Is cefuroxime (a cephalosporin antibiotic) effective in treating ear infections and streptococcal (strep) infections in patients without a history of allergy to cephalosporins?

Cefuroxime Coverage for Ear and Strep Infections

Yes, cefuroxime effectively covers both ear infections and streptococcal infections, with FDA-approved indications for lower respiratory tract infections caused by Streptococcus pneumoniae and Streptococcus pyogenes, and demonstrated efficacy in otitis media through extensive clinical trials. 1, 2

FDA-Approved Coverage for Streptococcal Infections

Cefuroxime has direct FDA approval for treating infections caused by Streptococcus pyogenes (Group A Strep) and Streptococcus pneumoniae across multiple infection sites including lower respiratory tract infections, skin and skin-structure infections, septicemia, meningitis, and bone/joint infections. 1

• The drug demonstrates excellent in vitro activity against streptococcal strains (excluding enterococci), with blood levels that exceed minimum inhibitory concentrations for these pathogens 3
• Clinical studies show 90-91% success rates in treating respiratory infections caused by streptococci 4

Efficacy in Ear Infections (Otitis Media)

While not explicitly listed in the FDA label for otitis media, cefuroxime axetil (the oral formulation) has proven highly effective in treating acute otitis media in multiple randomized controlled trials. 2, 5

• Clinical trials demonstrate that 5-10 days of oral cefuroxime axetil (250-500 mg twice daily) provides effective treatment for upper respiratory tract infections including otitis media, with efficacy comparable to amoxicillin/clavulanic acid and other cephalosporins 2, 5
• Five-day courses of cefuroxime axetil were shown to be as effective as 10-day courses in acute otitis media 5
• The American Academy of Pediatrics recognizes cefuroxime as an alternative cephalosporin for otitis media with predicted efficacy of 83-88% 6, 7

Spectrum Against Common Ear Infection Pathogens

Cefuroxime provides broad coverage against the three most common bacterial causes of otitis media:

• Streptococcus pneumoniae (including penicillin-susceptible and intermediate strains) 5, 3
• Haemophilus influenzae (including ampicillin-resistant, beta-lactamase-producing strains) 1, 5, 3
• Moraxella catarrhalis (including beta-lactamase-positive strains) 5

Streptococcal Pharyngitis Coverage

Cefuroxime axetil demonstrates superior or equivalent efficacy compared to penicillin V for Group A beta-hemolytic streptococcal pharyngitis:

• In patients aged 13-18 years, cefuroxime achieved 94% bacteriologic cure versus 67% with penicillin V (p<0.05) 8
• Cefuroxime may be more effective than penicillin in preventing the streptococcal carrier state 8
• The drug is at least as effective as phenoxymethylpenicillin for treating streptococcal tonsillopharyngitis 5

Practical Dosing Considerations

For oral therapy (cefuroxime axetil):

• Adults: 250-500 mg twice daily for 5-10 days 2, 5
• Adolescents (13-18 years): 250 mg twice daily 8
• Children (4-12 years): 125 mg twice daily 8

For parenteral therapy (cefuroxime sodium):

• Standard regimen: 750 mg every 8 hours intramuscularly or intravenously 1, 4

Important Clinical Caveats

Common pitfalls to avoid:

• Cefuroxime does NOT cover enterococci—if enterococcal infection is suspected, choose a different agent 3
• Pseudomonas aeruginosa is resistant to cefuroxime; superinfections may occur 3
• The drug is safe in penicillin-allergic patients with non-severe reactions, as cross-reactivity risk is approximately 0.1% when severe type I hypersensitivity is excluded 6, 7
• For patients with severe immediate-type penicillin allergy, cefuroxime (which has dissimilar side chains to most penicillins) can still be used with heightened monitoring 6

When to Choose Cefuroxime

Cefuroxime is particularly advantageous when:

• Beta-lactamase-producing H. influenzae or M. catarrhalis are suspected or confirmed 2, 5
• A twice-daily oral regimen is desired for improved compliance 2, 5
• Sequential IV-to-oral therapy is planned for hospitalized patients with respiratory infections 2, 5
• Penicillin allergy (non-severe) necessitates an alternative agent 6, 7