1. Clinical Overview
Cefuroxime is a second-generation cephalosporin antibiotic with broad-spectrum bactericidal activity. It is more resistant to beta-lactamases than first-generation cephalosporins and exhibits good activity against both Gram-positive and Gram-negative organisms, including Haemophilus influenzae and Neisseria gonorrhoeae. It is widely used in the Indian healthcare setting for respiratory, skin, soft tissue, and urinary tract infections.
| Onset | Duration | Bioavailability |
|---|---|---|
| Peak plasma concentration is reached within 2-3 hours after oral administration. | Approximately 8-12 hours, supporting a twice-daily (BD) dosing regimen. | Approximately 37-52% when taken orally as cefuroxime axetil, the prodrug ester. Bioavailability increases when taken with food. |
2. Mechanism of Action
Cefuroxime is a bactericidal beta-lactam antibiotic. It inhibits bacterial cell wall synthesis by binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall. This binding inhibits the final transpeptidation step of peptidoglycan synthesis, leading to the formation of a defective cell wall and eventual osmotic lysis of the bacterium.
3. Indications & Uses
- Acute bacterial exacerbations of chronic bronchitis
- Community-acquired pneumonia (mild to moderate)
- Acute bacterial sinusitis
- Pharyngitis/Tonsillitis (when caused by susceptible Streptococcus pyogenes)
- Uncomplicated skin and skin structure infections (e.g., cellulitis, impetigo)
- Uncomplicated urinary tract infections (cystitis)
- Uncomplicated gonorrhea (single-dose regimen)
4. Dosage & Administration
Adult Dosage: Most infections: 250 mg orally twice daily. For more severe infections, lower respiratory tract infections, or skin/soft tissue infections: 500 mg twice daily. Uncomplicated Gonorrhea: Single 1 g dose. Lyme Disease: 500 mg twice daily for 20 days.
Administration: Take with food to enhance absorption and minimize gastrointestinal upset. Swallow the tablet whole; do not crush, break, or chew. Maintain adequate hydration. Complete the full prescribed course even if symptoms improve.
5. Side Effects
Common side effects may include:
- Diarrhea or loose stools
- Nausea
- Vomiting
- Abdominal pain/discomfort
- Headache
- Vaginal candidiasis or vaginitis
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Probenecid | Inhibits renal tubular secretion of cefuroxime, increasing and prolonging its serum levels. | Moderate |
| Oral Anticoagulants (Warfarin) | Cefuroxime may potentiate anticoagulant effect by reducing vitamin K-producing gut flora and possibly affecting platelet function. Monitor INR closely. | Moderate to High |
| Aminoglycosides (e.g., Gentamicin) | Potential additive nephrotoxicity. Monitor renal function. | Moderate |
| Loop Diuretics (e.g., Furosemide) | May increase the risk of nephrotoxicity. | Moderate |
| Oral Typhoid Vaccine | Antibiotics may render the live bacterial vaccine ineffective. Avoid concurrent use. | Moderate |
| Antacids / H2 Blockers / PPIs | May reduce gastric acidity and potentially decrease the absorption/bioavailability of cefuroxime axetil. Separate administration by 2 hours. | Mild |
7. Patient Counselling
- DO take the medicine exactly as prescribed, at evenly spaced intervals.
- DO take the tablet with food to get the full dose and reduce stomach upset.
- DO swallow the tablet whole; do not crush or chew.
- DO complete the entire course of therapy, even if you feel better.
- DON'T skip doses.
- DON'T share your antibiotic with anyone else.
- DON'T take antacids, iron, or zinc supplements within 2 hours of taking cefuroxime.
8. Toxicology & Storage
Overdose: Nausea, vomiting, epigastric distress, diarrhea, convulsions (especially in patients with renal failure). High serum levels can lead to neuromuscular excitability or seizures.
Storage: Store below 25°C, in a cool, dry place. Protect from light and moisture. Keep out of reach of children. Do not use after the expiry date printed on the pack.