Cefuroxime Side Effects

Not all side effects for cefuroxime may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to cefuroxime: oral powder for suspension, oral tablet

In addition to its needed effects, some unwanted effects may be caused by cefuroxime. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking cefuroxime:

More common
  • Chills
  • diarrhea
  • fever
  • general feeling of illness or discomfort
  • headache
  • itching of the vagina or genital area
  • pain during sexual intercourse
  • rigidity
  • sweating
  • thick, white vaginal discharge with no odor or with a mild odor
Less common
  • Black, tarry stools
  • chest pain
  • cough
  • loose stools
  • painful or difficult urination
  • shortness of breath
  • sore throat
  • sores, ulcers, or white spots on the lips or in the mouth
  • swollen glands
  • unusual bleeding or bruising
  • unusual tiredness or weakness
Rare
  • Back, leg, or stomach pains
  • bladder pain
  • bleeding gums
  • bloody or cloudy urine
  • body aches or pain
  • burning while urinating
  • dark urine
  • difficulty with breathing
  • ear congestion
  • fast, pounding, or irregular heartbeat or pulse
  • frequent urge to urinate
  • general body swelling
  • loss of appetite
  • loss of voice
  • lower back or side pain
  • nasal congestion
  • nausea or vomiting
  • nosebleeds
  • pain or tenderness around the eyes and cheekbones
  • pale skin
  • pink or red urine
  • sneezing
  • stuffy or runny nose
  • swelling of the joints
  • swollen glands
  • tightness of chest or wheezing
  • white or brownish vaginal discharge
  • white patches in the mouth or throat or on the tongue
  • white patches with diaper rash
  • yellowing of the eyes or skin
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • bloody, black, or tarry stools
  • clay-colored stools
  • cough or hoarseness
  • coughing up blood
  • decrease in urine output or decrease in urine-concentrating ability
  • feeling of discomfort
  • fever with or without chills
  • general feeling of tiredness or weakness
  • high fever
  • hives
  • increased menstrual flow or vaginal bleeding
  • joint or muscle pain
  • large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
  • light-colored stools
  • paralysis
  • prolonged bleeding from cuts
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • red or black, tarry stools
  • red or dark brown urine
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • seizures
  • swollen lymph glands
  • swollen or painful glands
  • unpleasant breath odor
  • upper right abdominal or stomach pain
  • vomiting of blood

Some of the side effects that can occur with cefuroxime may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Less common
  • Bad, unusual, or unpleasant (after) taste
  • change in taste
  • diaper rash
Rare
  • Abdominal or stomach cramps
  • acid or sour stomach
  • belching
  • bloated
  • difficulty with moving
  • excess air or gas in the stomach or intestines
  • flushing or redness of the skin
  • full feeling
  • gas in the stomach
  • heartburn
  • indigestion
  • irritability
  • irritation or soreness of the mouth
  • itching skin
  • muscle pain or stiffness
  • muscle spasm of the neck
  • passing gas
  • restlessness
  • sleepiness or unusual drowsiness
  • stomach discomfort, upset, or pain
  • swelling of the tongue
  • thirst
  • trouble sitting still
  • unusually warm skin
  • watering of the mouth and drooling
  • weight loss
Incidence not known
  • Hives or welts
  • redness of the skin

For Healthcare Professionals

Applies to cefuroxime: injectable powder for injection, intravenous solution, oral powder for reconstitution, oral tablet

General

Cefuroxime is generally well-tolerated.[Ref]

Side effects may be more likely and more severe in patients with liver disease and/or renal dysfunction.[Ref]

Gastrointestinal

Pseudomembranous colitis has been reported in patients treated with cephalosporins, including cefuroxime, and may occur during or after treatment. If diarrhea occurs and it is unresponsive to discontinuation of the drug and/or standard therapy, pseudomembranous colitis should be considered.[Ref]

Gastrointestinal side effects have included nausea and vomiting (1% to 3%), diarrhea/loose stools (1% to 8.6%), abdominal pain, abdominal cramps, flatulence, indigestion, mouth ulcers, and anorexia, dyspepsia, excess salivation, and pseudomembranous colitis.[Ref]

Hepatic

Hepatic side effects have included transient elevations of AST (2% to 4%), ALT (1.6% to 4%), and LDH (1%), alkaline phosphatase (2%, IV route), elevated bilirubin, hepatitis, cholestasis, and jaundice.[Ref]

Nervous system

Nervous system side effects have included headache, sleepiness, dizziness, somnolence, lockjaw-type reaction (less than 1%), and seizures. Cephalosporin class antibiotics, including cefuroxime, have been associated with seizures, especially in renally impaired patients.[Ref]

Hypersensitivity

Hypersensitivity reactions have included anaphylaxis, angioedema, rash, pruritus, serum sickness-like reaction, urticaria, drug fever, interstitial nephritis, toxic epidermal necrolysis, and Stevens-Johnson syndrome. At least one case of Kounis syndrome type I variant has been reported.[Ref]

Rare cases of erythema multiforme and Stevens-Johnson syndrome have been reported. There is a 10% to 20% incidence of allergy to cefuroxime in patients allergic to penicillin.

A case of occupational contact dermatitis due to cephalosporin allergy has been reported in a nurse who prepared cephalosporin solutions for administration to patients. The dermatitis resolved after the nurse stopped preparing the solutions.

A 90-year-old man, with no history of coronary artery disease, diabetes mellitus, hypertension, or hyperlipidemia, was administered 750 mg cefuroxime axetil intramuscularly for urinary tract infection. About 10 minutes after the injection, the patient developed chest pain and pruritic skin rashes. Kounis syndrome type I variant was diagnosed secondary to cefuroxime axetil. Five days after stopping cefuroxime axetil, the patient's symptoms had resolved.[Ref]

Hematologic

Rare cases of eosinophilia and positive direct Coombs' tests have been reported without other evidence of hypersensitivity.

Immune hemolytic anemia has been reported in a pediatric patient.[Ref]

Hematologic side effects have included eosinophilia (1.1%), positive Coombs' test (less than 1%), decreased hemoglobin and hematocrit (10%, IV route), transient neutropenia (less than 1%), leukopenia (0.1%), hemolytic anemia, pancytopenia, increased prothrombin time, thrombocytopenia, and autoimmune granulocytopenia. Cephalosporin class antibiotics have been associated with aplastic anemia, hemorrhage, neutropenia, and agranulocytosis.[Ref]

Renal

Acute renal failure has been reported in a patient treated with cefuroxime. Renal function improved after cefuroxime was stopped, and deteriorated upon rechallenge.[Ref]

Renal side effects have included renal dysfunction (less than 1%) and acute renal failure. Cephalosporin class antibiotics have been associated with toxic nephropathy, increased BUN, increased creatinine, and interstitial nephritis. Reversible fever, azotemia, pyuria, and eosinophilia are the hallmarks of cephalosporin-induced interstitial nephritis.[Ref]

Genitourinary

Genitourinary side effects have included vaginitis, vaginal candidiasis, vaginal discharge, vaginal itch, vulvar itch, dysuria, urethral pain and/or bleeding, and kidney pain in less than 1% of patients, and urinary tract infection (less than 1% of pediatric patients). Cephalosporin class antibiotics have been associated with false positive tests for urinary glucose.[Ref]

Dermatologic

Dermatologic side effects have included rash, hives, pruritus, urticaria, and erythema in less than 1% of patients, diaper rash (3.4% of pediatric patients), acute generalized exanthematous pustulosis, erythema multiforme, and toxic epidermal necrolysis.[Ref]

Metabolic

Metabolic side effects have included thirst (less than 1%).[Ref]

Other

Other side effects have included chest pain or tightness, chills, viral illness, gastrointestinal infection, swollen tongue, candidiasis, and fever in less than 1% of patients. At least one case of disulfiram reaction has been reported with cefuroxime axetil. Complaints about taste were reported in 5% of pediatric patients, leading to discontinuation in 1.4%.

The Jarisch-Herxheimer reaction has been reported in 5.6% of Lyme Disease patients.[Ref]

Respiratory

Respiratory side effects have included shortness of breath (less than 1%), and sinusitis, cough, and upper respiratory infection in less than 1% of pediatric patients.[Ref]

Musculoskeletal

Musculoskeletal side effects have included muscle cramps, muscle stiffness, and muscle spasm of the neck in less than 1% of patients, and joint swelling and arthralgia in less than 1% of pediatric patients.[Ref]

Cardiovascular

Cardiovascular side effects have included tachycardia (less than 1%).[Ref]

Local

Local side effects have included thrombophlebitis with intravenous administration (1.7%).[Ref]

Immunologic

Immunologic side effects have included cutaneous vasculitis (postmarketing experience).[Ref]

References

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2. Hebblethwaite EM, Brown GW, Cox DM "A comparison of the efficacy and safety of cefuroxime axetil and augmentin in the treatment of upper respiratory tract infections." Drugs Exp Clin Res 13 (1987): 91-4

3. Griffiths GK, Vandenburg MJ, Wight LJ, et al "Efficacy and tolerability of cefuroxime axetil in patients with upper respiratory tract infections." Curr Med Res Opin 10 (1987): 555-61

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5. Yangco BG, Lowe J, Nolen TM, et al "A multicenter trial comparing the efficacy and safety of cefuroxime axetil and cefaclor in pneumonia of adults." Clin Ther 12 (1990): 440-6

6. Henry D, Ruoff GE, Rhudy J, Puopolo A, Drehobl M, Schoenberger J, Giguere G, Collins JJ "Clinical comparison of cefuroxime axetil and amoxicillin/clavulanate in the treatment of patients with secondary bacterial infections of acute bronchitis." Clin Ther 17 (1995): 861-74

7. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome, Research Triangle Park, NC.

8. Henry D, Ruoff GE, Rhudy J, Puopolo A, Drehobl M, Schoenberger J, Giguere G, Collins JJ "Effectiveness of short-course therapy (5 days) with cefuroxime axetil in treatment of secondary bacterial infections of acute bronchitis." Antimicrob Agents Chemother 39 (1995): 2528-34

9. Pines A, Raafat H, Kennedy MR, Mullinger BM "Experience with cefuroxime in 190 patients with severe respiratory infections." Chemotherapy 26 (1980): 212-7

10. Sommers D, Van Wyk M, Williams PE, Harding SM "Pharmacokinetics and tolerance of cefuroxime axetil in volunteers during repeated dosing." Antimicrob Agents Chemother 25 (1984): 344-7

11. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70 (1988): 600-2

12. Abramowicz M, Aaron H "Cefuroxime axetil." Med Lett Drugs Ther 30 (1988): 57-9

13. Higuera F, Hidalgo H, Feris J, Giguere G, Collins JJ "Comparison of oral cefuroxime axetil and oral amoxycillin/clavulanate in the treatment of community-acquired pneumonia." J Antimicrob Chemother 37 (1996): 555-64

14. Holloway KL, Smith KW, Wilberger JE, Jemsek JG, Giguere GC, Collins JJ "Antibiotic prophylaxis during clean neurosurgery: a large, multicenter study using cefuroxime." Clin Ther 18 (1996): 84-94

15. Wormser GP "Clinical practice. Early Lyme disease." N Engl J Med 354 (2006): 2794-801

16. Baniasadi S, Fahimi F, Mansouri D "Serum sickness-like reaction associated with cefuroxime and ceftriaxone." Ann Pharmacother 41 (2007):

17. Romano A, Mayorga C, Torres MJ, Artesani MC, Suau R, Sanchez F, Perez E, Venuti A, Blanca M "Immediate allergic reactions to cephalosporins: Cross-reactivity and selective responses." J Allerg Clin Immunol 106 (2000): 1177-83

18. Biteker M, Duran NE, Biteker FS, et al. "Kounis syndrome secondary to cefuroxime-axetil use in an octogenerian." J Am Geriatr Soc 56 (2008): 1757-1758

19. Saeed SAM, Bazza M, Zaman M, Ryatt KS "Cefuroxime induced lymphomatoid hypersensitivity reaction." Postgrad Med J 76 (2000): 577-9

20. Romano A, Quaratino D, Venuti A, Venemalm L, Mayorga C, Blanca M "Selective type-1 hypersensitivity to cefuroxime." J Allergy Clin Immunol 101 (1998): 564-5

21. Filipe P, Almeida RSLS, Rodrigo FG "Occupational allergic contact dermatitis from cephalosporins." Contact Dermatitis 34 (1996): 226

22. Viken R, Van Arsdel PP "Allergy to cephalosporins." JAMA 265 (1991): 2254

23. Murphy MF, Metcalfe P, Grint PC, et al "Cephalosporin-induced immune neutropenia." Br J Haematol 59 (1985): 9-14

24. Malloy CA, Kiss JE, Challapalli M "Cefuroxime-induced immune hemolysis." J Pediatr 143 (2003): 130-2

25. Goddard JK, Janning SW, Gass JS, Wilson RF "Cefuroxime-induced acute renal failure." Pharmacotherapy 14 (1994): 488-91

26. Leong CL, Thiruventhiran T "Cefuroxime-induced acute renal failure." Nephron 84 (2000): 185

27. Manley HJ, Bailie GR, Eisele G "Bilateral renal cortical necrosis associated with cefuroxime axetil." Clin Nephrol 49 (1998): 268-70

28. Cohen AD, Cagnano E, Halevy S "Acute generalized exanthematous pustulosis mimicking toxic epidermal necrolysis." Int J Dermatol 40 (2001): 458-61

29. Mattes JA "Antabuse reaction with ceftin." Am J Psychiatry 163 (2006): 2019-20

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