What are the roles of cefuroxime (Ceftin, Kefurox, Zinacef) and cefixime (SUPRAX) in intravenous-to-oral switch therapy?

Updated: Jul 30, 2018
  • Author: Shirin A Mazumder, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Studies of intravenous cefuroxime followed by oral cefuroxime axetil suggest this regimen is both effective and well-tolerated as rapid switch therapy and has the potential to reduce overall health care costs and improve patient satisfaction. Specifically, Van den Brande and colleagues noted that intravenous cefuroxime twice daily followed by oral cefuroxime axetil is a simple and effective sequential therapy regimen for the treatment of CAP. [32]

Hamilton-Miller found that switch therapy to cefixime after 2-3 days used to treat serious infections resulted in excellent clinical outcomes. [33] Similarly, Dagan and colleagues found that 1 or 2 days' treatment with parenteral ceftriaxone before switching to oral cefetamet pivoxil was safe and effective in the treatment of childhood pneumonia. [34] This suggests that parenteral-to-oral switch therapy is a feasible treatment option in the treatment of serious pediatric CAP.

Cefuroxime (Ceftin, Kefurox, Zinacef) is a second-generation cephalosporin that maintains gram-positive activity of first-generation cephalosporins and adds activity against Proteus mirabilis, Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, and Moraxella catarrhalis. The condition of the patient, severity of the infection, and susceptibility of the microorganism determine proper dose and route of administration. The adult dose is 500 mg PO bid for 20 d or, alternatively, 750-1500 mg IV/IM q8h, not to exceed 6 g/d. In children, dosing is 250 mg PO bid for 20 d. Use the adult dose for adolescents. Cefuroxime is a pregnancy category C medication.

Cefixime (Suprax) has activity against aerobic gram-negative rods. It arrests bacterial cell-wall synthesis and inhibits bacterial growth by binding to one or more of the penicillin-binding proteins. The adult dose is 400 mg PO qd (recommended for gonococcal infections); alternatively, 200 mg PO q12h or 400 mg PO qd or divided q12h can be used. In children < 12 years, dosing is 8 mg/kg PO qd or 4 mg/kg bid. In children >50 kg or >12 years, administer cefixime as in adults. Cefixime is a pregnancy category B medication.


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