Cefuroxime Dosage and Treatment Plan for Bacterial Infections
Cefuroxime is an effective second-generation cephalosporin antibiotic with specific dosing regimens based on infection type, patient age, and administration route (oral vs. parenteral). The medication is available in two main forms: cefuroxime axetil (oral) and cefuroxime sodium (injectable).
Dosage for Adults
Oral Administration (Cefuroxime Axetil)
- Standard adult dosage: 250-500 mg twice daily 1
- Duration: 5-10 days for most infections 2
- Specific conditions:
Parenteral Administration (Cefuroxime Sodium)
- Standard adult dosage: 750 mg to 1.5 grams every 8 hours 3
- Duration: Usually 5-10 days 3
- Specific conditions:
- Uncomplicated infections: 750 mg every 8 hours 3
- Severe/complicated infections: 1.5 grams every 8 hours 3
- Bone/joint infections: 1.5 grams every 8 hours 3
- Life-threatening infections: 1.5 grams every 6 hours 3
- Bacterial meningitis: Up to 3 grams every 8 hours 3
- Surgical prophylaxis: 1.5 grams IV just before surgery 3
Dosage for Children
Oral Administration
- For respiratory infections: Appropriate dosing based on weight and severity 4
Parenteral Administration
- Children above 3 months: 50-100 mg/kg/day in divided doses every 6-8 hours 3
- Severe infections: 100 mg/kg/day (not exceeding maximum adult dose) 3
- Bone/joint infections: 150 mg/kg/day in divided doses every 8 hours 3
- Bacterial meningitis: 200-240 mg/kg/day IV in divided doses every 6-8 hours 3
Dosage Adjustment for Renal Impairment
- Creatinine clearance >20 mL/min: Standard dose every 8 hours
- Creatinine clearance 10-20 mL/min: 750 mg every 12 hours
- Creatinine clearance <10 mL/min: 750 mg every 24 hours 3
- Hemodialysis patients should receive an additional dose after dialysis 3
Specific Clinical Applications
Respiratory Tract Infections
- For acute bronchiolitis with high fever (>38.5°C) persisting for more than 3 days: cefuroxime axetil is recommended 4
- For 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) 2
Urinary Tract Infections
- Single daily dose of 250 mg cefuroxime axetil for 10 days has shown 93% clearance of original infecting organisms 5
Animal Bites
- Cefuroxime 500 mg twice daily orally or 1 g every 12 hours IV shows good activity against Pasteurella multocida but misses anaerobes 4
Administration Considerations
- Oral cefuroxime axetil should be taken with food to enhance absorption 1
- For parenteral administration, continue for at least 48-72 hours after the patient becomes asymptomatic 3
- For Streptococcus pyogenes infections, a minimum of 10 days treatment is recommended to prevent rheumatic fever or glomerulonephritis 3
Potential Adverse Effects
- Most common: Gastrointestinal disturbances including diarrhea, nausea, and vomiting 1
- These are generally mild to moderate in intensity and reversible upon discontinuation 2
Clinical Pearls
- Cefuroxime has enhanced beta-lactamase stability compared to first-generation cephalosporins 6
- It is effective against many beta-lactamase-producing respiratory pathogens 2
- Sequential IV-to-oral therapy can reduce hospitalization time while maintaining efficacy 2
- Avoid using cefuroxime for MRSA infections as it lacks activity against methicillin-resistant strains 1
When selecting an antibiotic treatment regimen, consider local resistance patterns, patient factors, and infection severity to optimize outcomes in terms of morbidity, mortality, and quality of life.