Cephalosporin antibiotic spectrum and clinical use
Cefuroxime axetil is an oral second-generation cephalosporin. [1] Cefixime is an oral third-generation cephalosporin. [2]
Antibacterial spectrum differences
Cefuroxime axetil has activity against susceptible respiratory pathogens, including Streptococcus pneumoniae and β-lactamase–negative Haemophilus influenzae. [1] Cefixime is indicated for infections that include respiratory, ear, throat, urinary tract infections, and uncomplicated gonorrhea caused by susceptible Neisseria gonorrhoeae. [3] Cefixime has limited activity against ESBL-producing Enterobacteriaceae. [3]
β-lactamase and resistance-related limitations
Cefuroxime axetil is not active against many ESBL-producing and carbapenemase-producing isolates. [1] Cefixime has limited activity against ESBL-producing Enterobacteriaceae. [3]
Dosing pattern differences in common practice
Cefuroxime axetil is typically dosed multiple times daily for common labeled indications. [1] Cefixime is typically dosed once daily in some labeled regimens and is also used in single-dose therapy for uncomplicated gonorrhea. [3]
Safety and adverse-effect profile differences
Drug-related gastrointestinal adverse events are more common with cefixime than with cefuroxime axetil in a randomized comparison in acute bronchitis (18% vs 10%; p = 0.01). [4] Diarrhea is specifically more common with cefixime than with cefuroxime axetil in that study (15% vs 5%; p = 0.001). [4]
Indication overlap and where selections often diverge
Both agents are used for community-acquired outpatient infections that involve susceptible respiratory pathogens. [1] Cefixime has a labeled indication for uncomplicated gonorrhea due to susceptible Neisseria gonorrhoeae. [3] Cefuroxime axetil has labeled indications that include acute bacterial exacerbations of chronic bronchitis and secondary bacterial infections of acute bronchitis due to susceptible Streptococcus pneumoniae and β-lactamase–negative Haemophilus influenzae. [1]
Practical prescribing constraint
Cefuroxime axetil tablet and cefuroxime axetil oral suspension formulations are not bioequivalent and are not substitutable on a milligram-for-milligram basis. [1]