Cefuroxime Dosing for Otitis Media
For acute otitis media, cefuroxime axetil is dosed at 30 mg/kg/day divided into two doses (maximum 1000 mg/day), typically given for 5-10 days, though it is not a first-line agent and should be reserved for penicillin-allergic patients or treatment failures. 1
First-Line Treatment Considerations
Cefuroxime axetil is not the preferred initial antibiotic for acute otitis media. High-dose amoxicillin (80-90 mg/kg/day) remains the first-line treatment due to superior efficacy, safety profile, cost-effectiveness, and narrow spectrum. 1, 2
When to Use Cefuroxime Axetil
Cefuroxime axetil is appropriate in specific clinical scenarios:
- Penicillin allergy (non-Type I hypersensitivity): Cefuroxime axetil 30 mg/kg/day in 2 divided doses is an acceptable alternative 1
- Treatment failure after 48-72 hours of initial amoxicillin therapy 1
- Recent antibiotic exposure (within 4-6 weeks) when amoxicillin-clavulanate is preferred but cannot be used 1
Specific Dosing Regimen
Pediatric Dosing
- Standard dose: 30 mg/kg/day divided into 2 doses (15 mg/kg twice daily) 3, 4
- Maximum daily dose: 1000 mg/day 1
- Duration: 5-10 days, with studies showing 5-day courses can be effective 3, 1
Adult Dosing
- Standard dose: 500 mg twice daily 1
- Duration: 7-10 days, though 5-day courses have demonstrated efficacy 1
Clinical Efficacy Evidence
Cefuroxime axetil demonstrates comparable clinical cure rates to amoxicillin-clavulanate (86-88% vs 88-89%) in acute otitis media 3. However, critical limitations exist:
- Reduced efficacy against intermediately penicillin-resistant Streptococcus pneumoniae: Bacteriologic failure occurs in 21% of cases with MIC 0.125-0.25 mcg/mL and 64% with MIC 0.38-1.0 mcg/mL 5
- Better gastrointestinal tolerability: Significantly fewer drug-related adverse events (16%) compared to amoxicillin-clavulanate (37%), particularly diarrhea 4
Important Clinical Caveats
Reassessment is mandatory at 48-72 hours if symptoms fail to improve. 1, 2 At this point, consider:
- Switching to high-dose amoxicillin-clavulanate (90 mg/kg/day of amoxicillin component with 6.4 mg/kg/day clavulanate) 1, 2
- Parenteral ceftriaxone (50 mg/kg/day for 3 days) for treatment failures 1
Avoid cefuroxime axetil in:
- Patients who received antibiotics in the previous 30 days (use amoxicillin-clavulanate instead) 1, 2
- Concurrent purulent conjunctivitis (otitis-conjunctivitis syndrome requires amoxicillin-clavulanate) 1, 2
- Areas with high prevalence of intermediately penicillin-resistant pneumococci 5