Ceftin (Cefuroxime) Dosing for UTI
For uncomplicated urinary tract infections, cefuroxime axetil (Ceftin) should be dosed at 250 mg orally twice daily for 7-10 days. 1, 2
Dosing by UTI Type
Uncomplicated Cystitis (Lower UTI)
- Standard dose: 250 mg orally twice daily for 7-10 days 2, 3, 4
- Alternative: 125 mg twice daily has shown effectiveness in some uncomplicated cases 2
- Clinical studies demonstrate 86-97% cure rates with this regimen 3, 4
Uncomplicated Pyelonephritis (Upper UTI)
- Oral cephalosporins are NOT first-line agents for pyelonephritis due to lower efficacy compared to fluoroquinolones 5
- If oral cephalosporins like cefuroxime are used, an initial IV dose of a long-acting parenteral agent (e.g., ceftriaxone 1g) should be administered first 5
- Duration: 10-14 days when using oral beta-lactams 5
Complicated UTI
- Parenteral cefuroxime: 750 mg IV every 8 hours for uncomplicated UTI 1
- Severe/complicated infections: 1.5 grams IV every 8 hours 1
- Oral formulations are generally inadequate for complicated UTI without initial parenteral therapy 5
Important Clinical Considerations
When Cefuroxime is Appropriate
- Beta-lactamase producing organisms (E. coli, Klebsiella) where cefuroxime maintains activity 3, 4
- Patients with fluoroquinolone allergy or contraindication requiring an alternative agent 5
- Uncomplicated lower UTI where local resistance patterns support use 5
Critical Limitations
- Oral beta-lactams are less effective than fluoroquinolones or trimethoprim-sulfamethoxazole for pyelonephritis 5
- Should not be used as monotherapy for pyelonephritis without initial parenteral long-acting agent 5
- Local susceptibility patterns must guide selection - E. coli resistance varies geographically 5
Dosing Frequency Evidence
- Twice-daily dosing (250 mg BID) is as effective as more frequent dosing for uncomplicated UTI 3, 6
- Single daily dosing (250 mg once daily at night) showed 86% cure rate but is not standard practice 3
- Twice-daily dosing improves adherence compared to four-times-daily regimens 6
Renal Impairment Adjustments
- CrCl >20 mL/min: Standard dosing (750 mg-1.5g IV every 8 hours) 1
- CrCl 10-20 mL/min: 750 mg IV every 12 hours 1
- CrCl <10 mL/min: 750 mg IV every 24 hours; additional dose after hemodialysis 1
Common Pitfalls
- Do not use for febrile UTI/pyelonephritis without initial IV therapy - this is a critical error that reduces efficacy 5
- Avoid empiric use without considering local E. coli resistance patterns 5
- Gastrointestinal adverse effects (diarrhea 4-5%, candida vaginitis 8%) are common; twice-daily dosing may reduce GI effects compared to once-daily 2, 3, 4
- Do not use doses below 250 mg BID for active infection 1