Skip to main content

Zinacef Side Effects

Generic name: cefuroxime

Medically reviewed by Drugs.com. Last updated on Oct 20, 2023.

Note: This document contains side effect information about cefuroxime. Some dosage forms listed on this page may not apply to the brand name Zinacef.

Applies to cefuroxime: oral powder for suspension, oral tablet. Other dosage forms:

Serious side effects of Zinacef

Along with its needed effects, cefuroxime (the active ingredient contained in Zinacef) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking cefuroxime:

More common

Less common

Rare

Incidence not known

Other side effects of Zinacef

Some side effects of cefuroxime may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Rare

Incidence not known

For Healthcare Professionals

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

General

This drug was generally well tolerated. The side effects most commonly reported with the parenteral formulation have included neutropenia, eosinophilia, transient liver enzyme/bilirubin elevations, and injection site reactions. The side effects most commonly reported with the oral formulations have included Candida overgrowth, eosinophilia, headache, dizziness, gastrointestinal disturbances, and transient liver enzyme elevations.[Ref]

Gastrointestinal

Common (1% to 10%): Diarrhea/loose stools, nausea/vomiting, abdominal pain, nausea

Uncommon (0.1% to 1%): Abdominal cramps, flatulence, indigestion, mouth ulcers, swollen tongue, dyspepsia, gastrointestinal (GI) infection, ptyalism/excess salivation, GI disturbance, vomiting

Frequency not reported: Abdominal discomfort, dry mouth, Clostridioides difficile-associated diarrhea

Postmarketing reports: GI disturbances (including diarrhea, nausea, vomiting, abdominal pain), pseudomembranous colitis

Cephalosporin-class:

-Frequency not reported: Vomiting, abdominal pain, colitis[Ref]

The onset of pseudomembranous colitis symptoms has been reported during or after antibacterial therapy.[Ref]

Hepatic

Common (1% to 10%): Transient increase in AST, transient increase in ALT, transient increase in liver enzyme levels

Uncommon (0.1% to 1%): Transient increase in bilirubin

Postmarketing reports: Hepatic dysfunction, hepatitis, cholestasis, jaundice (mainly cholestatic)

Cephalosporin-class:

-Frequency not reported: Hepatic dysfunction (including cholestasis)[Ref]

Nervous system

Common (1% to 10%): Headache, dizziness

Uncommon (0.1% to 1%): Sleepiness, somnolence, hyperactivity

Postmarketing reports: Seizures, encephalopathy[Ref]

Cephalosporin-class antibiotics (including this drug) have been associated with seizures, especially in patients with renal dysfunction when the dose was not reduced.[Ref]

Hypersensitivity

Common (1% to 10%): Delayed hypersensitivity reaction

Uncommon (0.1% to 1%): Hypersensitivity reactions (including rash, pruritus, urticaria)

Rare (0.01% to 0.1%): Severe hypersensitivity reactions

Frequency not reported: Serum sickness

Postmarketing reports: Anaphylaxis, serum sickness-like reaction[Ref]

Delayed hypersensitivity reaction to this drug has been reported in 2.9% of patients with history of delayed hypersensitivity to penicillin (but not a cephalosporin).

Rare cases of severe hypersensitivity reactions (including erythema multiforme, toxic epidermal necrolysis [exanthematic necrolysis], drug fever, serum sickness-like reaction, anaphylaxis, Stevens-Johnson syndrome) have been reported.[Ref]

Hematologic

Common (1% to 10%): Eosinophilia, decreased hemoglobin and hematocrit, neutropenia, decreased hemoglobin concentration

Uncommon (0.1% to 1%): Positive Coombs test, leukopenia, thrombocytopenia

Frequency not reported: Autoimmune granulocytopenia, increased coagulation time

Postmarketing reports: Hemolytic anemia, pancytopenia, increased prothrombin time

Cephalosporin-class:

-Frequency not reported: Aplastic anemia, hemolytic anemia, hemorrhage, prolonged prothrombin time, pancytopenia, agranulocytosis, positive Coombs test[Ref]

Profound leukopenia has sometimes been profound with oral therapy.[Ref]

Renal

Acute renal failure has been reported. Renal function improved after this drug was stopped, and deteriorated upon rechallenge.[Ref]

Frequency not reported: Increased BUN, increased creatinine, decreased CrCl, acute renal failure

Postmarketing reports: Renal dysfunction, interstitial nephritis (including reversible fever, azotemia, pyuria, eosinophilia)

Cephalosporin-class:

-Frequency not reported: Toxic nephropathy[Ref]

Genitourinary

Common (1% to 10%): Vaginitis

Uncommon (0.1% to 1%): Vulvar itch, dysuria, vaginal candidiasis, vaginal discharge, vaginal itch, urethral pain/bleeding, kidney pain, urinary tract infection, vaginal irritation

Cephalosporin-class:

-Frequency not reported: Vaginitis (including vaginal candidiasis)[Ref]

Dermatologic

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.[Ref]

Common (1% to 10%): Diaper/nappy rash

Uncommon (0.1% to 1%): Rash, urticaria/hives, pruritus, erythema

Rare (0.01% to 0.1%): Erythema multiforme, toxic epidermal necrolysis (exanthematic necrolysis), Stevens-Johnson syndrome

Frequency not reported: Acute generalized exanthematous pustulosis

Postmarketing reports: Angioedema/angioneurotic edema, urticaria, toxic epidermal necrolysis, Stevens-Johnson syndrome, erythema multiforme, cutaneous vasculitis

Beta-lactam antibiotics:

-Frequency not reported: Severe cutaneous adverse reactions (including Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms [DRESS], acute generalized exanthematous pustulosis)[Ref]

Metabolic

Uncommon (0.1% to 1%): Anorexia

Cephalosporin-class:

-Frequency not reported: Urine glucose false positive[Ref]

Other

Common (1% to 10%): Transient increase in LDH, transient increase in alkaline phosphatase, Candida overgrowth, dislike of taste

Uncommon (0.1% to 1%): Chest pain/tightness, chills, thirst, viral illness, candidiasis, fever

Rare (0.01% to 0.1%): Drug fever

Frequency not reported: C difficile overgrowth, disulfiram reaction[Ref]

Respiratory

Uncommon (0.1% to 1%): Shortness of breath, sinusitis, cough, upper respiratory infection[Ref]

Musculoskeletal

Uncommon (0.1% to 1%): Muscle cramps, muscle stiffness, muscle spasm of the neck, lockjaw-type reaction, joint swelling, arthralgia[Ref]

Cardiovascular

Uncommon (0.1% to 1%): Tachycardia

Frequency not reported: Kounis syndrome type I variant

Postmarketing reports: Acute myocardial ischemia (with or without myocardial infarction)[Ref]

A 90-year-old man, with no history of coronary artery disease, diabetes mellitus, hypertension, or hyperlipidemia, was administered 750 mg cefuroxime axetil IM 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 the drug. Five days after stopping the drug, the patient's symptoms had resolved.

Acute myocardial ischemia (with or without myocardial infarction) has occurred as part of an allergic reaction.[Ref]

Local

Common (1% to 10%): Injection site reactions (including pain, thrombophlebitis), thrombophlebitis with IV administration, phlebitis, transient pain at injection site

Frequency not reported: Pain at IM injection site[Ref]

Immunologic

Common (1% to 10%): Jarisch-Herxheimer reaction[Ref]

Psychiatric

Uncommon (0.1% to 1%): Irritable behavior

References

1. Bulpitt D, Potter CE, Jaderberg M. A large scale, general practice based investigation into the clinical efficacy and tolerability of cefuroxime axetil in women with uncomplicated urinary tract infect. Curr Med Res Opin. 1991;12:318-24.

2. Cerner Multum, Inc. Australian Product Information.

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

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

5. 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. 1987;10:555-61.

6. 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. 1987;13:91-4.

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

8. Abramowicz M, Aaron H. Cefuroxime axetil. Med Lett Drugs Ther. 1988;30:57-9.

9. 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. 1990;12:440-6.

10. Product Information. Ceftin (cefuroxime). Glaxo Wellcome. 2002;PROD.

11. Product Information. Zinacef (cefuroxime). Glaxo Wellcome. 2002;PROD.

12. 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. 1995;39:2528-34.

13. 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. 1995;17:861-74.

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. 1996;18:84-94.

15. 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. 1996;37:555-64.

16. Wormser GP. Clinical practice. Early Lyme disease. N Engl J Med. 2006;354:2794-801.

17. Viken R, Van Arsdel PP. Allergy to cephalosporins. JAMA. 1991;265:2254.

18. Filipe P, Almeida RSLS, Rodrigo FG. Occupational allergic contact dermatitis from cephalosporins. Contact Dermatitis. 1996;34:226.

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

20. Saeed SAM, Bazza M, Zaman M, Ryatt KS. Cefuroxime induced lymphomatoid hypersensitivity reaction. Postgrad Med J. 2000;76:577-9.

21. 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. 2000;106:1177-83.

22. Baniasadi S, Fahimi F, Mansouri D. Serum sickness-like reaction associated with cefuroxime and ceftriaxone. Ann Pharmacother. 2007;41.

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

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

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

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

27. Leong CL, Thiruventhiran T. Cefuroxime-induced acute renal failure. Nephron. 2000;84:185.

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

29. Cerner Multum, Inc. UK Summary of Product Characteristics.

30. Mattes JA. Antabuse reaction with ceftin. Am J Psychiatry. 2006;163:2019-20.

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

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.