Cefuroxime Dosing for a 5-Year-Old Child with Acute Tonsillitis
For a 5-year-old child weighing 30kg with acute tonsillitis, the recommended dose of cefuroxime is 50-100 mg/kg/day divided every 6-8 hours, which translates to approximately 500-1000 mg per day divided into 2-3 doses. 1
Dosing Calculation and Administration
- The FDA-approved pediatric dosing for cefuroxime in children above 3 months of age is 50-100 mg/kg/day in equally divided doses every 6-8 hours 1
- For this 30kg child with tonsillitis (a respiratory tract infection), the appropriate dosing would be:
- Lower dose range: 50 mg/kg/day = 1,500 mg/day ÷ 3 doses = 500 mg every 8 hours
- Higher dose range: 100 mg/kg/day = 3,000 mg/day ÷ 3 doses = 1,000 mg every 8 hours
- For most infections susceptible to cefuroxime, including tonsillitis, the lower dose range (50 mg/kg/day) is typically sufficient 1
Treatment Duration
- For streptococcal tonsillopharyngitis, a 5-day course of cefuroxime axetil has been shown to be as effective as the standard 10-day course of penicillin V 2, 3
- A minimum of 5 days of treatment is recommended for tonsillitis caused by Group A beta-hemolytic streptococci 2
- Studies have demonstrated that cefuroxime achieves higher bacteriological cure rates compared to penicillin V in the treatment of streptococcal pharyngitis 4
Formulation Considerations
- Cefuroxime axetil (the oral form) is available as tablets containing 125,250, or 500 mg, and as an oral suspension for pediatric use 5
- For a 5-year-old child, the oral suspension formulation may be more appropriate for ease of administration 5
Clinical Efficacy
- Cefuroxime has demonstrated excellent activity against common respiratory pathogens including Streptococcus pyogenes, the most common bacterial cause of acute tonsillitis 5
- In comparative studies, cefuroxime has shown superior bacteriological eradication rates (90% vs 84%) compared to penicillin V in the treatment of tonsillopharyngitis 3
Important Considerations
- Gastrointestinal disturbances (diarrhea, nausea, vomiting) are the most common adverse effects of cefuroxime but are generally mild and transient 5
- Taking cefuroxime with food improves bioavailability; the maximum plasma concentration after 500 mg is approximately 7.9 mg/L when taken after a meal 5
- For children who cannot tolerate cefuroxime or have allergies to beta-lactam antibiotics, alternative agents should be considered 6