What is the typical dosage and duration of cefuroxime (Cefuroxime) for treating bacterial infections?

Cefuroxime Dosage and Duration for Bacterial Infections

For most bacterial infections, cefuroxime is dosed at 250-500 mg orally twice daily for 5-10 days, with the specific dose and duration determined by infection severity and site. 1

Standard Oral Dosing (Cefuroxime Axetil)

Respiratory Tract Infections

• Upper respiratory infections (otitis media, sinusitis, pharyngitis, tonsillitis): 250 mg twice daily for 5-10 days 2, 3
• Lower respiratory infections (acute/chronic bronchitis): 250 mg twice daily for 10 days 2, 4
• Community-acquired pneumonia or severe lower respiratory infections: 500 mg twice daily for 5-10 days 2, 3

Urinary Tract Infections

• Simple uncomplicated UTI: 125 mg twice daily for 7-10 days 2
• Alternative single daily dosing: 250 mg once daily at bedtime for 10 days (86% cure rate including reinfections) 5
• Complicated UTI or pyelonephritis: 250 mg twice daily 2

Other Infections

• Skin and soft tissue infections: 250-500 mg twice daily 2
• Uncomplicated gonorrhea: 1000 mg as a single oral dose 2

Parenteral Dosing (Cefuroxime Sodium)

Adult Dosing

• Uncomplicated infections (UTI, skin/soft tissue, uncomplicated pneumonia): 750 mg IV/IM every 8 hours for 5-10 days 1
• Severe or complicated infections (bone/joint): 1.5 grams IV/IM every 8 hours 1
• Life-threatening infections: 1.5 grams every 6 hours may be required 1
• Bacterial meningitis: Up to 3 grams every 8 hours (maximum dose) 1
• Uncomplicated gonorrhea: 1.5 grams IM as single dose at 2 different sites with 1 gram oral probenecid 1

Pediatric Dosing (>3 months)

• Most infections: 50-100 mg/kg/day IV divided every 6-8 hours 1
• Severe infections: 100 mg/kg/day (not exceeding maximum adult dose) 1
• Bone and joint infections: 150 mg/kg/day divided every 8 hours (not exceeding maximum adult dose) 1

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 highly effective and comparable to other regimens. 3 This approach allows earlier hospital discharge while maintaining therapeutic efficacy.

Renal Dose Adjustments

Dose reduction is mandatory in renal impairment: 1

• CrCl >20 mL/min: 750 mg-1.5 grams every 8 hours (standard dosing)
• CrCl 10-20 mL/min: 750 mg every 12 hours
• CrCl <10 mL/min: 750 mg every 24 hours
• Hemodialysis patients: Give additional dose after dialysis 1

Duration Considerations

Chronic Rhinosinusitis Context

• Standard duration: 14 days for chronic rhinosinusitis (500 mg twice daily) 6
• Important caveat: Cefuroxime showed significantly higher clinical relapse rates (8% vs 0%) compared to amoxicillin-clavulanate at 2-4 weeks follow-up in chronic rhinosinusitis, with slower symptom improvement at days 3-5 6
• Persistent purulent discharge was significantly more common with cefuroxime (12% vs 3%) 6

Minimum Treatment Duration

Continue therapy for minimum 48-72 hours after patient becomes asymptomatic or bacterial eradication is documented. 1 For Streptococcus pyogenes infections, a minimum 10-day course is required to prevent rheumatic fever or glomerulonephritis. 1

Clinical Pearls and Pitfalls

Absorption Considerations

• Food enhances absorption: Cefuroxime axetil should be taken with food to optimize bioavailability (68% absolute bioavailability with meals) 2
• Peak concentrations: Achieved 2-3 hours post-dose (4.6 mg/L for 250 mg; 7.9 mg/L for 500 mg) 2

Comparative Efficacy

• Shorter courses (5 days) are as effective as 10-day courses for appropriate indications 3
• Twice-daily dosing produces fewer gastrointestinal adverse events (particularly diarrhea: 5% vs 15%) compared to once-daily third-generation cephalosporins like cefixime 4

Resistance Considerations

• Beta-lactamase stability: Cefuroxime's methoxyimino side chain provides enhanced stability against beta-lactamases, making it effective against certain cephalothin-, cefamandole-, and gentamicin-resistant bacteria 7
• Appropriate empirical choice for community-acquired infections involving beta-lactamase-producing respiratory pathogens 3

Common Adverse Effects

• Gastrointestinal disturbances (diarrhea, nausea, vomiting) are most common but generally mild and transient 2
• Candida vaginitis occurred in 8% of women treated for UTI 5
• Overall adverse event rate: 23% in UTI studies, with most events being mild to moderate 5