Cefuroxime axetil.
Cefuroxime is the first commercially-available second-generation cephalosporine to be widely used in therapy; it is a semi-synthetic cephalosporin obtained from the 7-cephalosporanic acid nucleus of cephalosporin C. Cefuroxime axetil is the acetoxyethyl ester of cefuroxime. The majority of micro-organisms associated with respiratory infections are highly sensitive to cefuroxime. These include Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes and the other streptococci (excluding group D streptococci), and Moraxella catarrhalis. Bacteria sensitive to cefuroxime include the enterobacteria (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Salmonella and Shigella and Straphylococcus aureus (methicillin-sensitive strains). The pharmacokinetic studies show that the maximum plasma concentration of cefuroxime after oral administration of 250 mg and 500 mg of cefuroxime axetil after a meal are respectively 4.6 and 7.9 mg/l. The absolute bioavailability of tablets is 68% (extremes 63-73%) after oral administration of 500 mg cefuroxime axetil. The protein binding is 33+/-5.7%. Tissue diffusion was studied in the interstitial fluid, the bronchial mucosa, the tonsils, and the bronchial secretions. Cefuroxime axetil is available as capsule-shaped tablets containing 125, 250 or 500 mg. An oral suspension dosage form for paediatric purposes is also available as granules in multidose bottles and sachets. Constitution gives a suspension containing 125 mg or 250 mg cefuroxime (as cefuroxime axetil). Cefuroxime axetil is indicated for the treatment of infections caused by susceptible bacteria. Indications include: lower respiratory tract infections (e.g., acute and chronic bronchitis and pneumonia); upper respiratory tract infections (e.g., ear, nose and throat infections such as otitis media, sinusitis tonsillitis and pharyngitis); genito-urinary tract infections (e.g., pyelonephritis, cystitis and urethritis, gonorrhoea, acute uncomplicated gonococcal urethritis and cervicitis); and skin and soft tissue infections (e.g., furunculosis, pyoderma and impetigo). For most infections, a dose of 250 mg twice daily is appropriate. In some urinary tract infections, 125 mg twice daily has been shown to be effective. If pneumonia is suspected or in more severe lower respiratory tract infection, doses of 500 mg bd should be used. Uncomplicated gonorrhoea has been shown to respond to a single 1-g dose of cefuroxime axetil. Adverse reactions to cefuroxime have generally been mild and transient in nature (gastrointestinal disturbances, including diarrhoea, nausea and vomiting).
Dellamonica
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Department of Infectious Diseases, Archet Hospital, BP 79, 06202 Nice Cedex 3, France.