Cefuroxime Axetil for Otitis Media, Streptococcal Pharyngitis

• Generic name: Cefuroxime Axetil
• Brand names: Ceftin, Zinacef, Zinnat
• Dosages:
  Tablets 125 mg, 250 mg, 500 mg
  Suspension 125 mg/5 mL, 250 mg/5 mL
• Pharmacologic category: Cephalosporin antibiotic (Second Generation), β-lactam
• FDA approved: December 1987
• Manufacturer: GlaxoWellcome
• Pregnancy risk factor: B

Medical uses

Cefuroxime axetil is a second-generation cephalosporin antibiotic developed by Glaxo. It is resistant to beta-lactamase.

Cefuroxime is used to treat:

• Respiratory tract infections - acute and chronic bronchitis, pharyngitis, tonsillitis
• Urinary tract infections - pyelonephritis, cystitis
• Skin and skin structures infections - cellulitis, erysipelas, peritonitis and wound infections
• Uncomplicated gonorrhea
• Acute maxillary sinusitis, including complicated cases
• Otitis media (ear infection)
• Lyme disease

Cefuroxime for Ear Infection

Cefuroxime is officially labeled for the treatment of otitis media (middle ear infection). It is considered a second-line treatment as an alternative to amoxicillin or amoxicillin-clavulanate7. Cefuroxime axetil may be used in patients with Non-type I allergy to penicillin.

Studies in children 3 months to 12 years of age demonstrate that a 10-day course of cefuroxime axetil is as effective or more effective than a 10-day course of cefaclor, amoxicillin, or Augmentin. The overall clinical response rate to cefuroxime axetil in children with AOM ranges from 62–94%4.

Short 5-days regimen of cefuroxime axetil also appears to be effective for the treatment of otitis media in children. In a randomized study in children 3 months to 12 years of age with acute otitis media, a satisfactory bacteriologic response (cure or presumed cure) was obtained in 92% of those who received a 5-day regimen of cefuroxime axetil (30 mg/kg daily given in 2 divided doses), 84% of those who received a 10-day regimen or cefuroxime axetil (30 mg/kg daily given in 2 divided doses), or 95% of those who received a 10-day regimen of Augmentin (40 mg/kg daily given in 3 divided doses).

Cefuroxime axetil 5-day therapy is as effective as Augmentin 8- or 10-day therapy and produces fewer gastrointestinal side effects (diarrhea) in the treatment of acute otitis media in children 6–36 months of age1.

Some doctors caution that short-term antibiotic regimens (5 days or less) may not be appropriate for the treatment of otitis media in children younger than 2 years of age or for those with underlying disease, recurrent or persistent otitis media, or perforated tympanic membranes and spontaneous purulent drainage.

Cefuroxime dosage for Ear Infection

• Adult dose: 250 mg twice a day for 10 days.
• Children 3 months to 12 years: 15 mg/kg twice a day for 10 days;
  maximum daily dose is 1000 mg.
• Children 13 years or older: adult dose

Cefuroxime for Pharyngitis and Tonsillitis (Strep Throat)

Cefuroxime axetil is officially labeled for the treatment of streptococcal pharyngitis and tonsillitis caused by group A beta-hemolytic streptococci.

Cefuroxime is highly effective for the treatment of streptococcal pharyngitis and tonsillitis. In addition, short-course (4–5 day) of cefuroxime axetil also provides successful treatment. In clinical study5 the symptoms improvement rate was 94.8% in children who received the 4-day cefuroxime. 30 days after treatment, the infection relapse rate was only 2.8%.

Cefuroxime is very effective in eradicating chronic streptococcal carriage6.

Cefuroxime dosage for Pharyngitis and Tonsillitis

• Adult dose: 250 mg twice a day for 10 days.
• Children 3 months to 12 years: 10 mg/kg of the suspension twice a day for 10 days; maximum daily dose is 500 mg.
• Children 13 years or older: adult dose

Pharmacological characteristics

• Elimination half-life: 1.2 - 1.3 h (tablets), 1.4 - 1.9 h (suspension), and about 80 min (IV/IM). (tablets/suspension) and about 89% over 8 h (IV/IM).
• Oral absorption: 40–50%
• Excretion: About 50% is excreted unchanged in the urine within 12 h.

Benefits

• May be taken with food.
• Convenient BID (twice daily) dosing schedule.
• Generally well tolerated and side effects are usually transient.
• Cefuroxime is more active against gram-negative bacteria than are the first-generation cephalosporins (e.g. cephalexin).
• It is distributed into most body tissues and fluids including gallbladder, liver, kidney, bone, uterus, ovary, sputum, bile, and peritoneal, pleural, and synovial fluids.
• Improved activity against common beta-lactamase­producing respiratory pathogens such as H. influenzae and M. catarrhalis2.

Mechanism of action

Cefuroxime is a bactericidal beta-lactam antimicrobial. It inhibits the third and final stage of bacterial cell wall synthesis by preferentially binding to specific proteins (PBPs) that are located inside the bacterial cell wall. After antibiotic has bound to these receptors, the transpeptidation reaction is inhibited and peptidoglycan synthesis is blocked. Finally, it results in bacterial lysis.

References

• 1. Pessey JJ, Gehanno P, Thoroddsen E, Dagan R, Leibovitz E, Machac J, Pimentel JM, Marr C, Leblanc F. Short course therapy with cefuroxime axetil for acute otitis media: a randomized multicenter comparison. PubMed
• 2. Kayser FH, Bille J. In-vitro activity of cefuroxime-axetil against pathogens of bacterial infections of the respiratory tract. Schweiz Rundsch Med Prax. 1990 Nov 6;79(45):1383-6. PubMed
• 3. U.S. FDA. Cefuroxime axetil (Ceftin) Prescribing Information
• 4. Turik MA, Johns D Jr. Comparison of cefaclor and cefuroxime axetil in the treatment of acute otitis media with effusion in children who failed amoxicillin therapy. J Chemother. 1998 Aug;10(4):306-12
• 5. Aujard Y, Boucot I, Brahimi N, Chiche D, Bingen E. Comparative efficacy and safety of four-day cefuroxime axetil and ten-day penicillin treatment of group A beta-hemolytic streptococcal pharyngitis in children. Pediatr Infect Dis J. 1995 Apr;14(4):295-300.
• 6. Gooch WM, Swenson E, Higbee MD, Cocchetto DM, Evans EC. Cefuroxime axetil in the treatment of group A beta-hemolytic streptococcal pharyngitis. Clin Ther. 1987;9(6):670-7. PubMed
• 7. The Diagnosis and Management of Acute Otitis Media. The American Academy of Pediatrics

By HealthyStock Research Group, October 2009
Medical resources reviewed: August 2018