Cefuroxime
Cefuroxime axetil, Cefuroxime sodium
Also known as: Ceftin · Zinacef · Aprokam · Zinnat · CCI-15641 · cefuroxima · cefuroximum · cefuroksiimi · cefuroksimas · Cefuroxime axetil · Cefuroxime sodium
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Soft tissue infections | 10 mg/kg PO q12h | PO | q12h | 10 days | 🌎 NA |
| Systemic infections | 15 mg/kg IV q8h | IV | q8h | — | 🌎 NA |
| Meningitis | 30 mg/kg IV q8h | IV | q8h | — | 🌎 NA |
| Surgery prophylaxis | 20 mg/kg IV 30 minutes prior to surgery and every 2 hours during surgery. | IV | 30 mins prior and q2h during | Perioperative | 🌎 NA |
| Surgical prophylaxis | 20 mg/kg | IV | 30 min prior to surgery and then repeat q1.5-3h during surgery | Perioperative | 🌍 EU |
| Susceptible infections | 10-30 mg/kg | IV | q8-12h | As directed | 🌍 EU |
- Soft tissue infections: Extrapolated from human dosages.
- Systemic infections: Extrapolated from human dosages.
- Meningitis: Extrapolated from human dosages.
- Surgical prophylaxis: Administer slowly over 5 min
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Surgical prophylaxis | 20 mg/kg | IV | 30 min prior to surgery and then repeat q1.5-3h during surgery | Perioperative | 🌍 EU |
| Susceptible infections | 10-30 mg/kg | IV | q8-12h | As directed | 🌍 EU |
- Surgical prophylaxis: Administer slowly over 5 min
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Cefuroxime is a semi-synthetic 2nd generation cephalosporin antibiotic available in both oral (axetil) and parenteral (sodium) formulations.
- Spectrum of Activity: It offers enhanced activity against certain gram-negative pathogens (e.g., E. coli, Klebsiella pneumoniae, Salmonella, Enterobacter) compared to 1st generation cephalosporins like cephalexin, while retaining good efficacy against many gram-positive organisms.
- Clinical Utility: It is particularly useful in small animal medicine when treating infections resistant to 1st generation cephalosporins, when broader gram-negative coverage is needed for surgical prophylaxis, or when high central nervous system (CNS) concentrations are required (as it can cross inflamed meninges).
- Limitations: It is not effective against methicillin-resistant Staphylococcus (MRSA/MRSP), Pseudomonas, Serratia, or Enterococcus.
Mechanism of action
Cefuroxime is a bactericidal time-dependent antibiotic.
It binds to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall → inhibits the third and final stage of bacterial cell wall synthesis (peptidoglycan cross-linking) → weakens the cell wall → leads to cell lysis and death due to osmotic pressure.
Clinical Pearl: Like other beta-lactams, its efficacy depends on the amount of time the drug concentration remains above the Minimum Inhibitory Concentration (MIC) at the site of infection.
Safety & warnings
Contraindications
- Known hypersensitivity to cefuroxime or other cephalosporins
Adverse effects
- Inappetence
- Vomiting
- Diarrhea
- Injection site inflammation (IV use)
- Eosinophilia
- Hypersensitivity reactions (including anaphylaxis)
- Neurologic effects (hearing loss, seizures - rare)
- Pseudomembranous colitis (rare)
- Serious dermatologic reactions (TEN, Stevens-Johnson syndrome - rare)
- Hematologic effects (pancytopenia, thrombocytopenia - rare)
- Interstitial nephritis (rare)
Precautions
Renal Impairment: Dosage adjustment is recommended in patients with severe renal impairment, as the drug is primarily excreted unchanged in the urine.
- Laboratory Interference: May cause false-positive urine glucose determinations when using the copper reduction method (Benedict's, Fehling's, Clinitest). Tests utilizing glucose oxidase are unaffected.
- Coombs' Test: Cephalosporins have caused false-positive direct Coombs' tests in humans, particularly those with azotemia.
- Nursing Mothers: Enters maternal milk in low concentrations; potential for altering gut flora of nursing offspring.
Drug interactions
Potential for increased risk of nephrotoxicity; monitor renal function. However, may have synergistic or additive actions against some gram-negative bacteria (Enterobacteriaceae).
Possible increased risk of nephrotoxicity.
Possible increased risk of nephrotoxicity.
Reduced renal excretion of cephalosporins, potentially increasing serum levels.
Bacteriostatic agents may antagonize the bactericidal activity of cefuroxime.
Bacteriostatic agents may antagonize the bactericidal activity of cefuroxime.
Increased risk of nephrotoxicity; monitor renal function.
Monitoring
- Clinical efficacy (resolution of infection signs)
- Renal function in patients with pre-existing renal insufficiency
- Gastrointestinal tolerance
Pharmacokinetics
Absorption
In humans, cefuroxime axetil is well absorbed orally and rapidly hydrolyzed in the intestinal mucosa and circulation to the parent compound. Bioavailability is 37% (fasted) to 52% (with food). Peak serum levels occur in 2-3 hours (PO) or 15 min-1 hour (IM).
Distribution
Widely distributed to tissues including bone, aqueous humor, and joint fluid. Therapeutic levels can be attained in the CSF if meninges are inflamed. Human plasma protein binding is 35-50%.
Metabolism
Cefuroxime axetil is rapidly hydrolyzed in the intestinal mucosa and systemic circulation to the active parent compound (cefuroxime).
Elimination
Primarily excreted unchanged in the urine.
Overdose
Cefuroxime has a wide margin of safety. Beagles receiving daily dosages up to 1600 mg/kg/day orally tolerated the drug well, with only minor vomiting, slight weight gain suppression, and minor hematologic changes at the highest doses.
In humans, massive overdoses have caused cerebral irritation and seizures. If severe toxicity occurs, plasma levels can be reduced via hemodialysis or peritoneal dialysis. Treatment is largely supportive.
Available products
Formulations
- Oral tablets (film coated)
- Oral suspension
- Powder for injection
- Premixed frozen injection
Human-labeled
- Cefuroxime Axetil Oral Tablets (film coated): 125 mg, 250 mg, & 500 mg (Ceftin, generic)
- Cefuroxime Axetil Oral Suspension: 125 mg/5 mL & 250 mg/5 mL (generic)
- Cefuroxime Sodium Powder for Injection: 750 mg, 1.5 g & 7.5 g (Zinacef, generic)
- Cefuroxime Sodium Injection: 750 mg & 1.5 g premixed frozen (Zinacef)
Regulatory status
Human authorized products (POM) used off-label in veterinary medicine under the cascade.
Human authorized products (POM) used off-label in veterinary medicine under the cascade.
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Tablets: Store in tight containers at room temperature (15-30°C); protect from excessive moisture. Suspension: Unreconstituted powder store at 2-30°C. Once reconstituted, refrigerate (2-8°C) and discard any unused portion after 10 days. Injection: Powder store at room temperature (15-30°C). Reconstituted solution (90 mg/mL) is stable for 24 hours at room temperature or 48 hours refrigerated. Diluted in compatible IV solutions (D5W, normal saline, Ringer's), it is stable for 24 hours at room temperature or up to 7 days refrigerated.
Client information
- Give with Food: Administer the oral tablets with a meal to enhance drug absorption and reduce the chance of stomach upset.
- Do Not Crush: Avoid crushing the tablets. They have a very strong, bitter taste that pets will reject. If you absolutely must crush them, mix the powder with a strong-tasting dairy product (like milk or pet-safe cheese) to mask the taste and improve absorption.
- Finish the Prescription: Give the medication exactly as directed by your veterinarian. Continue treating for the full prescribed duration, even if your pet seems completely better, to prevent the infection from returning or becoming resistant.
- Watch for Side Effects: Contact your veterinarian if your pet develops severe vomiting, persistent diarrhea, rash, itching, or facial swelling.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.