Ceftum 500: Uses, Benefits, Dosage & Side Effects

Ceftum 500 is an antibiotic tablet containing cefuroxime axetil. It is used to treat bacterial infections affecting the throat, ears, sinuses, chest, urinary tract and skin. It may also be prescribed for gonorrhoea. It is a prescription-only medicine in India.

Ceftum 500 is a tablet that contains cefuroxime axetil equivalent to 500 mg of cefuroxime. Cefuroxime axetil is a prodrug — the tablet itself is inactive. Once you swallow it, the body converts it into cefuroxime, which is the form that actually attacks bacteria.

Cefuroxime belongs to a group of antibiotics called cephalosporins. It is a second-generation cephalosporin, which means it covers a useful range of both gram-positive and gram-negative bacteria, including many strains that have become resistant to older penicillins.

Ceftum is a brand of cefuroxime axetil tablets from GlaxoSmithKline Pharmaceuticals Limited, India. Two tablet strengths are covered by the manufacturer's current label:

• Ceftum 250 — Cefuroxime axetil equivalent to 250 mg cefuroxime
• Ceftum 500 — Cefuroxime axetil equivalent to 500 mg cefuroxime

This article is about Ceftum 500. Check the strength printed on your pack before you take it, because Ceftum 250 contains half as much medicine and is used for the same infections at lower doses. Other companies also make the same tablet, so the name on the carton matters.

In India, cefuroxime appears in Schedule H of the Drugs and Cosmetics Rules, 1945.

Bacteria need a strong outer wall to survive. Cefuroxime attaches to the proteins that bacteria use to build that wall - the penicillin-binding proteins — and blocks the building process. Without a working wall, the bacterium breaks apart and dies. This is why cefuroxime is called bactericidal: it kills the bacteria rather than just stopping them from multiplying.

Cefuroxime is also stable against many of the enzymes (beta-lactamases) that bacteria produce to destroy penicillins. That is why it still works against some strains that are resistant to amoxicillin and ampicillin.

Because the medicine works this way, it only helps when the infection is actually caused by bacteria that are susceptible to it. That is why doctors sometimes send a sample for testing before or during treatment.

Ceftum 500 is used to treat the bacterial infections listed on the manufacturer's label. These include:

• Infections of the ear, nose and throat - middle-ear infection (otitis media), sinus infection, tonsillitis and pharyngitis
• Chest infections - pneumonia and flare-ups of chronic obstructive pulmonary disease (COPD)
• Urinary tract infections - kidney infection (pyelonephritis), bladder infection (cystitis) and urethritis
• Skin and soft tissue infections - boils, impetigo and other bacterial skin infections
• Gonorrhoea - acute, uncomplicated gonococcal urethritis and cervicitis

The fever, pain, discharge or swelling that come with the infection usually settle as it comes under control.

What are the benefits

• It acts on the bacteria causing the infection, rather than only easing the symptoms.
• It is taken by mouth, so many chest, urine and skin infections can be completed at home instead of in hospital with injections.
• It is not broken down by many of the beta-lactamase enzymes that bacteria produce, so it stays useful against some strains that are otherwise resistant.

In hospital, cefuroxime is sometimes started as an injection and then switched to tablets to finish the course. This is called sequential therapy, and it keeps the same antibiotic working for you in a simpler form.

What it is not for

• Viral illnesses. Colds, flu, most sore throats and viral fevers are not caused by bacteria, so this antibiotic will not help them. Taking it for a viral illness only adds side effects and encourages resistance.
• Infections caused by organisms it cannot kill. Cefuroxime does not act on Enterococcus, Listeria, Acinetobacter, Pseudomonas, Clostridioides difficile, Bacteroides fragilis, or on Chlamydia, Mycoplasma and Legionella. Your doctor picks a different antibiotic for those.
• Fever or pain on its own. It is an antibiotic, not a fever or pain medicine. If you need relief from fever or aches, ask your doctor what you may take alongside it.

One more point worth knowing: in the United States, this antibiotic is also approved to treat early Lyme disease. That use is not listed on the Indian label for this medicine, so in India the decision is your doctor's.

The dose depends on which infection is being treated, how severe it is, your weight, your age and how well your kidneys are working. Your doctor will decide the exact dose and the number of days. Do not change the dose on your own.

For adults and children weighing more than 40 kg, the manufacturer's label gives these typical doses:

• Tonsillitis and pharyngitis — 250 mg twice a day
• Middle-ear infection (otitis media) — 500 mg twice a day
• Sinus infection (acute bacterial sinusitis) — 500 mg twice a day
• Pneumonia, and flare-ups of COPD — 500 mg twice a day
• Urinary tract infections — 250 mg to 500 mg twice a day
• Skin and soft tissue infections — 250 mg to 500 mg twice a day
• Uncomplicated gonorrhoea — A single dose of 1,000 mg

The 250 mg doses in this table are taken with the 250 mg tablet. Never split or halve a Ceftum 500 tablet to make a 250 mg dose — if your prescription is for 250 mg twice a day, ask your pharmacist for the 250 mg strength.

Children weighing between 20 kg and 40 kg are usually given 250 mg twice a day, and up to 500 mg twice a day for some infections. A 250 mg dose needs the 250 mg tablet — never split a Ceftum 500 tablet to make up a child's dose.

Practical points about taking it

• The tablet is swallowed whole with a glass of water. It should not be crushed, split or chewed.
• It is taken after food. Absorption is better that way, so the dose is meant to be taken shortly after a meal.
• Twice a day means roughly every 12 hours — for example, after breakfast and after dinner. Keeping to the same times each day helps.
• The usual course is seven days. Depending on the infection, it may be as short as five days or as long as ten.
• Finish the whole course your doctor prescribed, even if you feel well after two or three days. Stopping early can let the infection return.
• Tablets are not suitable for young children who cannot swallow them whole. If your child cannot swallow a tablet, tell the doctor — a liquid form of this antibiotic is available, but it is not interchangeable with tablets milligram for milligram, so the dose has to be worked out separately.

If your kidneys are not working well

Cefuroxime leaves the body mainly through the kidneys. When kidney function is reduced, the medicine stays in the body longer, so the interval between doses is stretched rather than the dose itself being cut:

• 30 mL/min or more — No change; the standard dose twice a day
• 10 to 29 mL/min — The same single dose, once every 24 hours
• Less than 10 mL/min — The same single dose, once every 48 hours
• On haemodialysis — An extra single dose after each dialysis session

If you are on dialysis or have known kidney disease, make sure your doctor knows before you start.

Missed dose. Take the missed tablet as soon as you remember. If your next dose is almost due, skip it and carry on with your normal schedule. Never take two doses together to make up for a missed one — that increases the chance of side effects such as stomach pain, loose motions and nausea.

Too much. Taking too much cefuroxime can cause serious brain-related effects, including confusion, fits (seizures) and loss of consciousness. This is more likely in people whose kidneys are not working well.

If you or someone else has taken too many tablets:

• Go to the nearest hospital emergency department straight away.
• Carry the strip, the carton or the prescription with you so the doctor knows exactly what was taken.
• In an emergency in India, call 112. For an ambulance, call 108.

Do not wait for symptoms to appear before getting help.

Most people who take this medicine have no trouble with it, and the side effects that do occur are usually mild and settle once the course is over.

• Common (1 in 100 to 1 in 10) - Loose motions, nausea, stomach pain, headache, dizziness, overgrowth of Candida (thrush), a rise in eosinophils, and short-lived rises in liver enzymes
• Uncommon (1 in 1,000 to 1 in 100) - Vomiting, skin rash, low platelet or white blood cell counts, and a positive Coombs test
• Rare or very rare - Severe diarrhoea caused by Clostridioides difficile, severe allergic reactions, haemolytic anaemia, jaundice, hepatitis, and serious skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis

Warning signs that need urgent medical help

Get help immediately if you notice any of these, during the course or in the weeks after it:

• Swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing
• A spreading rash with blisters or peeling skin
• Severe, watery or bloody diarrhoea, or persistent stomach cramps
• Yellowing of the eyes or skin, or dark urine
• Fits, confusion or unusual drowsiness
• A fever, sore throat or chills that come back, or any sign that the infection is not getting better after a few days — call your doctor rather than waiting for the course to finish

Severe diarrhoea can start up to two months after you stop the antibiotic. If it happens, tell the doctor that you recently took cefuroxime.

Driving and machinery

This medicine can make you dizzy. Be careful when driving or using machines until you know how it affects you.

There is one clear contraindication: do not take this medicine if you have ever had an allergic reaction to cefuroxime or to any other cephalosporin antibiotic. A reaction can range from a rash to a serious, life-threatening one, and it can happen within minutes of a dose.

If you are not sure which antibiotic caused a reaction in the past, do not guess. Show your doctor the old prescription or the pack, or tell them the name of the antibiotic you reacted to.

These are situations where the medicine is not automatically ruled out, but your doctor needs to know about them before prescribing.

• Penicillin allergy. If you have reacted to penicillin or another beta-lactam antibiotic, you are at higher risk of reacting to a cephalosporin. Tell your doctor.
• Kidney disease. The dose interval needs to be extended, as shown in the table above.
• Liver disease. Cefuroxime is cleared by the kidneys, so liver problems are not expected to change how the medicine behaves. Still, tell your doctor about any liver condition.
• Pregnancy. Available data have not established a risk of birth defects or miscarriage with this antibiotic, but as with any medicine in pregnancy it is used only when clearly needed.
• Breastfeeding. Cefuroxime passes into breast milk in small amounts. Side effects in the baby are not expected at normal doses, but loose motions and thrush in the baby cannot be ruled out, and there is a small chance of sensitisation. Your doctor will weigh the benefit against the risk.
• Older adults. No differences in safety or effectiveness have been seen in older patients, but kidney function tends to fall with age, so the dose may need review.
• Children. The safety profile in children is the same as in adults. Tablets are not suitable for a child who cannot swallow them whole, and the tablet form should not be used in infants under 3 months.
• Diabetes. Cefuroxime can interfere with one older laboratory method for measuring glucose, so mention that you are taking it before any lab sugar test.

Medicines that reduce stomach acid. Antacids, and acid-suppressing medicines such as omeprazole, pantoprazole, ranitidine and famotidine, can lower how much of this antibiotic you absorb. Acid-suppressing medicines of this kind are best avoided while you are taking the antibiotic, for that reason. If you need one for another reason, ask your doctor first. If you take an antacid, keep at least two hours between it and your antibiotic dose.

Probenecid. This medicine, used for gout, raises the level of cefuroxime in your blood. The two are not usually taken together.

Hormonal contraception. Antibiotics can disturb the gut bacteria that help your body reabsorb the oestrogen in contraceptive pills. The pill may be less reliable while you are taking this antibiotic, so use an additional method of contraception during the course.

Alcohol. The label for this medicine does not list alcohol as an interaction, and it carries no alcohol warning. A disulfiram-like reaction — flushing, sweating, headache and a fast heartbeat — is a known problem with some other cephalosporin antibiotics, such as cefotetan, which carry an alcohol warning for that reason. Cefuroxime is a different medicine, and its label carries no such warning. Because this medicine can also make you dizzy, it is sensible to avoid alcohol until you have finished the course, and to check with your doctor if you drink regularly.

• Store the tablets protected from moisture, at a temperature not exceeding 30°C.
• Keep them in the original blister or container, and out of reach of children.
• Do not use the tablets after the expiry date printed on the pack.
• Return unused tablets to a pharmacy rather than throwing them in the bin or flushing them.