Likelihood of Vomiting as Cefuroxime Side Effect
Vomiting is a recognized but uncommon adverse effect of cefuroxime (Ceftin), occurring in fewer than 1 in 440 patients according to FDA labeling, making it a relatively unlikely cause of this child's symptoms. 1
Gastrointestinal Side Effects of Cefuroxime
The FDA-approved drug label for cefuroxime documents specific incidence rates for gastrointestinal adverse effects:
- Diarrhea: 1 in 220 patients (approximately 0.45%)
- Nausea: 1 in 440 patients (approximately 0.23%)
- Vomiting: Listed as a cephalosporin-class adverse reaction but not quantified with specific incidence in the primary adverse reaction data 1
Gastrointestinal symptoms overall occurred in approximately 1 in 150 patients (0.67%) treated with cefuroxime. 1
Clinical Context: Pyelonephritis vs. Medication Side Effect
The vomiting is more likely related to the underlying urinary tract infection itself rather than the antibiotic, particularly if this is pyelonephritis rather than simple cystitis:
- Acute pyelonephritis characteristically presents with systemic symptoms including vomiting, along with high fever, malaise, and abdominal or flank pain 2
- Between 50-64% of children with febrile UTI have acute pyelonephritis on renal cortical scintigraphy 2
- Vomiting is a typical presenting symptom of upper tract infection (pyelonephritis) in children, not lower tract infection (cystitis) 2
Key Distinguishing Features
To determine if vomiting is from the infection versus the medication, consider:
- Timing: If vomiting began before antibiotic initiation or within the first 24-48 hours of illness, it likely represents the infection itself 2
- Associated symptoms: Presence of high fever, flank pain, or severe systemic symptoms suggests pyelonephritis as the cause 2
- Response pattern: If the patient is not improving clinically within 48 hours of appropriate antibiotics, this defines an "atypical UTI" requiring further evaluation 2
Other Cefuroxime Adverse Effects to Monitor
While evaluating the vomiting, be aware of other potential adverse effects:
- Candida vaginitis occurred in 8% of women in clinical trials 3
- Diarrhea is more common than vomiting (4% incidence) 4, 3
- Pseudomembranous colitis can occur during or after treatment, presenting with watery and bloody stools 1
Clinical Recommendation
Do not discontinue cefuroxime based solely on vomiting unless:
- The patient develops severe diarrhea, particularly bloody stools suggesting pseudomembranous colitis 1
- Clear temporal relationship exists between medication administration and vomiting episodes
- Other signs of drug hypersensitivity appear (rash, urticaria) 1
Instead, reassess for treatment failure if vomiting persists beyond 48 hours of appropriate antibiotic therapy, as this may indicate an atypical or complicated UTI requiring imaging evaluation. 2