What is the recommended intravenous (IV) dosage of cefuroxime for pediatric patients?

Cefuroxime IV Dosage for Pediatric Patients

For pediatric patients above 3 months of age, administer cefuroxime IV at 50-100 mg/kg/day divided into equally divided doses every 6-8 hours for most infections, with higher dosing of 100 mg/kg/day (not exceeding maximum adult dosage) reserved for more severe or serious infections. 1

Standard Dosing by Infection Severity

Mild to Moderate Infections

• 50-100 mg/kg/day IV divided into equally divided doses every 6-8 hours 1
• This dosing range has demonstrated efficacy in clinical trials for pneumonia, with mean serum concentrations of 29.1 mcg/mL achieved 30 minutes after a 25 mg/kg IV dose 2
• Studies using 75 mg/kg/day divided every 8 hours showed 100% clinical efficacy in pediatric pneumonia and soft-tissue infections 2, 3

Severe or Serious Infections

• 100 mg/kg/day IV (not to exceed maximum adult dosage) in equally divided doses every 6-8 hours 1
• For bone and joint infections specifically: 150 mg/kg/day IV (not to exceed maximum adult dosage) in equally divided doses every 8 hours 1

Bacterial Meningitis

• 200-240 mg/kg/day IV in divided doses every 6-8 hours 1
• This higher dosing achieves adequate CSF penetration, with documented spinal fluid levels of 9.0 mcg/mL at 30 minutes and 3.8 mcg/mL at 2 hours after a 52.2 mg/kg dose 4

Dosing Adjustments for Renal Insufficiency

• In pediatric patients with renal insufficiency, modify the frequency of dosing consistent with adult recommendations 1
• For creatinine clearance 10-20 mL/min: reduce to every 12 hours 1
• For creatinine clearance <10 mL/min: reduce to every 24 hours 1

Administration Guidelines

IV Preparation and Administration

• Constitute each 750-mg vial with 8.3 mL Sterile Water for Injection (concentration: 90 mg/mL) 1
• Constitute each 1.5-gram vial with 16 mL Sterile Water for Injection (concentration: 90 mg/mL) 1
• Direct IV injection: slowly inject over 3-5 minutes 1
• Intermittent IV infusion: administer through Y-type set, temporarily discontinuing other solutions at the same site 1

Duration of Therapy

• Continue for minimum 48-72 hours after patient becomes asymptomatic or bacterial eradication is documented 1
• Minimum 10 days recommended for Streptococcus pyogenes infections to prevent rheumatic fever or glomerulonephritis 1
• Oral antibiotics may be administered following completion of parenteral therapy when appropriate 1, 2

Clinical Efficacy Data

• Clinical cure/improvement rates of 100% demonstrated in pediatric skin and soft-tissue infections 5
• Bacteriologic eradication achieved in 93.2-100% of cases 5
• Effective against Haemophilus influenzae (including beta-lactamase-positive strains), Streptococcus pneumoniae, and Staphylococcus aureus 2, 3

Important Caveats

• Do not confuse with oral cefuroxime axetil dosing (20-50 mg/kg/day), which is significantly lower than IV dosing (50-200 mg/kg/day) 6
• All infants <6 months with serious infections should be hospitalized regardless of antibiotic choice 6
• Eosinophilia may occur in approximately 10% of patients but is generally benign 2
• Transient granulocytopenia (<1,500/mm³) has been reported but causality unclear 3