Amoxicillin (Amoxil®) versus Cefuroxime (Ceftin®)

Based on "Antibiotic and Chemotherapy"
written by Roger G. Finch

Amoxicillin advantages over Cefuroxime

  • Treatment course with amoxicillin costs less than with cefuroxime.

Cefuroxime advantages over Amoxicillin

  • The main advantage of cefuroxime over amoxicillin is resistance to beta-lactamases.
  • Cefuroxime is effective against penicillinase-producing S. aureus. It is more resistant to beta-lactamases, contributing to a broader spectrum of activity.
  • Longer duration of action and more convenient dosing regimen.

Difference between Amoxicillin and Cefuroxime


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Table 1. Comparison of Amoxicillin and Cefuroxime

Amoxicillin Cefuroxime
Brand names
Amoxil® Ceftin®
Drug class
Penicillin antibiotic Cephalosporin antibiotic
Dose formulations
• Capsules
• Suspension
• Tablets
• Tablets, chewable
• Tablets, extended release
• Tablets
• Suspension
• Injection (IM, IV)
Antimicrobial spectrum
Gram-negative bacteria
• Escherichia coli
• Haemophilus influenzae
• Neisseria gonorrhoeae
• Proteus mirabilis
• Helicobacter pylori

Gram-positive bacteria
• Enterococcus faecalis
• Staphylococcus spp.
• Streptococcus pneumoniae
• Streptococcus pyogenes

• Amoxicillin is not active against beta-lactamase producing bacteria.
Gram-negative bacteria
• Enterobacter spp.
• Escherichia coli
• Klebsiella spp.
• Haemophilus influenzae
• Haemophilus parainfluenzae
• Neisseria meningitidis
• Neisseria gonorrhoeae
• Salmonella spp.
• Shigella spp.

Gram-positive bacteria
• Staphylococcus aureus
• Streptococcus pneumoniae
• Streptococcus pyogenes
FDA-approved indications
Otitis media
Streptococcal pharyngitis
• Sinusitis
• Skin and skin structure infections
• Pneumonia (uncomplicated)
• In combination for treatment of H. pylori infection and duodenal ulcer disease.
• Acute bacterial exacerbations of chronic bronchitis
• Secondary bacterial infections of acute bronchitis
• Urinary tract infections
• Early Lyme disease

Injection only:
• Bone and joint infections
• Lower respiratory tract infections
• Septicemia
• Meningitis
• Gonorrhea
"Off-label" uses
• Anthrax, inhalational post-exposure prophylaxis
• Erysipeloid
• Infective endocarditis (prophylaxis)
• Lyme neuroborreliosis
Chlamydia infection in pregnant women
• Intra-abdominal infections
• Cholecystitis (inflammation of the gallbladder)
• Animal bite wounds (in combination with metronidazole or clindamycin)
Mechanism of action
• Bactericidal, time-dependent killing
• Inhibits the synthesis of bacterial cell walls by binding to penicillin-binding proteins.
Half-life
• Immediate-release: ~ 60 minutes
• Extended-release: 90 minutes
• 1-2 hours (prolonged with renal impairment)
Oral bioavailability
• 74-92% • Fasting 37%;
• Postprandial 52%
Food enhances cefuroxime axetil bioavailability
Metabolism, Elimination
• Amoxicillin is eliminated
in urine (60% as unchanged drug).
• Cefuroxime is partially metabolized in liver.
• Elimination: urine 66-100% as unchanged drug.
Contraindications
• Hypersensitivity to amoxicillin
• Hypersensitivity to cefuroxime
• Hypersensitivity to penicillins or cephalosporins
Side effects
• Diarrhea
• Nausea
• Vomiting
• Rash
• Stomach pain
• Serious allergic reactions (anaphylaxis, serum sickness-like reaction)
• Diarrhea
• Decreased hemoglobin
• Eosinophilia
• Nausea
• Vomiting
• Transient rise in hepatic transaminases
• Rash

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Head-to-head comparative studies

Lyme disease

Both amoxicillin and cefuroxime axetil are safe and effective for Lyme disease.

Randomized, unblinded study1 compared 2 regimens of cefuroxime axetil (20 mg/kg/d and 30 mg/kg/d) with amoxicillin (50 mg/kg/d), each given for 20 days. At the end of treatment, there was total resolution of erythema migrans in 67% of the amoxicillin group, 92% of cefuroxime group (20 mg/kg/d), and 87% of cefuroxime group (30 mg/kg/d), and resolution of constitutional symptoms occurred in 100%, 69%, and 87%, respectively. Mild diarrhea occurred in a small number of participants in each group. No hypersensitivity reactions occurred.

Bronchitis

Both amoxicillin and cefuroxime are similarly effective in the improvement of bronchitis symptoms. However, amoxicillin therapy results in a significantly higher relapse rates.

In an investigator-blind, randomised, parallel group, multicentre study2 the two antibacterials had roughly similar efficacy:

Results of investigator-blind, randomised, parallel group, multicentre study of amoxicillin and cefuroxime in the treatment of bronchitis2 Amoxicillin Cefuroxime
Regimen 250 mg 3 times daily 250 mg 2 times daily
Clinical cure or improvement rate 24-72 hours after completion of the antibiotic treatment 80.4%
(123 of 153 patients)
76.2%
(109 of 143 patients)
Clinical relapses during the 4-week follow-up period following the end of treatment 20.8%
(16 of 77 patients)
5.9%
(4 of 68 patients)
Adverse events mild and transient

Otitis media

Cefuroxime axetil has comparable efficacy to amoxicillin in the treatment of children with middle ear infection and both antibiotics are well tolerated.

In a multicentre general practice study3 of cefuroxime axetil suspension and amoxycillin syrup in the treatment of acute otitis media the overall cure or improvement rate was 94.3% for patients treated with cefuroxime axetil and 94.5% for those receiving amoxicillin. Some Streptococcus pneumoniae and Moraxella catarrhalis strains were resistant to amoxicillin.

Further reading

References

  • 1. Eppes SC, Childs JA. Comparative study of cefuroxime axetil versus amoxicillin in children with early Lyme disease. Pediatrics. 2002 Jun;109(6):1173-7.
  • 2. Shah SH, Shah IS, Turnbull G, Cunningham K. Cefuroxime axetil in the treatment of bronchitis: comparison with amoxycillin in a multicentre study in general practice patients. Br J Clin Pract. 1994 Jul-Aug;48(4):185-9. PubMed
  • 3. Brodie DP, Griggs JV, Cunningham K. Comparative study of cefuroxime axetil suspension and amoxycillin syrup in the treatment of acute otitis media in general practice. J Int Med Res. 1990 May-Jun;18(3):235-9. PubMed

Published: October 27, 2017
Last updated: October 27, 2017

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