Cefuroxime Generation Classification
Cefuroxime is a second-generation cephalosporin. 1
Classification Basis
- Cephalosporins are classified into generations based primarily on their spectrum of activity against gram-negative bacteria, with each successive generation typically having expanded gram-negative coverage 2
- Second-generation cephalosporins like cefuroxime have enhanced gram-negative coverage compared to first-generation agents while maintaining good gram-positive activity 2
Key Antimicrobial Characteristics
Spectrum of Activity:
- Cefuroxime demonstrates excellent activity against both gram-positive organisms (staphylococci, streptococci excluding enterococci) and gram-negative pathogens 3, 4
- It has particularly strong activity against Haemophilus influenzae (including beta-lactamase producing strains), Streptococcus pneumoniae, Moraxella catarrhalis, and Neisseria gonorrhoeae 3, 5
- Among the Enterobacteriaceae, it covers E. coli, Klebsiella pneumoniae, and Proteus mirabilis 3
Beta-Lactamase Stability:
- A defining feature of cefuroxime as a second-generation agent is its enhanced resistance to beta-lactamases produced by staphylococci and most gram-negative aerobic bacteria 6, 5
- This beta-lactamase stability makes it effective against organisms resistant to first-generation cephalosporins like cephalothin 4, 6
Clinical Context in Guidelines
Guideline Recognition:
- Multiple international guidelines explicitly classify cefuroxime as a second-generation cephalosporin when recommending empirical therapy 1
- The IWGDF/IDSA 2023 guidelines list cefuroxime alongside third-generation agents (cefotaxime, ceftriaxone) for moderate-to-severe diabetic foot infections, noting its classification as "2nd generation" in parentheses 1
- Taiwan pneumonia guidelines similarly designate cefuroxime as a second-generation agent when treating beta-lactamase producing H. influenzae 1