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 is effective against many Gram-positive and Gram-negative bacteria. In India, it is widely used for respiratory, urinary, skin, and soft tissue infections, and as surgical prophylaxis.
| Onset | Duration | Bioavailability |
|---|---|---|
| Peak plasma concentrations are achieved within 2-3 hours after oral administration. | Approximately 8-12 hours, supporting a twice-daily (BD) dosing regimen. | Approximately 37-52% for the oral tablet (as cefuroxime axetil prodrug), increased when taken with food. |
2. Mechanism of Action
Cefuroxime is a bactericidal antibiotic that 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 subsequent osmotic lysis of the bacterium.
3. Indications & Uses
- Acute bacterial exacerbations of chronic bronchitis
- Community-acquired pneumonia (mild to moderate)
- Acute bacterial sinusitis
- Uncomplicated urinary tract infections (cystitis)
- Uncomplicated skin and skin structure infections (e.g., cellulitis, impetigo)
- Pharyngitis/Tonsillitis (when caused by susceptible Streptococcus pyogenes)
- Early Lyme disease
4. Dosage & Administration
Adult Dosage: Most infections: 250mg to 500mg orally twice daily. For more severe infections, lower respiratory tract infections, or Lyme disease: 500mg twice daily. Duration: Typically 5-10 days, depending on infection.
Administration: Swallow tablet whole with a glass of water. Take with food to enhance absorption. Complete the full prescribed course even if symptoms improve. Space doses evenly (e.g., every 12 hours).
5. Side Effects
Common side effects may include:
- Diarrhea or loose stools
- Nausea
- Vomiting
- Abdominal pain/discomfort
- Headache
- Vaginal candidiasis or itching
6. Drug Interactions
| Drug | Effect | Severity |
|---|---|---|
| Probenecid | Inhibits renal tubular secretion of cefuroxime, increasing and prolonging its blood levels. | Moderate |
| Oral Anticoagulants (Warfarin, Acenocoumarol) | Cefuroxime may potentiate anticoagulant effect, increasing risk of bleeding. Monitor INR closely. | Major |
| Aminoglycosides (e.g., Gentamicin) | Increased potential for nephrotoxicity. Monitor renal function. | Moderate |
| Loop Diuretics (e.g., Furosemide) | Potential for increased nephrotoxicity. | Moderate |
| Oral Typhoid Vaccine | Antibiotics may render the live bacterial vaccine ineffective. Avoid concurrent use. | Moderate |
| Alcohol (disulfiram-like reaction is rare with cephalosporins) | Theoretical risk, though more common with certain cephalosporins (cefamandole, cefoperazone). Generally not a concern with cefuroxime, but caution advised. | Low |
7. Patient Counselling
- DO take the medicine exactly as prescribed, at evenly spaced intervals.
- DO complete the full course of therapy, even if you feel better.
- DO take the tablet with food or immediately after a meal to get the full dose.
- DO swallow the tablet whole; do not crush, break, or chew it.
- DO inform your doctor if you are pregnant, planning pregnancy, or breastfeeding.
- DONT skip doses or stop the medication early.
- DONT share your antibiotic with anyone else.
- DONT take it for viral infections like the common cold or flu.
8. Toxicology & Storage
Overdose: Nausea, vomiting, epigastric distress, diarrhea, and convulsions (especially in patients with renal impairment). High doses may lead to increased risk of neurological effects like encephalopathy, myoclonus, and seizures.
Storage: Store below 30°C in a cool, dry place, protected from light and moisture. Keep out of reach of children. Do not use after the expiry date printed on the pack.