Cefuroxime Dosing for Abdominal Infections
For abdominal infections, the recommended dose of cefuroxime is 20-30 mg/kg IV three times daily for all ages, with oral dosing of 125 mg twice daily for ages 1-24 months and 250 mg twice daily for ages 2-12 years. 1
IV Dosing for Abdominal Infections
Intravenous cefuroxime is the preferred route for treating abdominal infections due to better tissue penetration and more reliable absorption. The dosing regimen is as follows:
- All ages: 20-30 mg/kg IV three times daily 1
- Adults: Typically 750 mg to 1.5 g IV every 8 hours, depending on severity 1
Oral Dosing (for step-down therapy or less severe infections)
When switching to oral therapy after clinical improvement:
- Ages 1-24 months: 125 mg twice daily 1
- Ages 2-12 years: 250 mg twice daily 1
- Adults: 250-500 mg twice daily (higher dose for more severe infections) 2
Duration of Therapy
- Standard duration is 4-7 days if adequate source control is achieved 3
- Consider extending to 7 days for immunocompromised or critically ill patients 3
Clinical Considerations
Antimicrobial Coverage
Cefuroxime provides good coverage against many pathogens involved in community-acquired intra-abdominal infections, including:
- Most Enterobacteriaceae (E. coli, Klebsiella)
- Streptococci
- Methicillin-sensitive Staphylococcus aureus 2
Important Limitations
- Limited anaerobic coverage - consider adding metronidazole for intra-abdominal infections 1
- Not effective against Pseudomonas, Enterococcus, and some ESBL-producing organisms 1
Alternative Regimens for Abdominal Infections
For more severe or healthcare-associated abdominal infections, consider:
- Piperacillin-tazobactam: 4.5 g IV every 6 hours (adults) 3
- Carbapenems: Ertapenem 1 g IV daily or meropenem/imipenem for more severe cases 3
- Ceftriaxone + metronidazole: For broader coverage when needed 3
Special Populations
Renal Impairment
Dosage adjustment is required for patients with renal impairment:
- For creatinine clearance <20 mL/min: Reduce frequency to every 12 hours
Obesity
Studies in morbidly obese patients undergoing abdominal surgery showed that cefuroxime does distribute into subcutaneous tissue, but standard doses may be insufficient for adequate coverage against Gram-negative organisms 4. Consider higher doses or alternative agents in morbidly obese patients.
Source Control
Remember that antimicrobial therapy is an adjunct to appropriate source control, which remains the cornerstone of treatment for intra-abdominal infections. Surgical drainage of abscesses or infected collections and removal of infected foreign bodies should be performed when indicated 1.
Monitoring
- Clinical response should be evident within 48-72 hours
- Consider changing therapy if no improvement after 72 hours
- Monitor for adverse effects, primarily gastrointestinal disturbances (diarrhea, nausea, vomiting) 2
Cefuroxime can be an effective component of treatment for mild to moderate community-acquired intra-abdominal infections when combined with appropriate source control and anaerobic coverage when needed.