What is the recommended dosage and treatment regimen for Cefuroxime (Cefuroxime) for bacterial infections?

Cefuroxime Dosing for Bacterial Infections

For most bacterial infections, cefuroxime axetil should be dosed at 250-500 mg orally twice daily for 5-10 days, with 500 mg twice daily reserved for more severe infections like pneumonia, while parenteral cefuroxime is dosed at 750 mg to 1.5 grams IV/IM every 8 hours depending on infection severity. 1

Oral Cefuroxime Axetil Dosing

Adults

• Standard infections (UTI, skin/soft tissue, uncomplicated pneumonia): 250 mg twice daily for 5-10 days 1, 2
• Severe lower respiratory tract infections or suspected pneumonia: 500 mg twice daily 3, 1, 2
• Acute bacterial rhinosinusitis: 500 mg twice daily for 14 days, though this is a second-line option with slower symptom improvement compared to amoxicillin-clavulanate 3, 4
• Early Lyme disease (erythema migrans): 500 mg twice daily for 14-21 days 4
• Uncomplicated gonorrhea: 1 gram as a single oral dose 2
• Maximum daily dose: 4000 mg/day 4

Critical administration point: Cefuroxime axetil must be taken with food to optimize absorption 4. Taking it at night with a milk drink has been shown effective for urinary tract infections 5.

Pediatric Patients

• Standard dosing: 20-50 mg/kg/day divided into two doses (every 12 hours) 4
• Age-specific dosing for respiratory infections:
  • 1-24 months: 125 mg twice daily 4
  • 2-12 years: 250 mg twice daily 4
• Severe infections: Use the higher end of the dosing range (50 mg/kg/day) 4
• Maximum single dose: 500 mg 4

For children with acute bacterial rhinosinusitis who have not received recent antibiotics, cefuroxime axetil is recommended as initial therapy alongside other options like high-dose amoxicillin-clavulanate 3.

Parenteral Cefuroxime Dosing

Adults

• Uncomplicated infections (UTI, skin/soft tissue, uncomplicated pneumonia): 750 mg IV/IM every 8 hours 1
• Severe or complicated infections (bone/joint infections): 1.5 grams IV/IM every 8 hours 1
• Life-threatening infections or less susceptible organisms: 1.5 grams every 6 hours 1
• Bacterial meningitis: Up to 3 grams every 8 hours (maximum dose) 1
• Uncomplicated gonococcal infection: 1.5 grams IM as a single dose at two different sites with 1 gram oral probenecid 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

Pediatric Patients (>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

Renal Dose Adjustments

Dose reduction is mandatory in renal impairment 1:

• CrCl >20 mL/min: 750 mg to 1.5 grams every 8 hours (standard dosing) 1
• CrCl 10-20 mL/min: 750 mg every 12 hours 1
• CrCl <10 mL/min: 750 mg every 24 hours 1
• Hemodialysis: Give additional dose after dialysis 1

Sequential IV-to-Oral Therapy

For community-acquired pneumonia, sequential therapy is effective: start with IV cefuroxime 750 mg 2-3 times daily for 2-5 days, then switch to oral cefuroxime axetil 500 mg twice daily for 3-8 days 6. This approach provides similar efficacy to other sequential regimens and allows earlier hospital discharge 6.

Treatment Duration

• Most infections: 5-10 days minimum after symptom resolution or bacterial eradication 1, 2
• Streptococcus pyogenes infections: Minimum 10 days to prevent rheumatic fever or glomerulonephritis 1
• Chronic urinary tract infections: May require several weeks with frequent monitoring 1
• Lyme disease: Full 14-21 days required for β-lactams due to shorter half-life 4

Clinical Efficacy Context

Cefuroxime demonstrates 85-87% calculated clinical efficacy for acute bacterial rhinosinusitis in adults with mild disease and no recent antibiotic use 3. However, it shows significantly slower symptom improvement at days 3-5 and higher clinical relapse rates (8% vs 0%) compared to amoxicillin-clavulanate 3. For pneumococcal pneumonia with penicillin MIC <2, cefuroxime 1.5 grams IV every 8 hours is an acceptable alternative to penicillin-based regimens 3.

Adverse Effects

Cefuroxime is generally well tolerated with mild, transient adverse effects 2, 6. The most common are gastrointestinal disturbances (diarrhea, nausea, vomiting), with cefuroxime axetil causing significantly less diarrhea (5%) compared to cefixime (15%) 7. In urinary tract infection studies, 23% experienced adverse events, most commonly candida vaginitis (8%) and diarrhea (4%) 5.

Key Clinical Pitfalls

• Do not use cefuroxime as first-line for acute bacterial rhinosinusitis when amoxicillin-clavulanate is available, as it demonstrates inferior early symptom control and higher relapse rates 3, 4
• Always administer oral formulation with food to ensure adequate absorption 4
• Adjust doses in renal impairment to prevent accumulation 1
• Consider switch therapy after 72 hours if no improvement in rhinosinusitis, moving to respiratory fluoroquinolones or high-dose amoxicillin-clavulanate 3