Second Generation Cephalosporins:  Cefuroxime

• Cefuroxime:  Adverse Reactions^2,3

  • Gastrointestinal

    • The most frequently reported adverse reactions to cefuroxime involve the gastrointestinal tract.

      • Nausea, vomiting, diarrhea, and abdominal pain occur in a dose-dependent manner, with oral formulations generating more GI upset than parenteral administration.

      • In clinical trials examining oral cefuroxime axetil for cystitis, 15.6% of patients reported adverse events, with diarrhea/loose motions being the most frequent gastrointestinal manifestation.

      • These reactions are typically mild and transient, often resolving spontaneously during continued therapy.

  • Hypersensitivity Reactions and IgE-Mediated Anaphylaxis^5,6,7

    • Although cefuroxime exhibits a overall favorable safety profile, IgE-mediated hypersensitivity reactions ranging from benign cutaneous reactions to life-threatening anaphylaxis can occur.

    • Anaphylaxis to cefuroxime is rare but well-documented, manifesting within seconds to minutes of drug exposure with symptoms including throat itching, tongue and angioedema, generalized urticaria, dyspnea, hypotension, and loss of consciousness.

    • Serum tryptase measurement provides objective documentation, with levels typically elevated above 13 µg/L during acute anaphylactic events, peaking within 1-2 hours and normalizing by 24 hours.

      • Anaphylaxis can occur even in patients with prior cefuroxime exposures that were tolerated without adverse events, indicating that sensitization may develop over time.

    • Diagnostic evaluation of cefuroxime anaphylaxis employs skin prick testing and specific IgE assays, though false-negative results occur and sensitivity/specificity remain imperfect.

    • Cross-reactivity to penicillins in patients developing cefuroxime anaphylaxis is minimal, as demonstrated by negative penicillin skin tests even in patients with documented cefuroxime-specific IgE.^6,7