Cefuroxime Dosing for UTI in Hemodialysis Patients
For patients on hemodialysis with a urinary tract infection, administer cefuroxime 750 mg every 24 hours, with an additional 750 mg dose given at the end of each dialysis session. 1
Dosing Rationale
The FDA-approved dosing for cefuroxime in patients with severe renal impairment (creatinine clearance <10 mL/min) is 750 mg every 24 hours, with a supplemental dose required after hemodialysis because cefuroxime is dialyzable. 1 This recommendation is based on the principle that hemodialysis removes a significant portion of the drug from circulation, necessitating replacement dosing to maintain therapeutic levels.
Key Pharmacokinetic Considerations
Dialyzability: Cefuroxime is removed by hemodialysis, requiring post-dialysis supplementation to prevent subtherapeutic levels. 1
Extended half-life in renal failure: In patients with severe renal impairment (creatinine clearance ≤23 mL/min), the elimination half-life of cefuroxime increases dramatically from normal values to as high as 22.3 hours in patients with creatinine clearance of 5 mL/min. 2
Adequate urinary concentrations: Even in patients with severe renal dysfunction, cefuroxime achieves adequate urinary concentrations for treating most urinary tract infections caused by common uropathogens including E. coli, Klebsiella, and Proteus mirabilis. 2
Clinical Efficacy in Renal Impairment
Studies demonstrate good clinical efficacy with 750 mg once or twice daily dosing (depending on degree of renal impairment) in patients with severe renal insufficiency and UTI, with symptoms resolving within 3-4 days and pathogen eradication achieved without nephrotoxicity. 2
The drug is well-tolerated in this population with no significant adverse effects or changes in hematological parameters. 2
Common Pitfalls to Avoid
Forgetting the post-dialysis dose: This is critical—failure to administer the supplemental 750 mg dose after dialysis will result in subtherapeutic levels and potential treatment failure. 1
Using oral formulation inappropriately: The evidence provided primarily addresses intravenous cefuroxime dosing for serious infections; oral cefuroxime axetil has different bioavailability and may not be appropriate for all UTI cases in dialysis patients. 3
Inadequate dosing interval: Do not use the standard every 8-hour dosing in dialysis patients—this will lead to drug accumulation and potential toxicity. 1