Cefuroxime (Ceftin®) versus Ceftriaxone (Rocepin®)

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

Ceftriaxone advantages over Cefuroxime

An important advantage of ceftriaxone over the other cephalosporins is its long half-life, which allows once or twice daily dosing.
Ceftriaxone is the best cephalosporin for H. influenza.
Ceftriaxone is highly effective for a wide range of serious infections including bacterial meningitis, multidrug resistant typhoid fever, complicated urinary tract infections, blood poisoning, and abdominal sepsis.
Recommended first-line antibiotic therapy for Neisseria gonorrhoeae (in combination with azithromycin), even for resistant infections1.
No dosage adjustments are necessary for patients with renal impairment.
Ceftriaxone has a broader antimicrobial coverage.

Cefuroxime advantages over Ceftriaxone

Ceftriaxone is available for parenteral administration only, while cefuroxime axetil is available as oral tablets and oral solution.
Cefuroxime does not trigger cholecystitis-like syndrome.

Difference between Cefuroxime and Ceftriaxone

Table 1. Comparison of Cefuroxime and Ceftriaxone

Cefuroxime	Ceftriaxone
Brand names
Ceftin®	Rocepin®
Drug class
Cephalosporin antibiotic
2nd generation	3rd generation
Dose formulations
• Tablets • Suspension • Injection (intravenous, intramuscular)	• Injection (intravenous, intramuscular)
Antimicrobial spectrum
Ceftriaxone is more potent against Streptococcus pneumoniae than cefuroxime5.
Gram-negative bacteria • Enterobacter spp. • E. coli • Klebsiella spp. • H. influenzae • H. parainfluenzae • Meningococcus • Gonococcus • Salmonella spp. • Shigella spp. Gram-positive bacteria • S. aureus • Pneumococcus • S. pyogenes	Gram-negative bacteria • A. calcoaceticus • E. aerogenes • E. cloacae • E. coli • H. influenzae • H. parainfluenzae • K. oxytoca • K. pneumoniae • M. catarrhalis • M. morganii • Gonococcus • Meningococcus • P. mirabilis • P. vulgaris • P. aeruginosa • S. marcescens • Salmonella spp. • Shigella spp. Gram-positive bacteria • S. aureus • S. epidermidis • Pneumococcus • S. pyogenes • Viridans group streptococci Anaerobic bacteria • B. fragilis • Clostridium species • Peptostreptococcus species
FDA-approved indications
• Otitis media • Skin and skin structure infections • Urinary tract infections
• Streptococcal pharyngitis (strep throat) • Sinusitis • Pneumonia (uncomplicated) • Acute bacterial exacerbations of chronic bronchitis • Secondary bacterial infections of acute bronchitis • Early Lyme disease Injection only: • Bone and joint infections • Lower respiratory tract infections • Septicemia • Meningitis • Gonorrhea	• Lower respiratory tract infections (pneumonia, acute bronchitis) • Gonorrhea • Pelvic inflammatory disease • Septicemia (blood infection) • Bone and joint infections • Intra-abdominal infections (e.g. peritonitis, diverticulitis, cholangitis, pancreatitis) • Meningitis • Antimicrobial prophylaxis in surgery First line therapy for: • Penicillin-resistant gonorrhea • Lyme disease involving the central nervous system or joints • Meningitis, including meningitis in children • Typhoid fever
"Off-label" uses
• Bite wounds (in combination with other antibiotics)
• Intra-abdominal infections • Perioperative prophylaxis9	• Chancroid • Disseminated gonococcal infection 1 • Infective endocarditis 2 • Epiglottitis 3 • Whipple disease 4
Mechanism of action
• Bactericidal, time-dependent killing • Inhibits the synthesis of bacterial cell walls by binding to penicillin-binding proteins.
Half-life
• 1-2 hours (prolonged with renal impairment)	• 5.8-8.7 hours one of the longest lasting beta-lactams
Metabolism, Elimination
• Cefuroxime is partially metabolized in liver. • Elimination: urine 66-100% as unchanged drug.	• Ceftriaxone is not metabolized. • 33% to 67% of the dose is excreted in the urine as unchanged drug and the remainder is secreted in the bile and is excreted in the feces as inactive compounds.
Contraindications
• Hypersensitivity to cefuroxime, other penicillins or cephalosporins	• Hypersensitivity to ceftriaxone or other cephalosporins • Premature, hyperbilirubinemic or requiring calcium containing intravenous solutions neonates • Intravenous administration of ceftriaxone solutions containing lidocaine
Side effects
• Diarrhea • Decreased hemoglobin • Eosinophilia • Nausea • Vomiting • Transient rise in hepatic transaminases • Rash	• Chronic use may result in formation of biliary sluge. • Diarrhea • Rash • Eosinophilia • Thrombocythemia • Elevations of serum transaminases

Head-to-head comparative studies

Surgical prophylaxis

Both antibiotics are effective for prevention of surgical site infections. Single-dose ceftriaxone is more cost-effective than 3-day cefuroxime for prophylaxis of surgical site infection after gastric or colorectal operations6.

Ceftriaxone and cefuroxime are effective for infection prophylaxis in coronary artery bypass grafting. Ceftriaxone prophylaxis therapy is less expensive10.

Meningitis

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

Results of comparison of ceftriaxone and cefuroxime for bacterial meningitis in children 7.	Cefuroxime	Ceftriaxone
Percentage of patients with positive cultures of cerebrospinal fluid after 18 to 36 hours of therapy	12 % (6 of 52 percents)	2% (1 of 52 patients)
Clinical response rate	similar, all children were cured
Number of patients in whom reversible biliary pseudolithiasis was detected	16 of 35 patients	0 of 35 patients
Moderate-to-profound hearing loss two months after treatment	17%	4%

Lower respiratory tract infections
Both ceftriaxone and cefuroxime are effective and safe. But ceftriaxone offers more convenient treatment regimen.

Results of randomized comparative study of ceftriaxone and cefuroxime in mild to moderate respiratory tract infections 8.	Cefuroxime	Ceftriaxone
Regimen	0.75 g 3 times a day intravenously	1 g once a day intravenously
Bacteriological eradication and clinical cure or clear improvement rate	79%	81%
Eradication rate	75%	80%

References

1. STD Treatment Guidelines Gonococcal Infections
2. Francioli PB. Ceftriaxone and outpatient treatment of infective endocarditis. Infect Dis Clin North Am. 1993 Mar;7(1):97-115.
3. Knight GJ, Harris MA, Parbari M, O'Callaghan MJ, Masters IB. Single daily dose ceftriaxone therapy in epiglottitis. J Paediatr Child Health. 1992 Jun;28(3):220-2.
4. Feurle GE, Junga NS, Marth T. Efficacy of ceftriaxone or meropenem as initial therapies in Whipple's disease. Gastroenterology. 2010 Feb;138(2):478-86
5. Barry AL, Brown SD, Fuchs PC. Eur J Clin Microbiol Infect Dis. 1996 Apr;15(4):344-6.
6. Li ZL, Tong SX, Yu BM, et al. Single-dose ceftriaxone versus multiple-dose cefuroxime for prophylaxis of surgical site infection. Zhonghua Wai Ke Za Zhi. 2003 May;41(5):372-4.
7. 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
8. Gao B, Hu J, Deng W. Multicentre, randomized, prospective and comparative study of ceftriaxone, cefotaxime and cefuroxime in treating mild to moderate respiratory tract infection. Zhonghua Jie He He Hu Xi Za Zhi. 1998 Sep;21(9):528-31. PubMed
9. Meyer JM. Comparative study of ceftriaxone and cefuroxime for perioperative prophylaxis in orthopedic surgery. Am J Surg. 1984 Oct 19;148(4A):27-9.
10. Sisto T, Laurikka J, Tarkka MR. Ceftriaxone vs cefuroxime for infection prophylaxis in coronary bypass surgery. Scand J Thorac Cardiovasc Surg. 1994;28(3-4):143-8.