What is the recommended dosage of cefuroxime (Cefuroxime) IV for pediatric patients?

Pediatric Cefuroxime IV Dosing Recommendations

The recommended intravenous (IV) dosage of cefuroxime for pediatric patients is 100-200 mg/kg/day divided every 6-8 hours, with a maximum dose of 1500 mg per dose. 1

Dosing Guidelines by Age and Indication

Neonates and Infants

• For neonates less than 7 days old: 30 mg/kg IV every 12 hours 1
• For neonates greater than 7 days old: 30 mg/kg IV every 8 hours 1
• For infants over 1 month: 100-150 mg/kg/day divided every 6-8 hours 1

Children

• For most pediatric infections: 100-150 mg/kg/day divided every 6-8 hours 1, 2
• For severe infections: 150-200 mg/kg/day divided every 6-8 hours 1, 2
• Maximum daily dose should not exceed 6000 mg per day (1500 mg per dose) 1

Indication-Specific Dosing

Respiratory Tract Infections

• For pneumonia and other respiratory infections: 100-150 mg/kg/day divided every 8 hours 1, 3
• Some studies have shown efficacy with 75 mg/kg/day divided every 8 hours for pneumonia 3

Soft Tissue Infections

• For soft tissue infections: 75-100 mg/kg/day divided every 8 hours 4
• For severe infections: increase to 150-200 mg/kg/day 1

Intra-abdominal Infections

• For complicated intra-abdominal infections: 150 mg/kg/day divided every 6-8 hours 1

Meningitis and Severe Infections

• For bacterial meningitis: 200-240 mg/kg/day divided every 6-8 hours is recommended (though third-generation cephalosporins are generally preferred) 1, 2

Administration Considerations

• For direct intermittent IV administration, slowly inject the solution over 3-5 minutes 2
• For intermittent IV infusion, cefuroxime can be administered through Y-type administration sets 2
• Duration of therapy should be based on clinical response, typically 5-10 days for most infections 2

Dosage Adjustments

• For patients with renal impairment, dosage adjustment is necessary 2:
  • Creatinine clearance >20 mL/min: standard dosing
  • Creatinine clearance 10-20 mL/min: 75% of standard dose every 12 hours
  • Creatinine clearance <10 mL/min: 50% of standard dose every 24 hours

Clinical Pearls and Caveats

• Cefuroxime has good activity against common pediatric pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and methicillin-sensitive Staphylococcus aureus 5, 3
• For suspected MRSA infections, additional coverage with vancomycin or clindamycin is recommended 1
• Therapeutic drug monitoring is not routinely required for cefuroxime 2
• For patients with beta-lactam allergies, alternative agents should be considered based on the severity of the allergy 1
• Studies have shown that cefuroxime achieves adequate concentrations in pleural fluid, making it suitable for respiratory infections 3

Oral Step-Down Therapy

• When switching to oral therapy, cefuroxime axetil can be used at a dose of 20-50 mg/kg/day divided every 12 hours (maximum 500 mg per dose) 1, 5
• Oral bioavailability is improved when administered with food 5

Remember that while these dosing recommendations are evidence-based, clinical judgment should be exercised based on the severity of infection, local antimicrobial resistance patterns, and patient-specific factors.