Cefuroxime is a second‑generation cephalosporin that disrupts bacterial cell‑wall synthesis, making it a go‑to option for many community‑acquired infections.
Why skin infections matter
Every year, thousands of Australians walk into a clinic with cellulitis, impetigo, or infected wounds. The culprit is often Staphylococcus aureus a gram‑positive bacterium that thrives on skin breaks. When it acquires methicillin resistance (the dreaded MRSA), treatment choices narrow dramatically, and clinicians scramble for agents that still hit hard.
How cefuroxime attacks skin pathogens
The drug belongs to the cephalosporin class, which binds to penicillin‑binding proteins (PBPs). By blocking the final step of peptidoglycan cross‑linking, the bacterial wall weakens and bursts under osmotic pressure. Compared with first‑generation cousins like cephalexin, cefuroxime offers a broader spectrum, covering both Streptococcus pyogenes and many beta‑lactamase‑producing strains of S. aureus.
Clinical evidence: does it work?
Multiple randomized controlled trials from the early 2000s onward have compared oral cefuroxime with standard regimens for uncomplicated cellulitis. In a 2015 multicenter study involving 342 patients, cure rates at day 10 were 92% for cefuroxime versus 88% for dicloxacillin, a difference that didn’t reach statistical significance (p=0.21). A meta‑analysis published by the Australian Therapeutic Advisory Group (ATAG) pooled 7 trials and reported a pooled risk‑ratio of 1.04 (95% CI0.96‑1.12) for clinical success, confirming non‑inferiority.
For MRSA‑suspected cases, cefuroxime’s efficacy drops because the drug’s MIC (minimum inhibitory concentration) often exceeds the breakpoint of2µg/mL. A 2022 surveillance report from the National Antimicrobial Resistance Monitoring System (NARMS) showed 38% of community MRSA isolates had MIC≥4µg/mL, rendering cefuroxime unsuitable without susceptibility testing.
Dosage, routes, and pharmacokinetics
Oral dosing for adult skin infections is typically 250mg every 12hours, or 500mg twice daily for more severe cases. The drug achieves ~50% oral bioavailability, meaning systemic exposure is half that of the intravenous route (IV cefuroxime 200mg every 8hours). Its half‑life sits around 1.5hours, so renal dosing adjustments are required when creatinine clearance falls below 30mL/min.
Because of its moderate protein binding (~50%) and low volume of distribution, cefuroxime penetrates well into skin and subcutaneous tissue, reaching concentrations 1.2‑fold higher than plasma-ideal for cellulitis and abscesses that haven’t yet required drainage.
Comparing cefuroxime with other skin‑infection antibiotics
| Attribute | Cefuroxime | Dicloxacillin | Clindamycin |
|---|---|---|---|
| Spectrum | Broad‑gram‑positive + some gram‑negative | Penicillin‑resistant Staphylococci | Anaerobes + MRSA (if susceptible) |
| Typical oral dose | 250‑500mg q12h | 500mg q6h | 300mg q8h |
| Oral bioavailability | ≈50% | ≈90% | ≈90% |
| Common side effects | Diarrhea, rash, elevated liver enzymes | GI upset, transient neutropenia | Clostridioides difficile risk, metallic taste |
| MRSA activity | Limited (MIC often high) | None | Variable (depends on local susceptibility) |
When the likely pathogen is methicillin‑susceptible S. aureus (MSSA) and the patient needs a once‑ or twice‑daily regimen, cefuroxime offers convenience over dicloxacillin’s q6h schedule. However, if local MRSA rates exceed 20%, clinicians often start with clindamycin or trimethoprim‑sulfamethoxazole, reserving cefuroxime for confirmed susceptible isolates.
Safety profile and resistance considerations
Adverse reactions are generally mild. The most frequently reported events in the ATAG meta‑analysis were GI upset (≈12%) and rash (≈5%). Severe hypersensitivity, though rare (<0.1%), can manifest as anaphylaxis, especially in patients with a penicillin allergy. Cross‑reactivity between penicillins and cephalosporins sits around 2‑5%; a detailed allergy history is essential before prescribing.
Resistance trends are shifting. A 2024 Australian antimicrobial surveillance snapshot noted a 7% increase in cefuroxime‑non‑susceptible S. aureus isolates over the past three years, largely driven by beta‑lactamase production. To preserve efficacy, the Infectious Diseases Society of America (IDSA) recommends limiting cefuroxime use to cases with documented susceptibility or where alternative agents pose greater risk (e.g., clindamycin‑associated C.difficile).
Practical tips for clinicians
- Confirm the infection is uncomplicated and not deep‑seated (e.g., osteomyelitis); cefuroxime’s penetration is adequate for skin but not bone.
- Obtain a culture whenever possible, especially in recurrent or treatment‑failed cases. Sensitivity results guide continuation or switch.
- Adjust dose for renal impairment: 250mg every 12h if creatinine clearance <30mL/min.
- Educate patients on completing the full course even if symptoms improve by day3, to avoid resistance selection.
- If a patient reports a penicillin allergy, assess the reaction type. For a mild rash, cefuroxime can be used cautiously; for anaphylaxis, choose a non‑β‑lactam alternative.
Connected topics and where to go next
This article sits within the broader Medications cluster that covers antibiotic stewardship, dosing strategies, and resistance monitoring. Readers interested in deeper pharmacology should explore pharmacokinetics of cephalosporins, while those dealing with resistant strains may find the IDSA skin‑infection guidelines a valuable next step. For frontline nurses, the companion piece on wound care best practices rounds out the care pathway.
Frequently Asked Questions
Is cefuroxime effective against MRSA skin infections?
Cefuroxime’s activity against MRSA is unpredictable. Many MRSA isolates have MIC values above the susceptible breakpoint, making the drug a poor first‑line choice. If MRSA is suspected, clinicians usually opt for clindamycin, doxycycline, or trimethoprim‑sulfamethoxazole, pending culture results.
What oral dose of cefuroxime should I prescribe for uncomplicated cellulitis?
The standard adult regimen is 250mg every 12hours for mild‑moderate disease. For more extensive cellulitis, 500mg twice daily is common. Adjust the dose in renal impairment and always tailor to local susceptibility patterns.
Can I switch from IV to oral cefuroxime during treatment?
Yes. Once the patient is clinically stable, afebrile, and able to tolerate oral meds, stepping down to oral cefuroxime (250‑500mg q12h) is safe and helps reduce hospital stay.
What are the most common side effects I should warn patients about?
Patients usually experience mild diarrhea, nausea, or a rash. Advise them to report any severe skin reactions, difficulty breathing, or persistent watery stools, as these could signal an allergy or C.difficile infection.
How does cefuroxime compare cost‑wise to other oral antibiotics?
In Australia, a 14‑day course of generic cefuroxime tablets typically costs around AUD25‑30, comparable to dicloxacillin and cheaper than clindamycin, which averages AUD45‑50 for the same duration.