Cefuroxime

Cefuroxime is a broad-spectrum antibiotic from the cephalosporin group (2nd generation). It is used for various bacterial infections, including urinary tract infections (bladder infection, kidney infection), respiratory tract infections, and skin infections.

The oral form used is cefuroxime axetil, which is converted in the body into active cefuroxime. It is available as a generic from numerous manufacturers and is generally used as a reserve medication for urinary tract infections when first-line therapies are not an option.

Mechanism of action:

• Cefuroxime inhibits bacterial cell wall synthesis
• Binds to penicillin-binding proteins (PBPs)
• Prevents cross-linking of peptidoglycan
• The bacterial cell can no longer divide and dies

Spectrum of activity:

• Gram-positive pathogens: staphylococci, streptococci
• Gram-negative pathogens: E. coli, Klebsiella, Proteus, Haemophilus
• Stable against many beta-lactamases

Resistance situation: Resistance rates of E. coli to cephalosporins are rising. Cefuroxime is therefore not the first choice for uncomplicated bladder infections, but a reserve option.

Cefuroxime is suitable for:

• Urinary tract infections (lower and upper)
• Complicated bladder infections
• When first-line antibiotics are unsuitable or ineffective
• Respiratory tract infections, skin infections, Lyme disease

Not suitable:

• If you have a known allergy to cephalosporins or a severe penicillin allergy (cross-allergy possible)
• For infections with confirmed cefuroxime resistance

Bladder infection/urinary tract infection:

• 250 mg twice daily for 5–7 days (uncomplicated)
• 500 mg twice daily for 7–14 days (complicated)

Other infections:

• 250–500 mg twice daily, depending on severity

Available strengths:

• 250 mg, 500 mg film-coated tablets
• Oral suspension for children available

Dose adjustment:

• In impaired kidney function (creatinine clearance 10 to 29 ml/min): usual single dose only every 24 hours
• With creatinine clearance below 10 ml/min: usual single dose only every 48 hours
• On hemodialysis: an additional single dose at the end of each dialysis session

How to take:

• Twice daily, morning and evening
• Take after meals (improves absorption by 40–50%)
• Swallow tablets whole with water
• Even interval of approx. 12 hours

Important notes:

• ALWAYS finish the full course of antibiotics
• Do not stop early, even if you feel better
• Drink plenty of fluids for support
• If diarrhea occurs while taking it: inform your doctor

Cefuroxime must not be taken in case of:

• Allergy to cephalosporins
• Severe hypersensitivity (anaphylaxis) to penicillins (risk of cross-allergy)

Caution in case of:

• Mild penicillin allergy (cross-allergy approx. 1–5%)
• Renal impairment (dose adjustment)
• Gastrointestinal disorders (increased C. difficile risk)
• Pregnancy: use possible if clinically indicated

Common (1–10%):

• Diarrhea
• Nausea
• Abdominal pain
• Headache
• Dizziness
• Fungal infection (vaginal/oral)
• Temporarily elevated liver enzymes
• Eosinophilia (change in blood count)

Uncommon (0.1–1%):

• Skin rash, urticaria

Rare but serious:

• C. difficile-associated diarrhea (pseudomembranous colitis)
• Severe allergic reactions (anaphylaxis)
• Changes in blood count

Interactions with other medicines:

• Medicines that reduce stomach acid: They can reduce the absorption of cefuroxime and cancel out the benefit of taking it after a meal
• Probenecid: Concomitant use is not recommended. Probenecid markedly increases the blood levels of cefuroxime and prolongs its half-life
• Blood-thinning medicines taken by mouth (oral anticoagulants): The INR value may rise
• Medicines that inhibit the movement of the bowel: They must not be used in the case of bowel inflammation caused by antibiotics (colitis)

Effect on laboratory tests:

• Cefuroxime can cause a positive Coombs test and thereby affect blood cross-matching tests
• When measuring blood sugar, ferrocyanide tests can give false negative results