Cefuroxime axetil
Class: Second-generation cephalosporin antibiotic (beta-lactam); broad-spectrum bactericidal agent with resistance to many beta-lactamases.
Manufacturer: Glenmark
Dosage Form: Tablet, Suspension
Similar Brands:
Uses:
Treatment of mild to moderate infections caused by susceptible bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae including beta-lactamase producers, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus aureus including beta-lactamase producers). Common indications include:
- Pharyngitis/tonsillitis (S. pyogenes).
- Acute bacterial otitis media (pediatrics primarily).
- Acute bacterial maxillary sinusitis.
- Acute exacerbations of chronic bronchitis.
- Uncomplicated skin and skin structure infections (e.g., impetigo).
- Uncomplicated urinary tract infections (e.g., cystitis).
- Early Lyme disease (erythema migrans).
Not for viral infections; use only when bacterial etiology is proven or strongly suspected.
Dosage:
Administer every 12 hours (BID); take with food for better absorption. Duration typically 7–10 days (10 days minimum for streptococcal infections; 20 days for Lyme).
Tablet (adults and pediatrics ≥13 years or those who can swallow whole; weight-based for younger if able):
- Pharyngitis/tonsillitis, sinusitis, uncomplicated UTI: 250 mg BID.
- Acute exacerbations of chronic bronchitis, skin infections: 250–500 mg BID.
- Uncomplicated gonorrhea: 1 g single dose (not first-line per current guidelines).
- Early Lyme disease: 500 mg BID for 20 days.
- Pediatrics (if using tablet): Often 250 mg BID for otitis media/sinusitis (10 days).
Suspension (primarily pediatrics 3 months–12 years; weight-based):
- Pharyngitis/tonsillitis: 20 mg/kg/day divided BID (max 500 mg/day).
- Otitis media, sinusitis, skin infections: 30 mg/kg/day divided BID (max 1,000 mg/day).
Example (for 125 mg/5 mL): 10 kg child at 30 mg/kg/day = 300 mg/day (15 mL/day total, 7.5 mL BID).
No established use in <3 months; adjust in renal impairment (e.g., extend interval if CrCl <30 mL/min).
Side Effects:
Common (>1–10%): Diarrhea/loose stools, nausea/vomiting, abdominal pain, taste disturbance (suspension may have “dislike of taste”), diaper rash (pediatrics).
Serious (rare): Hypersensitivity (rash, urticaria, anaphylaxis), Clostridium difficile-associated diarrhea/colitis, hepatotoxicity (elevated liver enzymes), hematologic (neutropenia, thrombocytopenia), seizures (high doses/renal failure), Jarisch-Herxheimer reaction (in Lyme).
Warnings & Precautions:
Hypersensitivity: Contraindicated in cephalosporin/penicillin allergy history (cross-reactivity risk); discontinue if allergic signs occur.
C. difficile diarrhea: Monitor for persistent/severe diarrhea.
Renal impairment: Adjust dosing.
Phenylketonuria (PKU): Some suspensions contain aspartame (phenylalanine source)—avoid or use caution.
Superinfection: Possible with prolonged use.
Not bioequivalent—do not substitute forms mg-for-mg.
Culture/susceptibility testing recommended.
Take with food; avoid crushing tablets.
C. difficile diarrhea: Monitor for persistent/severe diarrhea.
Renal impairment: Adjust dosing.
Phenylketonuria (PKU): Some suspensions contain aspartame (phenylalanine source)—avoid or use caution.
Superinfection: Possible with prolonged use.
Not bioequivalent—do not substitute forms mg-for-mg.
Culture/susceptibility testing recommended.
Take with food; avoid crushing tablets.
Pregnancy & Lactation:
Pregnancy: Limited human data; animal studies show no major risks at therapeutic doses—use only if clearly needed (generally considered low risk, former Category B equivalent).
Lactation: Excreted in breast milk in low amounts; generally compatible, but monitor infant for diarrhea, thrush, or rash—consult provider.
Lactation: Excreted in breast milk in low amounts; generally compatible, but monitor infant for diarrhea, thrush, or rash—consult provider.
Drug Interactions:
Probenecid: Increases cefuroxime levels (may require adjustment).
Antacids, H2 blockers, PPIs: Reduce absorption—separate dosing or take with food.
Oral contraceptives: Possible reduced efficacy (use backup).
Warfarin: Potential increased anticoagulation (monitor INR).
Nephrotoxic drugs (e.g., aminoglycosides, diuretics): Additive renal risk
Antacids, H2 blockers, PPIs: Reduce absorption—separate dosing or take with food.
Oral contraceptives: Possible reduced efficacy (use backup).
Warfarin: Potential increased anticoagulation (monitor INR).
Nephrotoxic drugs (e.g., aminoglycosides, diuretics): Additive renal risk
Contraindications:
Known hypersensitivity to cefuroxime, other cephalosporins, or any component.
History of severe immediate hypersensitivity to penicillins (cross-reactivity risk).
History of severe immediate hypersensitivity to penicillins (cross-reactivity risk).
Price: Ksh Altacef Tablet 500mg 10s - 1300/-, Altacef Suspension 50ml - 606/-
Notes:
Tablet: Film-coated oral tablets (Altacef 500 mg cefuroxime equivalent as cefuroxime axetil); swallow whole (do not crush due to bitter taste and risk of vomiting).
Suspension: Powder for oral suspension (reconstitutes to 125 mg of cefuroxime equivalent per 5 mL), 50 mL after adding water); shake well before use; administer with food.