Cefuroxime Axetil - An updated review of its use in the management of bacterial infections

Cefuroxime axetil, a prodrug of the cephalosporin cefuroxime, has proven in vitro antibacterial activity against several Gram-positive and Gram-negati ve organisms, including those most frequently associated with various commo n community-acquired infections. In numerous randomised, controlled trials, 5 to 10 days' treatment with ora l cefuroxime axetil (250 or 500mg twice daily) was an effective treatment i n patients with upper (URTI) and lower respiratory tract infections (LRTI) as assessed by clinical and bacteriological criteria. The drug was as effec tive as several other cephalosporins, quinolones, macrolides and amoxicilli n/clavulanic acid. Shorter courses (5 to 10 days') of cefuroxime axetil wer e at least as effective as a 10 day course. Furthermore, sequential therapy with intravenous cefuroxime (750mg 2 or 3 t imes daily for 2 to 5 days) followed by oral cefuroxime axetil (500mg twice daily for 3 to 8 days) proved an effective treatment in adult patients wit h community-acquired pneumonia (CAP). This approach provided similar effica cy to intravenous ampicillin/sulbactam, followed by oral amoxicillin/clavul anic acid, a full parenteral. course of cefuroxime, or intravenous then ora l azithromycin or clarithromycin. Additionally, cefuroxime axetil was an effective treatment in patients with genitourinary, skin and soft-tissue infections, and erythema migrans assoc iated with early stage Lyme disease. The drug is well tolerated by adult and paediatric patients, with adverse e ffects that are consistent with those of other cephalosporins. The majority of adverse events (primarily gastrointestinal disturbances) were mild to m oderate in intensity and reversible upon discontinuation of treatment, with very few serious adverse events reported. Conclusions: Cefuroxime axetil is a broad spectrum antibacterial agent with a pharmacokinetic profile that permits convenient twice-daily administrati on. The drug is an effective and well tolerated treatment in patients with various infections, including otitis media, pharyngitis, sinusitis, CAP and acute exacerbations of chronic bronchitis. Cefuroxime axetil proved effect ive as a component of intravenous/oral sequential therapy in the treatment of CAP, although there are currently no dosage recommendations available fo r this regimen in some countries. Cefuroxime axetil may be considered as an empirical therapy for a range of community-acquired in 5 ctions, including those in which beta -lactamase-producing strains of common respiratory pat hogens are identified as the causative organisms. In an era of rapidly emer ging bacterial resistance, empirical treatment with agents such as cefuroxi me. axetil may ensure the appropriate use of newer antibacterial agents, po tentially preventing the emergence of bacterial resistance to these newer d rugs.