What is the maximum dose of cefuroxime (Cefuroxime Axetil) oral suspension (250 mg/5 mL) for a pediatric patient weighing 50 kg?

Maximum Dose of Cefuroxime Axetil Oral Suspension (250 mg/5 mL) for a 50 kg Pediatric Patient

For a 50 kg pediatric patient, the maximum dose of cefuroxime axetil oral suspension is 500 mg per dose (10 mL of the 250 mg/5 mL suspension), given twice daily, regardless of weight-based calculations that might suggest a higher dose. 1

Dosing Algorithm and Rationale

Weight-Based Calculation vs. Maximum Dose Cap

• Standard pediatric dosing for cefuroxime axetil ranges from 20-50 mg/kg/day divided twice daily, depending on the indication 1, 2
• For a 50 kg patient, weight-based calculations would suggest:
  • Lower respiratory infections/sinusitis/otitis media: 30 mg/kg/day = 1,500 mg/day (750 mg per dose)
  • Pharyngitis/tonsillitis: 20 mg/kg/day = 1,000 mg/day (500 mg per dose)
• However, the per-dose maximum of 500 mg must never be exceeded for oral cefuroxime axetil, even when weight-based calculations suggest higher doses 1

Critical Dosing Principle

The key principle is that oral cefuroxime axetil has an absolute maximum of 500 mg per dose, which takes precedence over any weight-based calculation. 1 This differs fundamentally from IV cefuroxime, which allows up to 1,500 mg per dose 1, 3

Practical Application for This Patient

• Give 500 mg (10 mL of 250 mg/5 mL suspension) twice daily 1, 2
• This equals a total daily dose of 1,000 mg, which is 20 mg/kg/day for this 50 kg patient 2
• The FDA label confirms that the daily maximum dose is 1,000 mg for pharyngitis/tonsillitis and 1,000 mg for other common pediatric infections when using the per-dose cap 2

Common Pitfalls to Avoid

Never Exceed the Per-Dose Maximum

• Do not give more than 500 mg per dose simply because the total daily dose calculation seems reasonable 1
• The per-dose limit exists regardless of the patient's weight or the calculated daily dose 1

Bioequivalence Warning

• Cefuroxime axetil tablets and oral suspension are NOT bioequivalent and are NOT substitutable on a milligram-per-milligram basis 2
• Always verify which formulation is being prescribed and dispensed 2

Administration Requirements

• Cefuroxime axetil oral suspension must be administered with food to optimize absorption 2
• Shake the suspension well before each use 2
• Store reconstituted suspension refrigerated (2-8°C) and discard after 10 days 2

When to Consider Alternatives

If Higher Doses Are Clinically Needed

• If the clinical situation requires doses higher than 500 mg per dose, switch to IV cefuroxime (which allows up to 1,500 mg per dose) or consider an alternative antibiotic such as high-dose amoxicillin 1
• IV cefuroxime can be dosed at 100-200 mg/kg/day divided every 6-8 hours with a maximum of 1,500 mg per dose 3

Age Considerations

• The FDA label specifies that cefuroxime axetil oral suspension is approved for pediatric patients aged 3 months to 12 years 2
• For a 50 kg patient who may be approaching or exceeding 12 years of age, verify age appropriateness and consider whether adult dosing guidelines apply 2