What is the recommended dosage and treatment duration for Cefuroxime (Cephalosporin) in bacterial infections?

Recommended Dosage and Treatment Duration for Cefuroxime in Bacterial Infections

The recommended dosage of cefuroxime for most bacterial infections is 500 mg orally twice daily for 7-10 days, or 750 mg to 1.5 grams intravenously every 8 hours for 5-10 days, with dosage adjustments required for renal impairment. 1

Oral Cefuroxime (Cefuroxime Axetil) Dosing

Standard Adult Dosing

• Common infections: 500 mg twice daily 2
• Duration: 7-10 days (range 5-14 days depending on infection type) 1, 3
• Administration: Should be taken with food to improve absorption

Specific Infection Types (Oral)

• Skin and soft tissue infections: 250 mg twice daily for 10 days 4
• Respiratory tract infections: 500 mg twice daily for 5-10 days 3
• Urinary tract infections: 250 mg once daily (taken at night) for 10 days 5
• Lyme disease (erythema migrans): 500 mg twice daily for 14-21 days 2

Intravenous Cefuroxime Dosing

Standard Adult Dosing

• Common infections: 750 mg every 8 hours 1
• Severe or complicated infections: 1.5 grams every 8 hours 1
• Life-threatening infections: 1.5 grams every 6 hours 1
• Duration: Usually 5-10 days 1

Specific Infection Types (IV)

• Bone and joint infections: 1.5 grams every 8 hours 1
• Bacterial meningitis: Up to 3 grams every 8 hours 1
• Uncomplicated gonorrhea: 1.5 grams as a single intramuscular dose (with 1 gram oral probenecid) 1
• Surgical prophylaxis: 1.5 grams IV pre-surgery, then 750 mg every 8 hours if procedure is prolonged 1

Pediatric Dosing (>3 months)

• Standard dosing: 50-100 mg/kg/day divided every 6-8 hours 1
• Severe infections: 100 mg/kg/day (not exceeding maximum adult dose) 1
• Bone and joint infections: 150 mg/kg/day divided every 8 hours (not exceeding maximum adult dose) 1

Dosing in Renal Impairment

• CrCl >20 mL/min: Standard dose (750 mg-1.5 g) every 8 hours
• CrCl 10-20 mL/min: 750 mg every 12 hours
• CrCl <10 mL/min: 750 mg every 24 hours
• Hemodialysis patients: Additional dose after dialysis 1

Sequential Therapy

For conditions like community-acquired pneumonia, sequential therapy with IV cefuroxime (750 mg 2-3 times daily for 2-5 days) followed by oral cefuroxime axetil (500 mg twice daily for 3-8 days) has proven effective 3.

Clinical Considerations

Antimicrobial Spectrum

• Good activity against: Streptococci, staphylococci, Pasteurella multocida 2
• Limited activity against: Anaerobes 2

Common Uses

1. Respiratory tract infections including community-acquired pneumonia, acute bronchitis, and sinusitis 3
2. Skin and soft tissue infections 2, 4
3. Urinary tract infections 1, 5
4. Lyme disease (early stage) 2
5. Animal and human bite infections (good activity against P. multocida) 2

Advantages

• Convenient twice-daily dosing for oral formulation 3
• Better gastrointestinal tolerance compared to some other antibiotics 6
• Good beta-lactamase stability compared to first-generation cephalosporins 7

Potential Pitfalls and Caveats

• Not effective against MRSA 2
• Limited activity against anaerobes - may need combination therapy for polymicrobial infections 2
• Dosage adjustment required in renal impairment 1
• Should be continued for at least 48-72 hours after patient becomes asymptomatic 1
• For streptococcal infections, minimum 10 days of treatment recommended to prevent rheumatic fever or glomerulonephritis 1

By following these dosing guidelines and considering the specific infection type, severity, and patient factors, cefuroxime can be effectively used for treating a wide range of bacterial infections.