IV Cefuroxime Dosage in Adults
For most adult infections, administer cefuroxime 750 mg to 1.5 grams IV every 8 hours, with severe infections requiring 1.5 grams every 6-8 hours and bacterial meningitis requiring up to 3 grams every 8 hours. 1
Standard Dosing by Infection Severity
Mild to Moderate Infections:
- 750 mg IV every 8 hours for uncomplicated urinary tract infections, skin and soft-tissue infections, disseminated gonococcal infections, and uncomplicated pneumonia 1
- This dosing achieves serum concentrations exceeding 8 μg/mL for approximately 100 minutes after administration 2
Severe or Complicated Infections:
- 1.5 grams IV every 8 hours for bone and joint infections, severe respiratory tract infections, and complicated infections 1
- Serum concentrations remain above 8 μg/mL for approximately 145 minutes with this dose 2
Life-Threatening Infections:
- 1.5 grams IV every 6 hours may be required for life-threatening infections or infections caused by less susceptible organisms 1
Bacterial Meningitis:
- Up to 3 grams IV every 8 hours (maximum dose) 1
- This higher dosing is critical for achieving adequate CNS penetration 3
Infection-Specific Dosing
Pneumonia:
- For community-acquired pneumonia, cefuroxime 0.75-1.5 grams IV every 8 hours is recommended as alternative therapy for S. pneumoniae 4
- For gram-negative enteric bacilli causing pneumonia, 1.5 grams IV every 8 hours is recommended 4
Surgical Prophylaxis:
- 1.5 grams IV administered 30 minutes to 1 hour before initial incision, followed by 750 mg IV/IM every 8 hours for prolonged procedures 1
- For open heart surgery, 1.5 grams IV at induction of anesthesia, then every 12 hours for total of 6 grams 1
- Re-dosing with 0.75 grams every 2 hours intraoperatively maintains adequate tissue levels 5
Gonococcal Infections:
- 1.5 grams IM as single dose at 2 different sites with 1 gram oral probenecid for uncomplicated gonococcal infection 1
Renal Impairment Dosing
Dosing must be reduced when renal function is impaired 1:
- Creatinine clearance >20 mL/min: 750 mg to 1.5 grams every 8 hours 1
- Creatinine clearance 10-20 mL/min: 750 mg every 12 hours 1
- Creatinine clearance <10 mL/min: 750 mg every 24 hours 1
- Hemodialysis patients: Give additional dose at end of dialysis 1
Pharmacokinetic Considerations
Cefuroxime has rapid renal elimination with a serum half-life of 1.1 hours 2:
- Approximately 45% is excreted through renal tubules 2
- Renal clearance is 150 mL/min/1.73m² 2
- Nearly complete urinary excretion occurs within 24 hours 2
Protein binding is 33%, allowing high concentrations of unbound drug in serum 6, 2
Pharmacodynamic Targets
For optimal efficacy, time above MIC (T>MIC) should exceed 50% 7:
- For S. pneumoniae: 750 mg every 12 hours achieves >99% probability of target attainment 7
- For S. aureus: 1500 mg every 8 hours achieves >97% probability of target attainment 7
- For E. coli and K. pneumoniae: Even 1500 mg every 6 hours may not achieve adequate target attainment (<90%), suggesting cefuroxime may not be optimal for these pathogens in healthy young adults 7
Treatment Duration
Continue therapy for minimum 48-72 hours after patient becomes asymptomatic or bacterial eradication is documented 1:
- Minimum 10 days for Streptococcus pyogenes infections to prevent rheumatic fever or glomerulonephritis 1
- 5-10 days for most infections 1
- Chronic urinary tract infections may require several months of follow-up 1
Critical Pitfalls to Avoid
Do not use doses smaller than those indicated above 1—underdosing increases risk of treatment failure and resistance development.
Surgical drainage must be performed when indicated for staphylococcal and other infections involving pus collections 1—antibiotics alone are insufficient.
For E. coli and K. pneumoniae infections in healthy young patients, cefuroxime may not achieve adequate pharmacodynamic targets even at maximum doses 7—consider alternative agents with better activity against these pathogens.
Cefuroxime is dialyzable—failure to provide supplemental dosing after hemodialysis results in subtherapeutic levels 1.