What is the recommended dosage of cefuroxime for treating bacterial infections?

Cefuroxime Dosage for Bacterial Infections

For most bacterial infections, cefuroxime should be dosed at 750 mg to 1.5 grams IV every 8 hours for adults, or 250-500 mg orally (as cefuroxime axetil) twice daily, with specific dosing determined by infection severity and site. 1, 2

Intravenous Cefuroxime Dosing (Adults)

Standard infections:

• Uncomplicated infections (UTI, skin/soft tissue, uncomplicated pneumonia): 750 mg IV every 8 hours 1
• Severe or complicated infections: 1.5 grams IV every 8 hours 1
• Bone and joint infections: 1.5 grams IV every 8 hours 1
• Life-threatening infections or less susceptible organisms: 1.5 grams IV every 6 hours 1
• Bacterial meningitis: Up to 3 grams IV every 8 hours (maximum dose) 1

Surgical prophylaxis:

• Clean-contaminated procedures: 1.5 grams IV 30-60 minutes before incision, then 750 mg IV/IM every 8 hours for prolonged procedures 1
• Open heart surgery: 1.5 grams IV at anesthesia induction, then every 12 hours for total of 6 grams 1

Renal impairment adjustments:

• CrCl >20 mL/min: 750 mg-1.5 grams every 8 hours 1
• CrCl 10-20 mL/min: 750 mg every 12 hours 1
• CrCl <10 mL/min: 750 mg every 24 hours (give additional dose after hemodialysis) 1

Oral Cefuroxime Axetil Dosing (Adults)

Respiratory tract infections:

• Mild-moderate infections (bronchitis, sinusitis, pharyngitis): 250 mg twice daily for 5-10 days 2, 3, 4
• Pneumonia or severe lower respiratory infections: 500 mg twice daily for 10 days 2, 3, 5
• Chronic rhinosinusitis: 500 mg twice daily for 14 days 6

Other infections:

• Uncomplicated UTI: 125 mg twice daily 3
• Skin and soft tissue infections: 250-500 mg twice daily 3
• Early Lyme disease (erythema migrans): 500 mg twice daily for 14-21 days 6, 2
• Animal bites: 500 mg twice daily 6

Important administration note: Cefuroxime axetil must be taken with food to optimize absorption (68% bioavailability when taken with meals) 2, 3

Pediatric Dosing

Intravenous (children >3 months):

• Standard infections: 50-100 mg/kg/day divided every 6-8 hours 1
• Severe infections: 100 mg/kg/day (not exceeding maximum adult dose) 1
• Bone and joint infections: 150 mg/kg/day divided every 8 hours (not exceeding maximum adult dose) 1

Oral cefuroxime axetil:

• Standard dosing: 20-50 mg/kg/day divided into two doses (every 12 hours) 2
• Maximum per dose: 500 mg 2
• Severe infections: Use higher end of range (50 mg/kg/day) 2

Duration of Therapy

Typical treatment courses:

• Most infections: 5-10 days 1, 4
• Continue for minimum 48-72 hours after patient becomes asymptomatic or bacterial eradication documented 1
• Streptococcus pyogenes infections: Minimum 10 days to prevent rheumatic fever/glomerulonephritis 1
• Chronic UTI: May require several months of monitoring after completion 1

Clinical Context and Comparative Efficacy

Evidence from rhinosinusitis trials shows important limitations: While cefuroxime 500 mg twice daily for 14 days achieved similar overall cure rates to amoxicillin-clavulanate, it demonstrated significantly slower symptom improvement at days 3-5 (56% vs 81%, p=0.0137), higher rates of persistent purulent discharge (12% vs 3%, p=0.036), and significantly higher clinical relapse rates at weeks 2-4 (7-8% vs 0%, p<0.05) 6. This suggests amoxicillin-clavulanate may be preferable for rhinosinusitis despite equivalent final outcomes.

For respiratory infections, cefuroxime axetil 250-500 mg twice daily demonstrated equivalent efficacy to fluoroquinolones, macrolides, and other cephalosporins in multiple trials, with clinical cure rates of 88-91% 4, 7. The drug is particularly valuable for its activity against beta-lactamase-producing H. influenzae and M. catarrhalis 3, 4.

Sequential IV-to-oral therapy (IV cefuroxime 750 mg 2-3 times daily for 2-5 days, followed by oral 500 mg twice daily for 3-8 days) proved effective for community-acquired pneumonia with similar outcomes to continuous IV therapy 4.

Safety Profile

Adverse events are generally mild and transient, primarily gastrointestinal (diarrhea, nausea, vomiting) 3, 4. Cefuroxime axetil causes significantly less diarrhea than cefixime (5% vs 15%, p=0.001) 7. Rash occurs in <1% of patients, and the drug can be used in penicillin-allergic patients with appropriate monitoring 8. No nephrotoxicity was observed even with concurrent furosemide use 8.