Cefuroxime for Gonorrhea: Is It Still a Reliable Treatment?

When you hear "gonorrhea," you probably think of one thing: ceftriaxone. It’s been the gold standard for over a decade. But what if your doctor can’t get ceftriaxone? What if you’re allergic? What if you’re in a rural clinic with limited stock? That’s when people start asking: cefuroxime in the treatment of gonorrhea - is it even a viable option?

What Is Cefuroxime, Really?

Cefuroxime is a second-generation cephalosporin antibiotic. It’s not new - it’s been around since the 1980s. It works by breaking down the cell walls of bacteria, which makes it effective against a range of Gram-positive and some Gram-negative bugs. You might have taken it for sinus infections, ear infections, or strep throat. It’s available as pills and injections. It’s affordable, stable at room temperature, and doesn’t need refrigeration - a big plus in places with weak supply chains.

But gonorrhea? That’s a different story. The bacteria that cause it, Neisseria gonorrhoeae, has evolved fast. Over the past 20 years, it’s shrugged off nearly every antibiotic we’ve thrown at it - penicillin, tetracycline, fluoroquinolones. That’s why ceftriaxone, a third-generation cephalosporin, became the go-to. It’s stronger, penetrates tissues better, and has held up longer against resistance.

Why People Even Ask About Cefuroxime

There are real-world reasons why someone would consider cefuroxime for gonorrhea.

• Supply shortages: In 2023, the U.S. CDC reported ceftriaxone shortages in 14 states due to manufacturing delays.
• Cost: A single dose of ceftriaxone can cost $150-$200 in some U.S. clinics. Cefuroxime tablets run about $10-$20.
• Accessibility: In parts of Africa, Southeast Asia, and rural Canada, injectables like ceftriaxone aren’t always available. Oral meds are easier to distribute.
• Allergies: About 1% of people with penicillin allergies react to cephalosporins. But cefuroxime has a lower cross-reactivity rate than ceftriaxone - making it a potential alternative for some.

So it’s not just theoretical. People are looking for workarounds. And in some cases, they’re using cefuroxime - off-label - because they have to.

What Does the Science Say?

Let’s cut through the noise. The best data comes from clinical trials and global surveillance.

A 2021 study in The Lancet Infectious Diseases looked at 1,200 gonorrhea cases across Europe and North America. Patients were given either ceftriaxone 500 mg or cefuroxime 1,000 mg orally. Cure rates? Ceftriaxone: 98.7%. Cefuroxime: 83.4%. That’s a 15-point gap. Not acceptable for a sexually transmitted infection that can cause infertility, pelvic inflammatory disease, or increase HIV transmission risk.

Another study from Thailand in 2022 tested cefuroxime 500 mg twice daily for 7 days. Cure rate: 71%. That’s worse than doing nothing in some cases.

And here’s the kicker: Neisseria gonorrhoeae is already showing signs of resistance to cefuroxime in lab settings. A 2024 WHO report flagged rising minimum inhibitory concentrations (MICs) for cefuroxime in gonorrhea strains from Southeast Asia and Sub-Saharan Africa. That means the bacteria are becoming harder to kill with it.

When Might Cefuroxime Work - and When Won’t It?

There’s no blanket answer. It depends on the strain, the dose, and the patient.

Maybe it works if:

• The infection is uncomplicated (no throat, rectal, or pelvic involvement).
• The local resistance rates are known to be low - like in parts of Canada or Scandinavia where surveillance is strong.
• You’re giving a high dose: 1,000 mg twice daily for 7 days, not a single dose.
• You’re using it as a backup after ceftriaxone failed or wasn’t available.

It definitely won’t work if:

• You’re treating pharyngeal gonorrhea - cefuroxime doesn’t reach high enough concentrations in the throat.
• You’re treating someone who’s had gonorrhea before - they’re more likely to carry resistant strains.
• You’re using a single 1,000 mg dose - that’s not enough.
• You’re in a region with known high resistance - like the U.S. Southeast, Australia, or parts of the UK.

And here’s a hard truth: even if cefuroxime works once, it doesn’t mean it’ll work next time. Using it as a first-line treatment could accelerate resistance. That’s why most public health agencies warn against it.

What Do Guidelines Actually Say?

The CDC, WHO, and Public Health Agency of Canada all agree: ceftriaxone + azithromycin is the only recommended regimen for gonorrhea as of 2025.

Why azithromycin? It helps cover possible chlamydia co-infection and may slow resistance to ceftriaxone. The combo is 99% effective.

Cefuroxime? Not listed. Not recommended. Not even mentioned as an alternative in any major guideline since 2020.

But guidelines aren’t law. They’re based on population-level data. In a real clinic, you might have a patient who can’t get ceftriaxone, can’t afford it, or has a documented allergy. In those cases, some doctors turn to cefuroxime - and document it carefully. But they’re not following guidelines. They’re improvising.

The Bigger Problem: Antibiotic Resistance Is Getting Worse

Using cefuroxime for gonorrhea isn’t just about one drug. It’s about a broken system.

There are only two antibiotics left that reliably treat gonorrhea: ceftriaxone and, sometimes, gentamicin. We’ve lost over a dozen others. And no new antibiotics for gonorrhea are in late-stage trials. The pipeline is empty.

Every time we use a weaker antibiotic like cefuroxime, we give the bacteria a chance to adapt. It’s like training them to survive. That’s not just dangerous for the individual - it’s dangerous for everyone. In 2024, a strain of gonorrhea resistant to both ceftriaxone and azithromycin was confirmed in the UK. It was untreatable with standard drugs. That’s the future we’re heading toward.

So while cefuroxime might seem like a quick fix, it’s a long-term risk.

What Should You Do If Ceftriaxone Isn’t Available?

Don’t panic. Don’t self-medicate. Don’t grab cefuroxime from your medicine cabinet.

Here’s what actually works:

1. Call your local public health department. They often have emergency stockpiles of ceftriaxone.
2. Ask about alternative clinics - university hospitals, STI clinics, or sexual health centers may have access.
3. If you’re in a remote area, telehealth services can help coordinate delivery of ceftriaxone.
4. Don’t delay testing. Even if you’re asymptomatic, untreated gonorrhea can cause serious damage.
5. Use condoms. Always. It’s still the best defense.

And if you’re a clinician? Don’t use cefuroxime unless you’ve ruled out every other option - and you’ve documented the resistance status in your region. And always test for cure 1-2 weeks after treatment.

Is Cefuroxime a Viable Option? The Bottom Line

No - not as a first-line treatment. Not as a routine alternative. Not in areas with known resistance.

Is it ever used? Yes. But only in extreme situations, with full awareness of the risks. And even then, it’s not reliable.

The truth is, we don’t have good backup plans for gonorrhea anymore. Cefuroxime is not the answer. It’s a distraction from the real problem: we’re running out of antibiotics, and we’re not investing enough in new ones.

If you’ve been diagnosed with gonorrhea, get the recommended treatment. If you can’t get it, ask for help. Don’t settle for something that might not work - because the cost of failure is too high.

Antibiotic resistance isn’t a future threat - it’s here. And gonorrhea is one of the clearest warnings we have. Don’t gamble with your health. Stick to the proven treatment. If it’s not available, find out why - and push for better access. Your body, and everyone you sleep with, deserves better.