Cefuroxime Axetil Dosage and Treatment Duration for Bacterial Infections
The recommended dosage of cefuroxime axetil for most bacterial infections in adults is 250-500 mg twice daily for 7-14 days, with the specific dose and duration depending on the type and severity of infection. 1, 2
Adult Dosing Recommendations
Respiratory Tract Infections
- Acute sinusitis: 250-500 mg twice daily for 10-14 days 2
- Some studies show effectiveness with shorter 5-day courses 3
- Acute bronchitis: 250 mg twice daily for 10 days 4
- Pneumonia: 500 mg twice daily for 10-14 days 1, 5
- Chronic rhinosinusitis: 500 mg twice daily for 14 days 2
Skin and Soft Tissue Infections
- Uncomplicated infections: 250 mg twice daily for 10 days 6
- Animal/human bites: 500 mg twice daily (duration based on clinical response) 2
Other Infections
- Urinary tract infections: 125-250 mg twice daily for 7-10 days 6, 5
- Lyme disease (early stage): 500 mg twice daily for 14-21 days 2
- Uncomplicated gonorrhea: Single 1g dose (not commonly used as first-line) 6
Pediatric Dosing
- Children >3 months: 10-15 mg/kg twice daily (not to exceed adult dose) 2
- Acute sinusitis in children:
- 30 mg/kg/day in 2 divided doses (maximum 500 mg per dose) 2
- Maximum daily dose: Not to exceed adult dosing recommendations 1
Important Clinical Considerations
Factors Affecting Dosage Selection
- Infection severity: Higher doses (500 mg twice daily) for more severe infections 5
- Pathogen susceptibility: Effective against many respiratory pathogens including H. influenzae, S. pneumoniae, and M. catarrhalis 6
- Renal function: Dosage adjustment required for creatinine clearance <20 mL/min 1
Administration Guidelines
- Take with food to enhance absorption and bioavailability (68% bioavailability) 6
- Complete the full prescribed course even if symptoms improve before completion 7
Monitoring and Follow-up
- Expect significant clinical improvement within 72 hours of treatment initiation 7
- If no improvement after 72 hours, reevaluation and possible change in therapy is warranted 7
Adverse Effects
- Most common: Gastrointestinal disturbances (11-17% of patients) 6, 8
- Better GI tolerability compared to amoxicillin/clavulanate (17% vs 29% adverse events) 8
- Diarrhea is the most common side effect but occurs less frequently than with other antibiotics 2, 8
Treatment Alternatives
When cefuroxime axetil is not appropriate (e.g., allergy, treatment failure):
- First-line alternatives: Amoxicillin-clavulanate 2
- For penicillin-allergic patients: Respiratory fluoroquinolones (levofloxacin, moxifloxacin) or macrolides (clarithromycin) 2
Common Pitfalls to Avoid
- Inadequate duration: Stopping treatment prematurely can lead to treatment failure and bacterial resistance 7
- Inappropriate use for viral infections: Cefuroxime is ineffective against viral pathogens
- Failure to adjust for renal impairment: Dose reduction needed for patients with renal dysfunction 1
- Not taking with food: Administration without food significantly reduces bioavailability 6
- Missing the need for treatment escalation: Failure to recognize when a switch to broader-spectrum antibiotics is needed 7
Cefuroxime axetil remains an effective option for many common bacterial infections with a favorable safety profile and convenient twice-daily dosing schedule 5.