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
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 |
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