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Cefuroxime axetil

Class
Antibiotics
Subclass
Second-generation cephalosporins
Substance name
Cefuroxime axetil
Brand names
Ceftin®, Zinacef®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Acute bacterial rhinosinusitis • Maxillary, mild-to-moderate
•
250 mg PO BID for 10 days
GAS pharyngitis
•
250 mg PO BID for 10 days
Gonorrhea • Uncomplicated
•
1,000 mg PO once
Lyme disease • Erythema migrans
•
500 mg PO BID for 20 days
Alternative
•
500 mg PO BID for 14-21 days
SSTIs • Uncomplicated
•
250-500 mg PO BID for 10 days
UTIs • Uncomplicated cystitis
•
250 mg PO BID for 7 days
Acute otitis media • Off-label
•
500 mg PO BID for 5-7 days (mild) or up to 10 days (severe)
Bite wound infection • Animal or human • Off-label
•
500 mg PO BID for 5-14 days
Community-acquired pneumonia • Off-label
•
500 mg PO BID for at least 5 days and until patient is stable
For use in patients with comorbidities in an outpatient setting.
COPD • Acute exacerbation • Off-label
•
250-500 mg PO BID for 10 days
Diabetic foot infection • Off-label
•
250-500 mg PO BID
Lyme disease • Carditis • Off-label
•
500 mg PO BID for 20 days
Alternative
•
500 mg PO BID for 14-21 days
Lyme disease • Neurologic • Off-label
•
500 mg PO BID for 14-21 days
Cranial-nerve palsy without meningitis.
Lyme disease • Arthritis • Off-label
•
500 mg PO BID for 28 days
Lyme disease • Acrodermatitis chronica atrophicans • Off-label
•
500 mg PO BID for 21-28 days
Lyme disease • Borrelial lymphocytoma • Off-label
•
500 mg PO BID for 14 days
Odontogenic infection • Off-label
•
500 mg PO BID for 5-14 days
Septic arthritis • Mild or moderate • Off-label
•
250-500 mg PO BID for 2-4 weeks
Step down after 1-2 weeks of intravenously therapy.
Prevention
Bite wound infection • Animal or human • Off-label
•
500 mg PO BID for 3-5 days
S. pneumoniae in patients with chronic GvHD • Off-label
•
250-500 mg PO BID
S. pneumoniae, during HSCT • Off-label
•
250-500 mg PO BID
Indications for use
Labeled indications
Adults
•
Treatment of Lyme disease (erythema migrans)
•
Treatment of acute bacterial rhinosinusitis (maxillary, mild-to-moderate)
•
Treatment of chronic bronchitis (acute exacerbation)
•
Treatment of gonorrhea (uncomplicated)
•
Treatment of GAS pharyngitis
•
Treatment of GAS pharyngitis (mild-to-moderate)
•
Treatment of SSTIs (uncomplicated)
•
Treatment of UTIs (uncomplicated cystitis)
Off-label indications
Adults
•
Treatment of Lyme disease (acrodermatitis chronica atrophicans)
•
Treatment of Lyme disease (arthritis)
•
Treatment of Lyme disease (borrelial lymphocytoma)
•
Treatment of Lyme disease (carditis)
•
Treatment of Lyme disease (neurologic)
•
Treatment of acute otitis media
•
Treatment of bite wound infection (animal or human)
•
Treatment of COPD (acute exacerbation)
•
Treatment of community-acquired pneumonia
•
Treatment of diabetic foot infection
•
Treatment of odontogenic infection
•
Treatment of septic arthritis (mild or moderate)
•
Prevention of S. pneumoniae in patients with chronic GvHD
•
Prevention of S. pneumoniae, in patients undergoing HSCT
•
Prevention of bite wound infection (animal or human)
Safety risks
Contraindications
Hypersensitivity to cefuroxime or its components or to other β-lactam antibiotics
Warnings and precautions
Abnormal oral glucose tolerance test
•
Maintain a high level of suspicion, as cefuroxime axetil has been reported to cause false-positive results for urine glucose tests using copper reduction.
•
Maintain a high level of suspicion, as cefuroxime axetil has been reported to cause false-negative results for bloode glucose tests using ferricyanide.
Antimicrobial resistance
•
Maintain a high level of suspicion, as the use of cefuroxime axetil in the absence of a proven or strongly suspected bacterial infection increases the risk of developing drug-resistant bacteria.
C. difficile infection
•
Maintain a high level of suspicion, as nearly all antibiotics, including cefuroxime axetil, are associated with an increased risk of C. difficile-associated diarrhea.
Superinfection
•
Maintain a high level of suspicion, as superinfections with fungal or bacterial pathogens may occur during treatment.
Specific populations
Renal impairment
eGFR ≥ 30 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-30 mL/min/1.73 m²
•
Do not exceed frequency of once daily. Dose reduce to either 250 mg every 12 hours OR 250-500 mg every 24 hours.
eGFR < 10 mL/min/1.73 m²
•
Maximal dose of 250-500mg. Do not exceed frequency of q48h.
Renal replacement therapy
Continuous renal replacement
•
No guidance available. Dose as in eGFR < 10 mL/min/1.73 m².
Intermittent hemodialysis
•
Administer an additional dose after each session. Dose as in eGFR < 10 mL/min/1.73 m².
Peritoneal dialysis
•
Dose as in eGFR < 10 mL/min/1.73 m².
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: B1
•
Use only if clearly needed. Cephalosporins are generally considered safe for use in pregnancy, though limited data is available specifically for cefuroxime. Cefuroxime is one of the effective antibiotics used for antibiotic prophylaxis for Cesarean delivery.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
Adverse reactions
Very common > 10%
•
Diarrhea
Common 1-10%
•
↑ blood eosinophil count, ↑ serum LDH, ↑ serum transaminases, Jarisch-Herxheimer reaction, nausea, vomiting, vaginitis
Uncommon < 1%
•
Tongue swelling, urticaria, headache, loss of appetite, chest pain, dyspnea, abdominal pain, abdominal cramps, flatulence, dyspepsia, mouth ulcers, skin rash, itching, dysuria, vulvar itching, chills, somnolence, ↑ thirst, dizziness, chest tightness, tachycardia, skin erythema, muscle cramps, muscle spasms, flank pain, vaginal discharge, vulvovaginal candidiasis
Unknown frequency
•
↓ WBC count, ↓ platelet count, jaundice, ↑PT, seizure, angioedema, erythema multiforme, hemolytic anemia, Clostridioides difficile infection, cholestasis, hepatitis, anaphylaxis, myocardial infarction, serum sickness-like reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis
Interactions
Drug(s)
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