What is the recommended dose of cefuroxime (Cefuroxime) for treating urinary tract infections (UTIs)?

Cefuroxime Dosing for Urinary Tract Infections

For uncomplicated UTIs, cefuroxime axetil 250 mg orally twice daily for 7-10 days is the recommended dose, while complicated UTIs require 500 mg orally twice daily for 10-14 days. 1, 2

Uncomplicated UTI Dosing

• Cefuroxime axetil 250 mg orally twice daily has been shown effective for uncomplicated lower urinary tract infections in multiple clinical trials, with cure rates of 86-97% 3, 4
• Treatment duration should be 7-10 days for uncomplicated cystitis 5, 3
• Some studies demonstrate that 125 mg twice daily may be sufficient for simple uncomplicated UTIs, though 250 mg is more commonly recommended 5
• The twice-daily dosing regimen is preferred over once-daily dosing due to better gastrointestinal tolerance 6

Complicated UTI and Pyelonephritis Dosing

• Cefuroxime 500 mg orally twice daily for 10-14 days is recommended for complicated UTIs (those with structural abnormalities, immunosuppression, pregnancy, diabetes, or in male patients) 1
• For outpatient pyelonephritis, the same dose of 500 mg twice daily for 10-14 days is appropriate 1
• The higher dose is necessary because complicated infections involve more resistant organisms and are more difficult to eradicate 1

Parenteral Dosing (When Oral Route Not Feasible)

• For uncomplicated UTIs requiring IV therapy, cefuroxime 750 mg IV every 8 hours is recommended 2
• For severe or complicated infections, increase to 1.5 grams IV every 8 hours 2
• Treatment duration is typically 5-10 days, with continuation for 48-72 hours after symptom resolution 2

Renal Dose Adjustments

• Creatinine clearance >20 mL/min: Standard dosing (750 mg - 1.5 grams every 8 hours for IV; no adjustment specified for oral) 2
• Creatinine clearance 10-20 mL/min: 750 mg every 12 hours 2
• Creatinine clearance <10 mL/min: 750 mg every 24 hours, with additional dose after hemodialysis 2

Critical Clinical Considerations

• Obtain urine culture before initiating therapy for complicated UTIs and pyelonephritis to guide targeted therapy, as local resistance patterns vary 1
• β-lactams like cefuroxime generally have inferior efficacy compared to fluoroquinolones for UTIs, but are necessary when fluoroquinolone resistance is present 1
• Consider initial IV ceftriaxone before transitioning to oral cefuroxime for complicated UTIs if fluoroquinolone resistance is a concern 1
• E. coli accounts for 61-85% of UTI pathogens in clinical trials, and cefuroxime demonstrates excellent activity against this organism 3, 7

Common Pitfalls and Adverse Effects

• Gastrointestinal adverse effects (particularly diarrhea) occur in 4-23% of patients, with higher rates when taken without food 5, 3, 4
• Candida vaginitis developed in 8% of women in one trial, representing the most common non-GI adverse effect 4
• Superinfections can occur, most commonly with Pseudomonas aeruginosa or Candida 3
• Reinfections and relapses emphasize the importance of post-treatment urine cultures for follow-up 7

Monitoring and Follow-up

• If symptoms persist after 72 hours of treatment, reevaluate diagnosis and consider imaging to rule out complications 1
• For complicated UTIs or pyelonephritis, obtain follow-up urine culture after completion of therapy to ensure resolution 1
• Post-treatment cultures are particularly important given the 11-14% reinfection rate observed in clinical trials 4, 7