Dosing of Oral Cefuroxime (Ceftin) in ESRD Patients
For patients with end-stage renal disease (ESRD), oral cefuroxime (Ceftin) should be dosed at 250 mg every 24 hours, or if on hemodialysis, 250 mg every 24 hours with an additional dose after dialysis. 1, 2
Pharmacokinetics in Renal Impairment
- Cefuroxime is primarily cleared by the kidneys, with elimination half-life increasing from approximately 1.4 hours in normal renal function to 16.8 hours in patients with creatinine clearance <10 mL/min 2
- The drug's elimination rate constant (kel) correlates significantly with creatinine clearance, allowing for predictable dosing adjustments 2
- In patients on hemodialysis, cefuroxime is dialyzable, necessitating a supplemental dose after dialysis sessions 1, 3
Dosing Recommendations Based on Renal Function
For oral cefuroxime (Ceftin):
- Creatinine clearance >30 mL/min: Standard dosing (typically 250-500 mg twice daily) 1, 2
- Creatinine clearance 10-29 mL/min: 250 mg every 24 hours 2
- Creatinine clearance <10 mL/min (ESRD): 250 mg every 24 hours 2
- Patients on hemodialysis: 250 mg every 24 hours with an additional dose after dialysis 1, 3
Important considerations:
- The FDA label for parenteral cefuroxime specifically states that patients on hemodialysis should receive a further dose at the end of dialysis 1
- This principle applies to oral formulations as well, as the active drug (cefuroxime) is the same and undergoes similar clearance during dialysis 3
Clinical Application
- When prescribing oral cefuroxime for ESRD patients, it's essential to consider both the reduced renal clearance and the effect of dialysis on drug removal 1, 2
- Monitoring for drug accumulation is important, particularly when treating infections in ESRD patients, as excessive accumulation may lead to toxicity 4
- For patients on peritoneal dialysis, limited data exists, but similar dosing as for patients with creatinine clearance <10 mL/min is generally recommended 5
Common Pitfalls to Avoid
- Failing to adjust the dose in ESRD can lead to drug accumulation and potential toxicity 4
- Not providing a supplemental dose after hemodialysis may result in subtherapeutic levels 1, 3
- Using standard twice-daily dosing in ESRD patients can lead to excessive drug exposure 2
- Remember that oral cefuroxime axetil is a prodrug that is converted to the active cefuroxime after absorption, so the same renal adjustment principles apply as with the intravenous formulation 6, 2
By following these evidence-based dosing recommendations, clinicians can optimize the efficacy of oral cefuroxime while minimizing the risk of adverse effects in patients with ESRD.