Cefuroxime Axetil Oral Dosage
For adults, cefuroxime axetil is dosed at 250-500 mg twice daily depending on infection severity, while children receive 20-50 mg/kg/day divided into two doses (maximum 500 mg per dose). 1
Adult Dosing
- Standard infections: 250 mg twice daily for uncomplicated urinary tract infections, skin infections, and mild respiratory infections 1, 2
- Severe infections/pneumonia: 500 mg twice daily 1, 2, 3
- Maximum daily dose: 4000 mg/day 1
- Early Lyme disease: 500 mg twice daily for 14-21 days 4, 1
- Uncomplicated gonorrhea: Single 1-gram dose 2
Pediatric Dosing (Children >3 months)
- Standard dosing: 20-50 mg/kg/day divided into two doses (every 12 hours) 1
- Maximum per dose: 500 mg 1
- Severe infections: Use the higher end of the dosing range (50 mg/kg/day) 1
Age-Based Pediatric Dosing for Common Infections
- 1-24 months: 125 mg twice daily 4
- 2-12 years: 250 mg twice daily 4
- Children ≥8 years with Lyme disease: 30 mg/kg/day in 2 divided doses for 14 days (alternative to doxycycline) 5
Treatment Duration
- Most infections: 5-10 days 2, 6
- Lyme disease: 14-21 days (full 14 days required for β-lactams due to shorter half-life) 4, 5
- Pneumonia: 10 days 2, 3
- Acute bronchitis: 10 days 7
Critical Administration Considerations
Cefuroxime axetil must be taken with food to increase absorption 1. The absolute bioavailability is 68% when taken after a meal 2.
Common Pitfalls to Avoid
- Do not use for Lyme disease in children <8 years as first-line: Amoxicillin is preferred (50 mg/kg/day in 3 divided doses) 5
- Avoid underdosing severe infections: Use 500 mg twice daily in adults for pneumonia, not 250 mg 1, 3
- Do not use first-generation cephalosporins (like cephalexin) for Lyme disease: They are ineffective against Borrelia burgdorferi 5
- Ensure adequate treatment duration: β-lactams require full 14-day courses for Lyme disease, unlike doxycycline which can be given for 10 days 5
Renal Dosing Adjustments
While the FDA label provides detailed IV dosing adjustments for renal impairment 8, oral cefuroxime axetil dosing in renal failure should be reduced proportionally, though specific oral guidelines are not provided in the available evidence.
Comparative Efficacy
Cefuroxime axetil demonstrates equivalent efficacy to other agents for respiratory infections, though it shows significantly slower symptom improvement and higher clinical relapse rates compared to amoxicillin-clavulanate for chronic rhinosinusitis 1. For acute bronchitis, cefuroxime axetil produces fewer gastrointestinal adverse events, particularly diarrhea, compared to cefixime (5% vs 15%, p=0.001) 7.