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Acute Otitis Media (ear infection)

Results of controlled clinical studies in children 3 months to 12 years of age with AOM indicate that a 10-day regimen of cefuroxime axetil is as effective or more effective than a 10-day regimen of cefaclor. In published studies, the overall clinical response rate to a 10-day regimen of cefuroxime axetil in pediatric patients with AOM has ranged from 62–94%.

Bronchitis

Cefuroxime axetil is as effective as cefixime in the treatment of acute bronchitis. Cefuroxime produces fewer gastrointestinal side effects, particularly diarrhea.

Randomized, investigator-blind, multicenter study5 compared the efficacy and safety of 250 mg cefuroxime axetil twice daily with that of 400 mg cefixime once daily in the treatment of acute bronchitis. Of 465 patients with acute bronchitis who were enrolled in the study, 227 received cefuroxime axetil and 238 received cefixime. Cure or improvement was achieved in 88% (130 of 148) and 91% (152 of 167) of the clinically evaluable patients who had received cefuroxime axetil or cefixime, respectively. Regarding the eradication of bacterial pathogens, a satisfactory outcome (cure or presumed cure) was obtained in 89% (47 of 53) and 91% (41 of 45) of bacteriologically evaluated patients who had received cefuroxime axetil or cefixime. Treatment with cefixime was associated with a significantly higher incidence of gastrointestinal adverse effects than with cefuroxime axetil (18% versus 10%, respectively). This difference primarily reflects a higher rate of diarrhea (15% versus 5%).

Skin infections

Cefuroxime axetil may be more effective than cafadroxil for the treatment of skin or skin structure infections in children.

A randomized, single-blind, multicenter study8 was conducted to evaluate the safety and efficacy of cefuroxime axetil and cefadroxil suspensions (30 mg/kg per day in two divided doses) for the treatment of skin or skin structure infections in 287 children. Staphylococcus aureus and Streptococcus pyogenes, or a combination of the two, were the primary pathogens isolated from infected skin lesions. A satisfactory bacteriological response (cure or presumed cure) was obtained in 97.1 and 94.3% of children in the cefuroxime axetil and cefadroxil groups, respectively. Satisfactory clinical responses (cure or improvement) were more likely to occur in cefuroxime axetil recipients than in cefadroxil recipients (97.8 versus 90.3%). Both regimens were equally well tolerated, with side effects occurring in 7.9 and 6.1% of cefuroxime axetil and cefadroxil recipients, respectively.

Exacerbations of chronic obstructive pulmonary disease

Both azithromycin and cefuroxime are effective for exacerbations in patients with chronic obstructive pulmonary disease. Azithromycin has a lower rate of side effects.

A randomized study11 compared 3 days of azithromycin and 10 days of cefuroxime for exacerbations of chronic obstructive pulmonary disease. 50 patients were treated with azithromycin and 51 with cefuroxime. The evolution of the symptoms was similar although with a trend to greater improvement in those treated with azithromycin. Functional and gasometric evolution was similar in the two schedules. Three patients treated with azithromycin required hospital admission, as did 5 treated with cefuroxime. A greater number of side effects were observed in patients treated with cefuroxime (18%) than in those receiving azithromycin (10%), with gastrointestinal side effects being the most commonly observed.

Sinusitis

Cefuroxime and clarithromycin are equally effective in the treatment of acute maxillary sinusitis.

A randomised, double-blind, multicentre study2 was performed to compare the efficacy and safety of cefuroxime axetil 250 mg twice daily (n = 185) and clarithromycin 250 mg twice daily (n = 185), both administered for 10 days, in the treatment of acute sinusitis. In the cefuroxime axetil group, 169/185 (91%) patients were cured or improved at post-treatment, as were 172/185 (93%) patients receiving clarithromycin and, of these, 137/169 (81%) and 143/172 (83%) maintained their response at follow-up. Follow-up radiography showed a reduction in incidence of air fluid level and/or opacification from 96% to 15% (cefuroxime axetil) and from 96% to 11% (clarithromycin), and a decrease in frequency of mucosal thickening from 58% to 28% (cefuroxime axetil) and from 56% to 29% (clarithromycin). Only 10% of patients in either group experienced adverse effects and days absent from work were comparable.

Lyme disease

Cefuroxime appears to be equally as effective as doxycycline in the treatment of early Lyme disease and in preventing the subsequent development of late Lyme disease.

A randomized, multicenter, investigator-blinded clinical trial7 was undertaken to compare the efficacies of cefuroxime axetil and doxycycline in the treatment of Lyme disease associated with erythema migrans. Patients with physician-documented erythema migrans were treated orally for 20 days with either cefuroxime axetil (500 mg twice daily), or doxycycline (100 mg three times daily). Patients were assessed as to the resolution of erythema migrans and of the signs and symptoms related to early Lyme disease as well as to the prevention of late Lyme disease. A satisfactory clinical outcome (success or improvement) was achieved in 90 of 100 (90%) patients treated with cefuroxime axetil and in 89 of 94 (95%) patients treated with doxycycline. Patients with paresthesia, arthralgia, or irritability at enrollment were at higher risk for an unsatisfactory clinical outcome at 1 month posttreatment. Of the patients with satisfactory outcomes at 1 month posttreatment who were evaluable at 1 year posttreatment, a satisfactory outcome was achieved in 62 of 65 (95%) and in 53 of 53 (100%) patients treated with cefuroxime axetil and doxycycline. 28% of patients treated with doxycycline and 17% of those treated with cefuroxime axetil had one or more adverse effects. Doxycycline was associated with more photosensitivity reactions (6% compared with 0%), and cefuroxime axetil was associated with more cases of diarrhea (5% compared with 0%). Jarisch-Herxheimer reactions occurred in 12% of the patients in each group

Acute exacerbations of chronic obstructive bronchitis (AECOB)

Cefuroxime and levofloxacin have similar efficacy in the treatment of acute exacerbations of chronic obstructive bronchitis.

The 6-month, randomised, open-label study10 evaluated the efficacy of levofloxacin (500 mg once daily for 10 days) and cefuroxime (250 mg twice daily for 10 days) in patients experiencing AECOB episodes. In the clinically evaluable per-protocol (PPc) population and the modified intent-to-treat population, the clinical cure rates were, respectively, 94.6% for levofloxacin versus 93.8% for cefuroxime, and 94.5% for levofloxacin versus 92.2% for cefuroxime, whilst the probability that 25% of patients would relapse during follow-up was reached within 93 days for levofloxacin compared with 81 days for cefuroxime in the PPc population. A multivariate analysis revealed that only congestive heart failure and number of AECOB episodes in the previous 12 months were predictive of relapse. Safety was comparable in the two treatment groups, with possibly related adverse events occurring in 5.0% and 2.9% of subjects in the levofloxacin and cefuroxime groups, respectively.

Community-acquired pneumonia

Levofloxacin is superior to cefuroxime axetil in the treatment of community-acquired pneumonia.

A multicenter, randomized study4 compared the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia.

Clinical success was higher with levofloxacin treatment (96%) compared with the ceftriaxone and/or cefuroxime axetil (90%). In patients with typical respiratory pathogens the bacteriologic eradication rates were higher with levofloxacin (98%) compared with the ceftriaxone and/or cefuroxime axetil (85%). Levofloxacin eradicated 100% of the most frequently reported respiratory pathogens (i.e., H. influenzae and S. pneumoniae) and provided a >98% clinical success rate in patients with atypical pathogens. Side effects were reported in 5.8% of patients receiving levofloxacin and in 8.5% of patients receiving ceftriaxone and/or cefuroxime axetil. Gastrointestinal and central and peripheral nervous system adverse events were the most common events reported with each treatment.

Sinusitis

Levofloxacin is more effective than cefuroxime for the treatment of sinusitis.

In the study3 the treatment success rates were 97.4% for patients who received levofloxacin and 92.8% for patients who received cefuroxime. The resolution rates of bacteria were 91.6% and 80.0%, respectively.

Urinary Tract Infections (UTI)

Ofloxacin may be somewhat more effective than cefuroxime axetil in the treatment of urinary tract infections in women.

In a multicenter study9 163 women with acute lower urinary tract infection were treated orally with either 125 mg cefuroxime axetil or 100 mg ofloxacin twice daily for three days. Both antibiotics were generally well tolerated. Four patients in the cefuroxime axetil group and two in the ofloxacin group experienced side effects. Clinical cure and improvement were registered in 56 of 66 (84.8%) and 59 of 62 (95.2%) of the evaluable patients treated with cefuroxime axetil and ofloxacin, respectively. Seven to nine days after therapy, bacteriuria (CFU < 10(3)/ml) had been eliminated in 53 of 66 (80.3%) and 57 of 64 (89.1%) of the evaluable patients receiving cefuroxime axetil and ofloxacin, respectively.

Acute Exacerbations of Chronic Bronchitis

Cefuroxime axetil has better efficacy and lower risk of side effects than ofloxacin.

In a randomized controlled multicenter trial1 128 patients with acute exacerbations of chronic bronchitis were treated with either cefuroxime axetil 2 x 500 mg/d (n = 65) or ofloxacin 2 x 200 mg/d for 7-8 days. According to final clinical assessment, cure was achieved with cefuroxime axetil in 75%, but only in 50% with ofloxacin. The clinical efficacy of cefuroxime axetil was assumed to be more reliable than ofloxacin. The difference is statistically significant. Therapy with ofloxacin had to be terminated in 2 cases due to side effects. Altogether 4 adverse events were documented with ofloxacin.

Sinusitis

Moxifloxacin is as effective as cefuroxime axetil in the treatment of acute sinusitis.

Prospective, multicenter, randomized, double-masked clinical trial6 compared the efficacy and safety of moxifloxacin with those of cefuroxime axetil for the treatment of community-acquired acute sinusitis. Adults with symptoms and radiographic evidence of acute maxillary sinusitis received a 10-day oral regimen of either moxifloxacin (400 mg once daily) or cefuroxime axetil (250 mg twice daily). Four hundred fifty-seven of the patients (223 moxifloxacin, 234 cefuroxime axetil) were included in the clinical efficacy analysis. Moxifloxacin was found to be similar in effectiveness to cefuroxime axetil at the end-of-therapy visit (90% vs. 89%). Clinical relapse at the follow-up visit was reported for only 8 patients (3 moxifloxacin, 5 cefuroxime axetil). No clinically significant differences were observed with respect to the number of patients experiencing a successful clinical response based on demographic or infection characteristics. Of the 537 patients in the intent-to-treat population, adverse events were reported in 37% of moxifloxacin-treated patients and in 26% of cefuroxime axetil-treated patients. Adverse-event profiles were comparable, with the exception of nausea, which was reported by 11% of moxifloxacin recipients compared with 4% of cefuroxime recipientss.

Meningitis

Ceftriaxone is superior to cefuroxime for bacterial meningitis in children. Ceftriaxone ensures milder hearing impairment and more rapid sterilization of the cerebrospinal fluid.

In the study 106 children (aged from 42 days to 16 years) with acute bacterial meningitis were randomly assigned to receive intravenously either ceftriaxone or cefuroxime12. After 18 to 36 hours of therapy, cultures of cerebrospinal fluid remained positive for 1 of the 52 children (2%) receiving ceftriaxone and 6 of 52 (12%) receiving cefuroxime. The clinical responses were similar in the two groups, and all 106 children were cured. Reversible biliary pseudolithiasis was detected only in the children treated with ceftriaxone (16 of 35 vs. 0 of 35). Other side effects were infrequent in both groups. Two months later, moderate-to-profound hearing loss was present in two children (4%) treated with ceftriaxone and in nine (17%) with cefuroxime; other neurologic abnormalities were similar.

• Cefuroxime (Ceftin) Facts

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• 3. Li XP, Qin ZM, Zheng RH, Tan QL, Zhou YY, Zhu L, Yin AF. Comparison of the effectiveness of levofloxacin and cefuroxime for the treatment of sinusitis. PubMed
• 4 .File TM Jr, Segreti J, Dunbar L, Player R, Kohler R, Williams RR, Kojak C, Rubin A. A multicenter, randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin versus ceftriaxone and/or cefuroxime axetil in treatment of adults with community-acquired pneumonia. Antimicrob Agents Chemother. 1997 Sep;41(9):1965-72. PubMed
• 5. Arthur M, McAdoo M, Guerra J, Maloney R, McCluskey D, Giguere G, Gomez G, Collins JJ. Clinical Comparison of Cefuroxime Axetil with Cefixime in the Treatment of Acute Bronchitis. Am J Ther. 1996 Sep;3(9):622-629. PubMed
• 6. Burke T, Villanueva C, Mariano H Jr, Huck W, Orchard D, Haverstock D, Heyd A, Church D. Comparison of moxifloxacin and cefuroxime axetil in the treatment of acute maxillary sinusitis.Clin Ther. 1999 Oct;21(10):1664-77. PubMed
• 7. Luger SW, Paparone P, Wormser GP, Nadelman RB, Grunwaldt E, Gomez G, Wisniewski M, Collins JJ. Comparison of cefuroxime axetil and doxycycline in treatment of early Lyme disease associated with erythema migrans. Antimicrob Agents Chemother. 1995 Mar;39(3):661-7. PubMed
• 8. Jacobs RF, Brown WD, Chartrand S, Darden P, Drehobl MA, Yetman R, Ossi MJ. Evaluation of cefuroxime axetil and cefadroxil suspensions for treatment of pediatric skin infections. Antimicrob Agents Chemother. 1992 Aug;36(8):1614-8. PubMed
• 9. Naber KG, Koch EM. Cefuroxime axetil versus ofloxacin for short-term therapy of acute uncomplicated lower urinary tract infections in women. Infection. 1993 Jan-Feb;21(1):34-9. PubMed
• 10. Petitpretz P, Chone C, Tremolieres F; Investigator Study Group. Levofloxacin 500 mg once daily versus cefuroxime 250 mg twice daily in patients with acute exacerbations of chronic obstructive bronchitis: clinical efficacy and exacerbation-free interval. Int J Antimicrob Agents. 2007 Jul;30(1):52-9. Epub 2007 May 18. PubMed
• 11. Alvarez Gutie'rrez FJ, Soto Campos G, del Castillo Otero D, Sa'nchez Go'mez J, Caldero'n Osuna E, Rodri'guez Becerra E, Castillo Go'mez J. A randomized comparative study of 3 days of azithromycin treatment and 10 days of cefuroxime treatment in exacerbations in patients with chronic obstructive pulmonary disease Med Clin (Barc). 1999 Jul 3;113(4):124-8. PubMed
• 12. Schaad UB, Suter S, Gianella-Borradori A, Pfenninger J, Auckenthaler R, Bernath O, Cheseaux JJ, Wedgwood J. A comparison of ceftriaxone and cefuroxime for bacterial meningitis in children. NEJM 1990 Jan 18;322(3):141-7. PubMed

Published: March 31, 2008
Last updated: April 25, 2011