Acute Otitis Media  (Oral Cefuroxime Axetil)

• Treatment of acute otitis media in children (and adults) due to S. pneumoniae, H. influenzae, M. catarrhalis, or S. pyogenes (including β-lactamase producing strains of Haemophilus influenzae and Moraxella catarrhalis).² 

• Treating acute otitis media is an important pediatric of cefuroxime due to its effectiveness against the major acute otitis media pathogens.^6,7,8

  • If a child has an ear infection not responding to amoxicillin (perhaps due to a β-lactamase producing H. influenzae), switching to cefuroxime axetil or amoxicillin-clavulanate may be appropriate.

Acute Bacterial Sinusitis (Oral Cefuroxime Axetil)^2,910  

• Treatment of acute bacterial maxillary sinusitis in adults or adolescents (≥13) caused by susceptible S. pneumoniae or non-β-lactamase-producing H. influenzae.

  • Cefuroxime axetil is indeed used for sinusitis, including in children, especially when organisms like M. catarrhalis or H. flu (which often elaborate β-lactamase) are suspected.

    •  Cefuroxime is effective in this context given its resistance to beta-lactamases associated with these bacteria.

Acute Bacterial Exacerbations of Chronic Bronchitis (Oral Cefuroxime Axetil)^2,11,12  

• In adults (and adolescents ≥13), oral cefuroxime is indicated for acute bacterial exacerbations of chronic bronchitis, caused by susceptible strains of S. pneumoniae, H. influenzae (β-lactamase–negative), or H. parainfluenzae.

  • This treatment may be targeted for COPD patients or smokers with chronic bronchitis who get a secondary bacterial infection.

    • Many of those infections involve β-lactamase–producing strains, against which cefuroxime would still be effective (except that some H. influenzae with certain β-lactamases or other resistance may require a stronger agent).

Uncomplicated Urinary Tract Infections (Oral Cefuroxime Axetil)^2,4,13,14

• Oral cefuroxime (in patients ≥13) is indicated for uncomplicated UTIs (like simple cystitis) due to E. coli or Klebsiella.

  • Oral cefuroxime is often reserved for cases where first-line oral agents can not be used.

  • Cefuroxime remains an effective oral option for UTIs caused by susceptible organisms, including some that produce narrow-spectrum β-lactamases given that cefuroxime will remain active whereas amoxicillin might not.

Uncomplicated Skin and Soft Tissue Infections (Oral Cefuroxime Axetil)²   

• Oral cefuroxime is indicated in patients ≥13 for uncomplicated skin infections (impetigo, cellulitis) due to MSSA or S. pyogenes.

  • Pediatric impetigo (often staph or strep) can also be treated with cefuroxime suspension as an alternative to first-generation cephalosporins or anti-Staphylococcal penicillins, especially if broader gram-negative coverage is desired to address possible mixed infection.

• Pathological Classification of uSSTIs

  Impetigo Impetigo represents the most superficial tier of Uncomplicated Skin and Soft Tissue Infections (uSSTIs, confined strictly to the stratum corneum of the epidermis) Non-bullous Impetigo15  This "honey-crusted" pathology involves the recruitment of neutrophils to the subcorneal space, typically initiated by Staphylococcus aureus or Streptococcus pyogenes. Bullous Impetigo This variant is a toxin-mediated phenomenon. S. aureus produces exfoliative toxin A, which acts as a molecular "scissor" which targets desmoglein 1.16 Desmoglein 1 is a cadherin protein responsible for cell-to-cell adhesion in the upper epidermis. Folliculitis, Furuncles, and Carbuncles (Appendage-Based Infections) These infections are associated with the hair follicle unit and progress based on the degree of dermal involvement. Folliculitis A localized purulent inflammation of the hair follicle. While often bacterial, fungal or chemical etiologies should be considered. Attribution Isolated Folliculitis Jmarchn, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Isolated_folliculitis.jpg Furuncles (Boils) and Carbuncles A furuncle is essentially a deep-seated folliculitis that has evolved into a walled-off abscess involving the dermis. Attribution Example of boil (furuncle) The original uploader was Mahdouch at French Wikipedia., CC BY 1.0 <https://creativecommons.org/licenses/by/1.0>, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Furoncle.jpg A carbuncle is a more complex pathological entity consisting of several coalescing furuncles that drain through multiple follicular openings. These are mainly caused by S. aureus, and the presence of a carbuncle often signals a greater risk for systemic bacteremia.17 Erysipelas (Superficial Dermal & Lymphatic Infection) Erysipelas involves the upper dermis and the superficial lymphatics. Attribution Facial Erysipelas infection CDC/Dr. Thomas F. Sellers/Emory University, Public domain, via Wikimedia Commons https://commons.wikimedia.org/wiki/File:Facial_erysipelas.jpg Pathology18,19  Erysipelas is characterized by sudden onset, massive dermal edema, and a prominent lymphatic infiltrate. A classic "peau d'orange" (orange peel) texture is caused by the skin's tethering at the hair follicles with significant interstitial swelling. Microbiology Erysipelas is almost exclusively caused by Group A beta-hemolytic Streptococci. Cellulitis (Deep Dermal and Subcutaneous Infection) Cellulitis is associated with deeper dermis and subcutaneous fat. Pathology Unlike erysipelas, the borders of cellulitis are diffuse because the infection spreads along tissue planes in the deeper, less-dense subcutaneous layers. Risk Factors Localized trauma, tinea pedis (serving as a portal of entry), and lymphedema are some risk factors. S. aureus and streptococcus species are implicated in cellulitis