Cefuroxime Axetil Tablets, USP
DESCRIPTION
Cefuroxime axetil tablets are uncoated and contain the equivalent of 125, 250 or 500 mg of cefuroxime as cefuroxime axetil. Cefuroxime axetil tablets contain the inactive ingredients colloidal silicon dioxide, croscarmellose sodium, hydrogenated vegetable oil, microcrystalline cellulose and sodium lauryl sulfate.
CLINICAL PHARMACOLOGY
Absorption and Metabolism
Pharmacokinetics
| Dose†(CefuroximeEquivalent) | Peak PlasmaConcentration(mcg/mL) | Time of PeakPlasmaConcentration (hr) | MeanEliminationHalf-Life (hr) | AUC(mcg-hr mL) |
| 125 mg | 2.1 | 2.2 | 1.2 | 6.7 |
| 250 mg | 4.1 | 2.5 | 1.2 | 12.9 |
| 500 mg | 7 | 3 | 1.2 | 27.4 |
| 1,000 mg | 13.6 | 2.5 | 1.3 | 50 |
Food Effect on Pharmacokinetics
Renal Excretion
Microbiology
Aerobic Gram-Positive Microorganisms
Aerobic Gram-Negative Microorganisms
Spirochetes
Aerobic Gram-Positive Microorganisms
Aerobic Gram-Negative Microorganisms
Anaerobic Microorganisms
Susceptibility Tests
Dilution Techniques
| MIC (mcg/mL) | Interpretation |
| ≤4 | (S) Susceptible |
| 8-16 | (I) Intermediate |
| ≥32 | (R) Resistant |
| Microorganism | MIC (mcg/mL) |
| Escherichia coli ATCC 25922 | 2-8 |
| Staphylococcus aureus ATCC 29213 | 0.5-2 |
Diffusion Techniques
| Zone Diameter (mm) | Interpretation |
| ≥23 | (S) Susceptible |
| 15-22 | (I) Intermediate |
| ≤14 | (R) Resistant |
| Microorganism | Zone Diameter (mm) |
| Escherichia coli ATCC 25922 | 20-26 |
| Staphylococcus aureus ATCC 25923 | 27-35 |
INDICATIONS AND USAGE
- Pharyngitis/Tonsillitis caused by Streptococcus pyogenes. NOTE: The usual drug of choice in the treatment and prevention of streptococcal infections, including the prophylaxis of rheumatic fever, is penicillin given by the intramuscular route. Cefuroxime axetil tablets are generally effective in the eradication of streptococci from the nasopharynx; however, substantial data establishing the efficacy of cefuroxime in the subsequent prevention of rheumatic fever are not available. Please also note that in all clinical trials, all isolates had to be sensitive to both penicillin and cefuroxime. There are no data from adequate and well-controlled trials to demonstrate the effectiveness of cefuroxime in the treatment of penicillin-resistant strains of Streptococcus pyogenes.
- Acute Bacterial Otitis Media caused by Streptococcus pneumoniae, Haemophilus influenzae (including beta-lactamase–producing strains), Moraxella catarrhalis (including beta-lactamase–producing strains), or Streptococcus pyogenes.
- Acute Bacterial Maxillary Sinusitis caused by Streptococcus pneumoniae or Haemophilus influenzae (non-beta-lactamase–producing strains only). (See CLINICAL STUDIES section.) NOTE: In view of the insufficient numbers of isolates of beta-lactamase–producing strains of Haemophilus influenzae and Moraxella catarrhalis that were obtained from clinical trials with cefuroxime axetil tablets for patients with acute bacterial maxillary sinusitis, it was not possible to adequately evaluate the effectiveness of cefuroxime axetil tablets for sinus infections known, suspected, or considered potentially to be caused by beta-lactamase–producing Haemophilus influenzae or Moraxella catarrhalis.
- Acute Bacterial Exacerbations of Chronic Bronchitis and Secondary Bacterial Infections of Acute Bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae (beta-lactamase negative strains), or Haemophilus parainfluenzae (beta-lactamase negative strains). (See DOSAGE AND ADMINISTRATION section and CLINICAL STUDIES section.)
- Uncomplicated Skin and Skin-Structure Infections caused by Staphylococcus aureus (including beta-lactamase–producing strains) or Streptococcus pyogenes.
- Uncomplicated Urinary Tract Infections caused by Escherichia coli or Klebsiella pneumoniae.
- Uncomplicated Gonorrhea, urethral and endocervical, caused by penicillinase-producing and non-penicillinase–producing strains of Neisseria gonorrhoeae and uncomplicated gonorrhea, rectal, in females, caused by non-penicillinase–producing strains of Neisseria gonorrhoeae.
- Early Lyme Disease (erythema migrans) caused by Borrelia burgdorferi.
CONTRAINDICATIONS
WARNINGS
PRECAUTIONS
General
Information for Patients/Caregivers (Pediatric)
- During clinical trials, the tablet was tolerated by pediatric patients old enough to swallow the cefuroxime axetil tablet whole. The crushed tablet has a strong, persistent, bitter taste and should not be administered to pediatric patients in this manner. Pediatric patients who cannot swallow the tablet whole should receive the oral suspension.
- Patients should be counseled that antibacterial drugs, including cefuroxime axetil, should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When cefuroxime axetil is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may: (1) decrease the effectiveness of the immediate treatment, and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by cefuroxime axetil or other antibacterial drugs in the future.
Drug/Laboratory Test Interactions
Drug/Drug Interactions
Carcinogenesis, Mutagenesis, Impairment of Fertility
Pregnancy
Teratogenic Effects
Labor and Delivery
Nursing Mothers
Pediatric Use
Geriatric Use
ADVERSE REACTIONS
CEFUROXIME AXETIL TABLETS IN CLINICAL TRIALS
Multiple-Dose Dosing Regimens
7 to 10 Days Dosing
| Incidence ≥1% | Diarrhea/loose stools 3.7% Nausea/vomiting 3% Transient elevation in AST 2% Transient elevation in ALT 1.6% Eosinophilia 1.1% Transient elevation in LDH 1% |
| Incidence <1% but >0.1% | Abdominal pain Abdominal cramps Flatulence Indigestion Headache Vaginitis Vulvar itch Rash Hives Itch Dysuria Chills Chest pain Shortness of breath Mouth ulcers Swollen tongue Sleepiness Thirst Anorexia Positive Coombs test |
5-Day Experience (see CLINICAL STUDIES section)
In Clinical Trials for Early Lyme Disease With 20 Days Dosing
Single-Dose Regimen for Uncomplicated Gonorrhea
| Incidence ≥1% | Nausea/vomiting 6.8% Diarrhea 4.2% |
| Incidence <1% but >0.1% | Abdominal pain Dyspepsia Erythema Rash Pruritus Vaginal candidiasis Vaginal itch Vaginal discharge Headache Dizziness Somnolence Muscle cramps Muscle stiffness Muscle spasm of neck Tightness/pain in chest Bleeding/pain in urethra Kidney pain Tachycardia Lockjaw-type reaction |
POSTMARKETING EXPERIENCE WITH CEFUROXIME AXETIL PRODUCTS
CEPHALOSPORIN-CLASS ADVERSE REACTIONS
OVERDOSAGE
DOSAGE AND ADMINISTRATION
| Population/Infection | Dosage | Duration(days) |
| Adolescents and Adults (13 years and older) |
| Pharyngitis/tonsillitis | 250 mg b.i.d. | 10 |
| Acute bacterial maxillary sinusitis | 250 mg b.i.d. | 10 |
| Acute bacterial exacerbations of chronic bronchitis | 250 or 500 mg b.i.d. | 10* |
| Secondary bacterial infections of acute bronchitis | 250 or 500 mg b.i.d. | 5-10 |
| Uncomplicated skin and skin-structure infections | 250 or 500 mg b.i.d. | 10 |
| Uncomplicated urinary tract infections | 250 mg b.i.d. | 7-10 |
| Uncomplicated gonorrhea | 1,000 mg once | single dose |
| Early Lyme disease | 500 mg b.i.d. | 20 |
| Pediatric Patients (who can swallow tablets whole) |
| Acute otitis media | 250 mg b.i.d. | 10 |
| Acute bacterial maxillary sinusitis | 250 mg b.i.d. | 10 |
Patients With Renal Failure
HOW SUPPLIED
CLINICAL STUDIES
Cefuroxime Axetil Tablets
Acute Bacterial Maxillary Sinusitis
| | U.S. Patients* | South American Patients† |
| Cefuroxime Axetil(n = 49) | Control(n = 43) | Cefuroxime Axetil(n = 87) | Control(n = 89) |
| Clinical success (cure + improvement) | 65% | 53% | 77% | 74% |
| Clinical cure | 53% | 44% | 72% | 64% |
| Clinical improvement | 12% | 9% | 5% | 10% |
Safety
Early Lyme Disease
| Part I(1 Month Posttreatment)* | Part II(1 Year Posttreatment)† |
| Cefuroxime Axetil(n = 125) | Doxycycline(n = 108) | Cefuroxime Axetil(n = 105‡) | Doxycycline(n = 83‡) |
| Satisfactory clinical outcome§ | 91% | 93% | 84% | 87% |
| Clinical cure/success | 72% | 73% | 73% | 73% |
| Clinical improvement | 19% | 19% | 10% | 13% |
Safety
Secondary Bacterial Infections of Acute Bronchitis
| CAE-516 and CAE-517* | CAEA4001 and CAEA4002† |
| 5 day(n = 127) | 10 day(n = 139) | 5 day(n = 173) | 10 day(n = 192) |
| Clinical success (cure + improvement) | 80% | 87% | 84% | 82% |
| Clinical cure | 61% | 70% | 73% | 72% |
| Clinical improvement | 19% | 17% | 11% | 10% |
Safety
REFERENCES
- National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. 3rd ed. Approved Standard NCCLS Document M7-A3, Vol. 13, No. 25. Villanova, Pa: NCCLS; 1993.
- National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests. 4th ed. Approved Standard NCCLS Document M2-A4, Vol. 10, No. 7. Villanova, Pa: NCCLS; 1990.