[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/) › Cefuroxime [Pharmacology](https://durgical.com/en/pharmacology/) · [Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/) # 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](https://durgical.com/en/pharmacology/classes/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 PBPs**Cefuroxime ⓘ 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](https://www.rcsb.org/structure/1QMF) · Drag to rotate · pinch to zoom ## 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 →](https://durgical.com/en/conditions/acute-rhinosinusitis/) - Acute otitis media. [Acute otitis media →](https://durgical.com/en/conditions/acute-otitis-media/) - Pharyngitis and tonsillitis. [Streptococcal pharyngitis →](https://durgical.com/en/conditions/streptococcal-pharyngitis/) - Community-acquired pneumonia (intravenous form) and exacerbations of chronic bronchitis. [Community-acquired pneumonia →](https://durgical.com/en/conditions/community-acquired-pneumonia/) - Early Lyme disease (erythema migrans). ## Adverse effects ### Common - Diarrhoea, nausea, vomiting - Vaginitis - Jarisch–Herxheimer reaction when treating Lyme disease ### Serious (rare, important) - Anaphylaxis - Clostridioides difficile diarrhoea, from mild to severe colitis ## 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. ## Memory aid 'Cefuroxime = respiratory': a second-generation agent that beats the β-lactamase of Haemophilus and Moraxella, owners of sinusitis and otitis. Bonus: early Lyme. ## 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). [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/cefuroxime/) ## Related drugs - [Cefoxitin](https://durgical.com/en/pharmacology/cefoxitin/) - [Amoxicillin + clavulanic acid](https://durgical.com/en/pharmacology/amoxicillin-clavulanic-acid/) - [Cefixime](https://durgical.com/en/pharmacology/cefixime/) ## Related conditions - [Acute rhinosinusitis](https://durgical.com/en/conditions/acute-rhinosinusitis/) - [Acute otitis media](https://durgical.com/en/conditions/acute-otitis-media/) - [Streptococcal pharyngitis](https://durgical.com/en/conditions/streptococcal-pharyngitis/) - [Community-acquired pneumonia](https://durgical.com/en/conditions/community-acquired-pneumonia/) [← Back to the class: Beta-lactams](https://durgical.com/en/pharmacology/classes/beta-lactams/) 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](https://medlineplus.gov/druginfo/meds/a601206.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [DailyMed - CEFUROXIME AXETIL tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=15cabe73-f39d-4798-a840-115fe94f8f96) (DailyMed (U.S. National Library of Medicine), 2026); [RCSB PDB - 1QMF: PENICILLIN-BINDING PROTEIN 2X (PBP-2X) ACYL-ENZYME COMPLEX](https://www.rcsb.org/structure/1QMF) (RCSB Protein Data Bank, 2026); Farmacología básica y clínica (Katzung), cap. 43 (McGraw Hill, 2025). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/cefuroxime/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/cefuroxime/