Cefuroxime

• Respiratory Tract Infections
• Lyme Disease
• Urinary Tract Infections
• Skin Infections

Cefuroxime is a second-generation cephalosporin antibiotic available in both oral and parenteral formulations. This versatile antibiotic offers broad-spectrum activity against many Gram-positive and Gram-negative bacteria and is widely used for respiratory, urinary, and skin infections.

Mechanism of Action

Cefuroxime exerts its bactericidal activity by binding to penicillin-binding proteins (PBPs) located on the bacterial cell membrane. This binding inhibits the transpeptidation step in peptidoglycan synthesis, weakening the bacterial cell wall and leading to cell lysis and death. Cefuroxime is relatively resistant to degradation by many beta-lactamases, enhancing its activity against beta-lactamase-producing strains. It has excellent activity against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus (methicillin-susceptible), making it effective for common respiratory pathogens.

Available Formulations

Cefuroxime is available in multiple formulations. The oral form (cefuroxime axetil) comes as tablets (250 mg, 500 mg) and suspension (125 mg/5 mL, 250 mg/5 mL). The injectable form (cefuroxime sodium) is available as powder for reconstitution in various vial sizes. The oral tablets should be taken with food to maximize absorption; the suspension can be taken with or without food but has a strong, unpleasant taste that may limit pediatric compliance.

Medical Uses

Cefuroxime is FDA-approved for numerous infections including pharyngitis/tonsillitis, acute bacterial otitis media, acute bacterial maxillary sinusitis, acute bacterial exacerbations of chronic bronchitis, community-acquired pneumonia, uncomplicated skin and skin structure infections, uncomplicated urinary tract infections, uncomplicated gonorrhea, and early Lyme disease. The injectable form is also used for surgical prophylaxis and more serious infections requiring parenteral therapy.

Dosing Guidelines

For oral administration in adults, typical doses range from 250-500 mg twice daily for 5-10 days depending on the infection. For early Lyme disease, 500 mg twice daily for 20 days is recommended. Pediatric oral dosing is typically 10-15 mg/kg twice daily (maximum 500 mg per dose). For parenteral administration, adult doses range from 750 mg to 1.5 g every 8 hours. The tablets must be swallowed whole; crushing releases a bitter taste and reduces absorption. Dose adjustment is needed for severe renal impairment.

Important Safety Information

Cefuroxime is contraindicated in patients with known hypersensitivity to cephalosporins. There is potential cross-reactivity with penicillins, though clinically significant cross-allergenicity is uncommon. Clostridioides difficile-associated diarrhea has been reported with all antibiotics and can occur even weeks after discontinuation. Prolonged use may result in superinfection with resistant organisms. The tablets and suspension are not bioequivalent on a mg-per-mg basis and should not be substituted for each other.

Drug Interactions

Antacids and H2 receptor antagonists may reduce absorption of oral cefuroxime axetil by increasing gastric pH. Probenecid reduces renal tubular secretion of cefuroxime, increasing serum concentrations. Cefuroxime may cause false-positive urine glucose tests with copper reduction methods. Concurrent use with aminoglycosides may increase nephrotoxicity risk. No significant interactions with warfarin have been reported, though monitoring is recommended.

Special Populations

Cefuroxime is pregnancy category B; use during pregnancy only if clearly needed. It is excreted in breast milk in low concentrations and is generally compatible with breastfeeding. Safety and efficacy have been established in pediatric patients 3 months and older for most indications. Elderly patients may require dose adjustment based on renal function. For patients with CrCl less than 30 mL/min, the dose frequency should be reduced. Hemodialysis removes cefuroxime; additional doses should be given after dialysis.