What is the recommended dose of cefuroxime (Cefuroxime axetil) for adults?

Cefuroxime Dosing for Adults

Oral Cefuroxime Axetil

For most common infections in adults, cefuroxime axetil 250-500 mg twice daily is the standard dose, with 500 mg twice daily recommended for more severe infections like pneumonia. 1, 2

Standard Oral Dosing by Indication

• Mild to moderate infections (uncomplicated UTIs, skin/soft tissue infections): 250 mg twice daily 1, 2
• Severe infections (pneumonia, complicated infections): 500 mg twice daily 1, 2
• Early Lyme disease (erythema migrans): 500 mg twice daily for 14-21 days 3, 1
• Uncomplicated gonorrhea: Single 1 g dose 4
• Maximum daily dose: 4000 mg/day 1

Administration Considerations

• Take with food to increase absorption 1
• Treatment duration typically 5-10 days for most infections 4, 5
• Twice-daily dosing provides convenient administration compared to older cephalosporins 5

Intravenous/Intramuscular Cefuroxime

For severe infections requiring parenteral therapy, the standard adult dose is 750 mg to 1.5 grams every 8 hours. 2

IV/IM Dosing by Severity

• Uncomplicated infections (UTIs, skin infections, uncomplicated pneumonia): 750 mg every 8 hours 2
• Severe or complicated infections (bone/joint infections): 1.5 grams every 8 hours 2
• Life-threatening infections: 1.5 grams every 6 hours may be required 2
• Bacterial meningitis: Up to 3 grams every 8 hours (maximum dose) 2

Surgical Prophylaxis

• Cardiac surgery: 1.5 g IV plus 0.75 g in priming, with 0.75 g reinjection every 2 hours intraoperatively 3, 1
• General surgery: 1.5 g IV as single dose, with 750 mg reinjection if procedure exceeds 2 hours 6
• Cataract surgery: 1 mg intracameral injection (0.1 mL) at end of procedure 3, 1
• Uncomplicated gonococcal infection: 1.5 grams IM as single dose at 2 different sites with 1 gram oral probenecid 2

Renal Impairment Dosing

Dose reduction is mandatory when renal function is impaired. 2

• Creatinine clearance >20 mL/min: 750 mg to 1.5 grams every 8 hours 2
• Creatinine clearance 10-20 mL/min: 750 mg every 12 hours 2
• Creatinine clearance <10 mL/min: 750 mg every 24 hours 2
• Hemodialysis patients: Give additional dose at end of dialysis 2

Sequential IV-to-Oral Therapy

For community-acquired pneumonia, sequential therapy with IV cefuroxime (750 mg 2-3 times daily for 2-5 days) followed by oral cefuroxime axetil (500 mg twice daily for 3-8 days) is effective. 5

• This approach proved as effective as continuous IV therapy or other sequential regimens 5
• Allows earlier hospital discharge while maintaining clinical efficacy 5

Important Caveats

• Cefuroxime provides coverage against beta-lactamase-producing strains of common respiratory pathogens 6, 4
• Not effective against methicillin-resistant Staphylococcus aureus or Pseudomonas 4
• For penicillin/cephalosporin allergy, alternative agents (clindamycin plus gentamicin) must be used 6
• Continue therapy minimum 48-72 hours after patient becomes asymptomatic 2