Cefuroxime Dosage and Treatment Duration for Bacterial Infections
For most bacterial infections, cefuroxime should be dosed at 250-500 mg orally twice daily for 5-10 days, or 750 mg to 1.5 grams intravenously every 8 hours, with specific dosing based on infection site, severity, and patient factors. 1
Dosage Recommendations by Infection Type
Respiratory Tract Infections
Community-acquired pneumonia:
Acute bronchitis: 250 mg twice daily for 10 days 4
Chronic rhinosinusitis: 500 mg twice daily for 14 days 5
Skin and Soft Tissue Infections
- Uncomplicated infections: 250 mg twice daily for 10 days 6
- More severe infections: 500 mg twice daily for 10 days 6
- Animal bites: 500 mg twice daily (oral) or 1 gram every 12 hours (IV) 5
Urinary Tract Infections
- Uncomplicated UTI: 250 mg once daily for 10 days 7
- Complicated UTI: 250-500 mg twice daily for 7-10 days 1
Lyme Disease
- Early Lyme disease: 500 mg twice daily for 14-21 days 5
Special Population Considerations
Pediatric Dosing
- Children >3 months: 50-100 mg/kg/day in divided doses 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 in divided doses every 8 hours (not exceeding maximum adult dose) 1
Renal Impairment
Dosage adjustment required based on creatinine clearance:
- CrCl >20 mL/min: Standard dose (750 mg-1.5 grams) every 8 hours
- CrCl 10-20 mL/min: 750 mg every 12 hours
- CrCl <10 mL/min: 750 mg every 24 hours 1
Clinical Pearls and Considerations
- Administration: Oral cefuroxime axetil should be taken with food to enhance absorption 8
- Duration: Minimum treatment duration should be 48-72 hours after patient becomes asymptomatic 1
- Streptococcal infections: Minimum 10 days of treatment recommended to prevent rheumatic fever or glomerulonephritis 1
- Efficacy: Cefuroxime has demonstrated similar efficacy to other antibiotics including amoxicillin/clavulanate, macrolides, and quinolones for respiratory infections 3
- Tolerability: Generally well-tolerated with primarily mild gastrointestinal side effects (diarrhea, nausea, vomiting) 8
Common Pitfalls to Avoid
- Underdosing in severe infections: For severe infections, use the higher end of the dosage range (500 mg orally twice daily or 1.5 grams IV every 8 hours)
- Inadequate duration: Continue treatment for at least 48-72 hours after symptom resolution 1
- Premature discontinuation: Patients often feel better before the infection is fully eradicated; emphasize completing the full course
- Failure to adjust for renal function: Cefuroxime is primarily eliminated renally and requires dose adjustment in renal impairment 1
- Inappropriate use for viral infections: Ensure bacterial etiology before prescribing
By following these evidence-based dosing recommendations and considering patient-specific factors, cefuroxime can be effectively used to treat a wide range of bacterial infections while minimizing the risk of treatment failure and antimicrobial resistance.