is recommended by the Infectious Diseases Society of America 6
• Equally effective as doxycycline and amoxicillin for early localized or early disseminated Lyme disease 6
• Appropriate for patients who cannot take doxycycline (pregnancy, lactation, children <8 years) 6

Uncomplicated Gonorrhea

• Single 1-gram oral dose for uncomplicated gonococcal urethritis and cervicitis 4
• Effective against both penicillinase and non-penicillinase-producing Neisseria gonorrhoeae 1

Sequential IV-to-Oral Therapy

• Step-down therapy for hospitalized patients: IV cefuroxime (750 mg 2-3 times daily for 2-5 days) followed by oral cefuroxime axetil (500 mg twice daily for 3-8 days) is as effective as full parenteral courses for community-acquired pneumonia 2, 3

Surgical Prophylaxis (Parenteral Cefuroxime Only)

• Clean-contaminated procedures (e.g., vaginal hysterectomy): Administer 0.5-1 hour preoperatively, repeat intraoperatively if lengthy, discontinue within 24 hours 1
• Open heart surgery: Continue for at least 48 hours postoperatively due to high-risk infection consequences 1

Critical Limitations and Caveats

Drug-Resistant S. pneumoniae

• Cefuroxime has NO clinically significant activity against drug-resistant S. pneumoniae (DRSP), which is a major limitation when selecting empiric therapy 5, 8
• If DRSP is suspected, use high-dose amoxicillin (80-100 mg/kg/day) or respiratory fluoroquinolones instead 6

Inferior Coverage Compared to Third-Generation Cephalosporins

• Cefuroxime achieves only 70-85% coverage of H. influenzae and approximately 50% coverage of M. catarrhalis, significantly lower than cefpodoxime or other third-generation agents 5, 8
• When H. influenzae is the likely pathogen, cefpodoxime is preferred due to markedly superior activity 8

Palatability Issues in Pediatrics

• The suspension formulation is notably unpalatable, which significantly limits adherence in children—consider alternatives like cefdinir or cefpodoxime for better compliance 8

No Activity Against Certain Pathogens

• No activity against Pseudomonas aeruginosa, enterococci, or anaerobes like Bacteroides fragilis 5
• First-generation cephalosporins (cephalexin) are ineffective for Lyme disease and should never be substituted 6

Dosing Summary

• Adults: 250 mg twice daily for most infections; 500 mg twice daily for pneumonia or severe infections 4, 2
• Children: 20-30 mg/kg/day divided twice daily, maximum 500 mg per dose 6
• Duration: 5-10 days for respiratory infections; 14-21 days for Lyme disease 6, 2

Safety Profile

• Well-tolerated with primarily mild-to-moderate gastrointestinal disturbances (diarrhea in 4-5% of patients) 4, 7
• Safe during pregnancy per 2015 US FDA recommendations 9
• Drug-related adverse events occur in approximately 10% of patients, with very few serious events 4, 7