What is the recommended dose of cefuroxime (Cefuroxime axetil) for adults and children with mild to moderate or severe infections?

Cefuroxime Dosage Recommendations for Adults and Children

For adults with mild to moderate infections, cefuroxime axetil should be administered at 250-500 mg orally twice daily, while for severe infections, intravenous cefuroxime at 750 mg to 1.5 g every 8 hours is recommended. 1

Adult Dosing

Oral Administration (Cefuroxime Axetil)

• Mild to moderate infections: 250 mg twice daily 1, 2
• More severe infections: 500 mg twice daily 1, 2
• Specific infections:
  • Respiratory tract infections: 250-500 mg twice daily for 7-10 days 3
  • Urinary tract infections: 125-250 mg twice daily 4
  • Skin and soft tissue infections: 250-500 mg twice daily 2
  • Lyme disease (erythema migrans): 500 mg twice daily for 14-21 days 5

Parenteral Administration (Cefuroxime Sodium)

• Mild to moderate infections: 750 mg every 8 hours 1
• Severe infections: 1.5 g every 8 hours 1
• Life-threatening infections: 1.5 g every 6 hours 1
• Bacterial meningitis: Up to 3 g every 8 hours 1

Pediatric Dosing

Oral Administration (Cefuroxime Axetil)

• Children ≥3 months: 10-15 mg/kg twice daily (maximum 500 mg per dose) 2
• Specific infections:
  • Otitis media: 15 mg/kg twice daily (maximum 500 mg per dose) 5
  • Pharyngitis/tonsillitis: 10 mg/kg twice daily (maximum 250 mg per dose) 5
  • Community-acquired pneumonia: 15 mg/kg twice daily (maximum 500 mg per dose) 5

Parenteral Administration (Cefuroxime Sodium)

• Children >3 months: 50-100 mg/kg/day divided every 6-8 hours (maximum adult dose) 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 1
• Bacterial meningitis: 200-240 mg/kg/day divided every 6-8 hours 1

Dosage Adjustments for Special Populations

Renal Impairment (Adults)

• CrCl >20 mL/min: Standard dose
• 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

Duration of Therapy

• Respiratory tract infections: 5-10 days 3
• Urinary tract infections: 7-10 days 4
• Skin and soft tissue infections: 7-10 days 5
• Lyme disease: 14-21 days 5

Clinical Considerations and Caveats

• Administration timing: Oral cefuroxime axetil should be taken with food to enhance absorption and bioavailability (68% when taken with food) 2
• Sequential therapy: For severe infections requiring hospitalization, consider 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) 3
• Common adverse effects: Primarily gastrointestinal disturbances (diarrhea, nausea, vomiting) which are generally mild and transient 2, 6
• Comparative tolerability: Cefuroxime axetil has fewer gastrointestinal side effects compared to some other cephalosporins (10% vs 18% for cefixime) 6

Antimicrobial Spectrum

Cefuroxime is effective against many common pathogens including:

• Streptococcus pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
• Streptococcus pyogenes
• Methicillin-sensitive Staphylococcus aureus
• Common Enterobacteriaceae (E. coli, K. pneumoniae, P. mirabilis) 2

Remember that dosing should be based on the severity of infection, the susceptibility of the causative organism, and patient-specific factors such as renal function. For severe infections or those caused by less susceptible organisms, higher doses or alternative antibiotics may be necessary.