Cefuroxime axetil

Second-generation oral cephalosporin

ATC code: J01DC02 (Cefuroxime axetil)

Brand names

Zinnat, Ceftin, Cefuracet

Mechanism of action

A bactericidal antibiotic that binds penicillin-binding proteins and disrupts cell-wall synthesis. Spectrum covers Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pyogenes, methicillin-susceptible Staphylococcus aureus, and some Escherichia coli and Klebsiella pneumoniae strains. Cefuroxime axetil is a prodrug converted to active cefuroxime by intestinal esterases. In Spain it is widely prescribed under the brand Zinnat – among the most prescribed oral cephalosporins.

Indications

Acute otitis media in children

Second line

Used in acute otitis media in children and adults as an alternative to amoxicillin/clavulanate when penicillins are intolerable without anaphylaxis. 2013 and the Spanish 2024 pediatric consensus set amoxicillin 80–90 mg/kg/day or amoxicillin/clavulanate (with suspected resistance) as first-line. Cefuroxime axetil in children: 30 mg/kg/day in 2 doses for 5–10 days. In children over 2 without severe disease, delayed antibiotic prescription over 48–72 hours is an option.

Sources

Community-acquired pneumonia

Second line

Alternative for non-severe outpatient community-acquired pneumonia. Adult dose 500 mg twice daily for 7 days. SEPAR 2024 first-line is high-dose amoxicillin, with a macrolide added for suspected atypical pathogens. Cefuroxime axetil is used in penicillin intolerance or confirmed resistance.

Sources

COPD exacerbation

Second line

Used in bacterial COPD exacerbations meeting Anthonisen criteria. Dose 500 mg twice daily for 5–7 days. 2024 and Spanish GesEPOC 2021 place it among alternatives to amoxicillin/clavulanate and cefditoren.

Sources

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Acute viral upper respiratory infection

Not recommended

Cefuroxime axetil is prescribed for upper respiratory infections, acute bronchitis and uncomplicated pharyngitis without group A streptococcal confirmation. 2024 AWaRe limits outpatient oral cephalosporin use. NG191 2020 does not recommend antibiotics for acute bronchitis in immunocompetent adults. Use in viral infections is irrational.

Sources

Practical notes

Timing and administration

Take with or immediately after food – meals raise bioavailability from 37% to 52%. Do not break or chew the tablet (bitter taste). With eGFR under 30, extend interval to 24 hours. Complete the course – early discontinuation on subjective improvement raises relapse and resistance risk.

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Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMA

Spanish Medicines Information Centre (CIMA)

Label dated: 07/18/2025

FDA / DailyMed

FDA — DailyMed Drug Labels

Label dated: 05/14/2026

Safety

Contraindications

Cephalosporin hypersensitivity
History of penicillin anaphylaxis
Age under 3 months

Serious adverse effects

Anaphylaxis
Pseudomembranous colitis
Hematologic disorders (eosinophilia, thrombocytopenia)
Hepatotoxicity
Stevens–Johnson syndrome (rare)

Common adverse effects

Diarrhea
Nausea
Abdominal pain
Headache
Skin rash
Candidiasis

PregnancyFDA B

FDA category B. Use in pregnancy is acceptable when indicated. Cefuroxime is among the cephalosporins with the largest body of pregnancy data.

Breastfeeding

Compatible with breastfeeding. Milk concentrations are low; transient infant diarrhea is possible.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Cefuroxime axetil used for?

Cefuroxime axetil is evaluated for the following indications with varying evidence strength: Acute otitis media in children (evidence tier B), COPD exacerbation (evidence tier B), Community-acquired pneumonia (evidence tier B). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Cefuroxime axetil?

Common side effects of Cefuroxime axetil (≥ 1 in 100): Diarrhea, Nausea, Abdominal pain, Headache, Skin rash, Candidiasis. See the Safety section for uncommon and serious reactions.

Is Cefuroxime axetil safe during pregnancy?

FDA category B. FDA category B. Use in pregnancy is acceptable when indicated. Cefuroxime is among the cephalosporins with the largest body of pregnancy data.

Is Cefuroxime axetil compatible with breastfeeding?

Compatible with breastfeeding. Milk concentrations are low; transient infant diarrhea is possible.

Who should not take Cefuroxime axetil?

Cefuroxime axetil is contraindicated in: Cephalosporin hypersensitivity; History of penicillin anaphylaxis; Age under 3 months. Full list in the Safety section.