Lower Respiratory Tract Infections (Parenteral Administration): Cefuroxime (IV/IM) is indicated for community-acquired pneumonia and other lower respiratory infections caused by susceptible bacteria. (Parenteral Administration)

• AP Chest X-ray showing right lower lobe pneumonia

  Attribution James Heilman, MD, CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:RLL_pneumoniaM.jpg

• Cefuroxime is effective against S. pneumoniae, H. influenzae (including β-lactamase-producing strains), Staphylococcus aureus (MSSA), Streptococcus pyogenes, and Klebsiella in the lungs.^2,5,6 

  • The Infectious Diseases Society of America (IDSA) and American Thoracic Society have endorsed cefuroxime as an option for hospitalized community-acquired pneumonia.

    • In practice, IV cefuroxime for pneumonia is often paired with a macrolide to cover atypical pathogens, or a respiratory fluoroquinolone might be used instead; however, cefuroxime is a reasonable β-lactam choice for many typical pneumonia cases.

  • Cefuroxime is also used for bacterial bronchitis or pneumonia in patients with chronic lung disease when those above organisms are suspected.^2,5

Upper Respiratory Tract Infections (Parenteral Administration): Although first-line therapy for many ENT infections is often amoxicillin or amoxicillin-clavulanate, cefuroxime is indicated as an alternative in certain situations.^2,7,8

• Acute bacterial maxillary sinusitis can be treated with cefuroxime in adults and adolescents (≥13 years old) when due to susceptible H. influenzae or S. pneumoniae.

  • Acute otitis media (AOM) is also an indication: cefuroxime axetil is effective for middle ear infections caused by H. influenzae, S. pneumoniae, S. pyogenes, or M. catarrhalis, including β-lactamase–producing strains.

• In pediatric practice, cefuroxime is often used for recurrent or persistent Acute Otitis Media (AOM), especially if the pathogen might be amoxicillin-resistant.

Skin and Soft Tissue Infections (Parenteral Administration)^2,9,10

• Cefuroxime is indicated for skin and skin-structure infections (SSTIs) such as cellulitis, wound infections, or impetigo, caused by susceptible strains of Staphylococcus aureus (MSSA, β-lactamase positive or negative) and Streptococcus pyogenes.

  • Cellulitis: Left Knee

    Attribution RafaelLopez at the English-language Wikipedia, CC BY-SA 3.0 <http://creativecommons.org/licenses/by-sa/3.0/>, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Cellulitis3.jpg

  •  

    Impetigo

    Attribution James Heilman, MD, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Impetigo2020.jpg

• Cefuroxime covers some Gram-negative causes of skin infections (e.g. certain E. coli or Klebsiella in wound infections).

• Uncomplicated skin and soft tissue infections (SSTIs) in adults and adolescents (≥13) can be treated with oral cefuroxime axetil, whereas more serious SSTIs may require IV cefuroxime.

• Oral cefuroxime serves as a useful step-down therapy after IV antibiotics for skin infections, or as an alternative for patients who cannot take penicillins.

• Cefuroxime is also effective for impetigo (a superficial skin infection) in children.

  • An oral suspension course can treat impetigo caused by Staphylococcus or Streptococcus.²

Urinary Tract Infections (Parenteral Administration)^2,11,12

• Cefuroxime is indicated for uncomplicated UTIs (e.g. cystitis) caused by susceptible organisms, particularly Escherichia coli and Klebsiella pneumoniae.

  • While first-line treatments for simple UTIs are often trimethoprim-sulfamethoxazole or nitrofurantoin, cefuroxime is an option especially if the pathogen is known to be susceptible.

  • Cefuroxime achieves high concentrations in urine due to renal excretion.

    • Parenteral cefuroxime can also treat pyelonephritis (kidney infections) caused by these bacteria, though in severe cases a broader-spectrum IV antibiotic might be chosen.^13,14

Septicemia (Parenteral Administration)^2,15

• IV cefuroxime is approved for treating septicemia (bacteremia) caused by susceptible organisms.

  • Cefuroxime for this indication includes sepsis due to:

    • Staphylococcus aureus (MSSA)

    • Streptococcus pneumoniae

    • H. influenzae

    • E. coli

    • Klebsiella and others if the isolate is sensitive to cefuroxime.

  • Management of sepsis depends on the source of infection and local resistance patterns.

    • For example, cefuroxime would be appropriate for sepsis arising from a community-acquired pneumonia, for example, but would not be adequate for Pseudomonas sepsis.

    • For life-threatening infections like sepsis or endocarditis, third-generation cephalosporins or other agents might be more frequently used unless cefuroxime’s spectrum is a perfect match for the identified pathogen.

Meningitis (Parenteral Administration)^2,16,17  

Bacterial Meningitis

• Cefuroxime is one of the few second-generation cephalosporins that achieves therapeutic levels in cerebrospinal fluid when meninges are inflamed.

  • Cefuroxime administration is indicated for bacterial meningitis caused by susceptible strains of Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), or Staphylococcus aureus (MSSA).² 

  • Prior to the widespread use of third-generation cephalosporins, cefuroxime was used in meningitis treatment.

    • H. influenzae meningitis and meningococcal meningitis can be treated with IV cefuroxime.

      • Current guidelines generally favor ceftriaxone or cefotaxime (third-gen cephalosporins) for empiric meningitis therapy because of their enhanced potency and CNS penetration.

      • Cefuroxime may still be employed in penicillin-allergic patients (without anaphylaxis) or in targeted therapy when the organism is known to be cefuroxime-susceptible and third-generation cephalosporins are contraindicated.

        • Cefuroxime is not effective against Listeria monocytogenes, an important cause of meningitis in neonates and the elderly, so it would never be monotherapy in those groups.²

Gonococcal Infections (Parenteral Administration)^2,18,19  

• Cefuroxime has activity against Neisseria gonorrhoeae, including penicillinase-producing gonococcal strains.

  • Cefuroxime was historically used for uncomplicated gonorrhea.

    • The FDA-approved regimen for gonorrhea (per older labeling) was a single IM dose of 1.5 g cefuroxime (usually split into two 750 mg injections given simultaneously at two sites), combined with oral probenecid to prolong levels.

    • Given rising resistance, ceftriaxone has become the recommended treatment for gonorrhea worldwide, and cefuroxime is no longer a preferred agent.

      • CDC guidelines do not list cefuroxime as first-line for gonorrhea today.

        • In disseminated gonococcal infections (e.g. gonococcal arthritis), ceftriaxone is again preferred over cefuroxime.

Bone and Joint Infections (Parenteral Administration)^2,3,20