Cefuroxime !

A second-generation cephalosporin, oral (cefuroxime axetil) or intravenous, for sinusitis, otitis, pneumonia and early Lyme disease.

Updated 2026-11-01

Class: Beta-lactams
Enzyme: Penicillin-binding protein 2x (PBP2x) and other PBPs
ATC code: J01DC02
WHO Model List of Essential Medicines

Also called: cefuroxime axetil

Penicillin-binding protein 2x (PBP2x) and other PBPsCefuroxime

The figure shows Streptococcus pneumoniae PBP2x acylated by cefuroxime, bonded to the active-site serine.

Target in 3D: Penicillin-binding protein 2x (PBP2x) and other PBPs. PDB structure 1QMF (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Cefuroxime acylates the PBPs. A second-generation agent, it keeps activity against gram-positive cocci and adds β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis, plus some enteric bacteria. It does not cover Bacteroides fragilis, enterococci or Pseudomonas. The oral form is a prodrug (axetil ester) that is hydrolysed in the gut to release cefuroxime.

The axetil ester is hydrolysed, releasing cefuroxime
Resists the β-lactamases of Haemophilus and Moraxella
Acylates the PBPs and halts cross-linking
The bacterium lyses

Pharmacokinetics

Absorption: Cefuroxime axetil is an oral prodrug; drugs that reduce gastric acid lower its bioavailability.
Elimination: By the kidney, unchanged; the half-life lengthens in kidney failure.

Indications

Acute bacterial sinusitis. Acute rhinosinusitis →
Acute otitis media. Acute otitis media →
Pharyngitis and tonsillitis. Streptococcal pharyngitis →
Community-acquired pneumonia (intravenous form) and exacerbations of chronic bronchitis. Community-acquired pneumonia →
Early Lyme disease (erythema migrans).

Adverse effects

Common

Diarrhoea, nausea, vomiting
Vaginitis
Jarisch–Herxheimer reaction when treating Lyme disease

Contraindications

Known hypersensitivity (for example anaphylaxis) to cefuroxime or other β-lactams

Key interactions

Antacids, H2 antagonists and proton pump inhibitors: Lower cefuroxime axetil bioavailability; H2 antagonists and proton pump inhibitors are avoided.
Probenecid: Raises cefuroxime exposure; the combination is not recommended.
Glucose tests: False positive in urine with copper reduction and false negative in blood with the ferricyanide method.

What is monitored

Clinical response
Kidney function in kidney failure

Administration and safety

The tablet is swallowed whole, with or without food; the oral suspension is not interchangeable with the tablets.
There is oral cefuroxime axetil and intravenous cefuroxime sodium: do not confuse the routes.
Do not confuse cefuroxime with cefotaxime or cefoxitin.

Nursing care

Before the first dose: ask about allergy to penicillins, cephalosporins and other β-lactams, and what the reaction was.
Check whether the patient takes antacids or acid suppressants.
Teach the patient to report watery or bloody diarrhoea, even weeks after the course ends.
In Lyme disease, warn about fever or malaise in the first hours (Jarisch–Herxheimer).

Pregnancy and breastfeeding

Decades of cephalosporin use in pregnancy have not shown more birth defects or miscarriages.

Test yourself

Think of the answer, then tap the question to see it.

What does cefuroxime gain over a first-generation cephalosporin?

Activity against β-lactamase-producing Haemophilus influenzae and Moraxella catarrhalis, which is why it works in sinusitis, otitis and pneumonia.

Which drugs reduce cefuroxime axetil absorption?

Those that lower gastric acidity: antacids, H2 antagonists and proton pump inhibitors.

Which spirochaete does cefuroxime axetil treat?

Borrelia burgdorferi, in early Lyme disease (erythema migrans).

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Cefuroxime: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - CEFUROXIME AXETIL tablet, film coated (DailyMed (U.S. National Library of Medicine), 2026); RCSB PDB - 1QMF: PENICILLIN-BINDING PROTEIN 2X (PBP-2X) ACYL-ENZYME COMPLEX (RCSB Protein Data Bank, 2026); Farmacología básica y clínica (Katzung), cap. 43 (McGraw Hill, 2025).

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Representative model, for educational purposes only.