What is the recommended dosage of cefuroxime (second-generation cephalosporin antibiotic) for an adult patient with an uncomplicated urinary tract infection (UTI)?

Cefuroxime Dosing for Uncomplicated UTI

For uncomplicated urinary tract infections (cystitis), cefuroxime axetil 250 mg orally twice daily for 7-10 days is the standard regimen, though cefuroxime is NOT a first-line agent and should be reserved for patients with contraindications to preferred antibiotics.

Key Dosing Recommendations

For Uncomplicated Lower UTI (Cystitis)

• Standard dose: 250 mg orally twice daily for 7-10 days 1, 2
• Some studies demonstrate efficacy with 125 mg twice daily for milder uncomplicated UTIs 2
• A single daily dose of 250 mg (taken at night) for 10 days has shown 86% cure rates in clinical trials 3

For Pyelonephritis (Upper UTI)

• Cefuroxime is NOT recommended as first-line therapy for pyelonephritis due to inferior efficacy compared to fluoroquinolones 4
• If used, must initiate with IV ceftriaxone 1 gram or another long-acting parenteral agent first, then transition to oral cefuroxime 4
• Duration: 10-14 days total when oral beta-lactams are used for pyelonephritis 4
• Do not use cefuroxime as monotherapy for febrile UTI/pyelonephritis without initial IV therapy—this is a critical error 4

Clinical Context and Limitations

When to Consider Cefuroxime

• Fluoroquinolone allergy or contraindication requiring an alternative agent 4
• Uncomplicated lower UTI where local resistance patterns support its use 4
• Beta-lactamase producing organisms where other oral agents may fail 3

Important Caveats

• Oral cephalosporins are less effective than fluoroquinolones or trimethoprim-sulfamethoxazole for both cystitis and pyelonephritis 4
• Local susceptibility patterns must guide selection—E. coli resistance to cephalosporins varies geographically 4
• In one study, 42.5% of UTI isolates were resistant to trimethoprim-sulfamethoxazole but all were susceptible to cefuroxime, suggesting cefuroxime may be useful when resistance to other agents is high 5

Practical Administration Details

Dosing Optimization

• Take with food or milk to enhance absorption—bioavailability is 68% when taken after meals 2
• Twice daily dosing (250 mg BID) is better tolerated than once-daily 400 mg dosing, with fewer gastrointestinal side effects 6
• For single daily dosing regimens (250 mg), administer at night with a milk drink to maintain urinary antimicrobial activity for 8-10 hours 3

Adverse Effects

• Gastrointestinal disturbances (diarrhea, nausea, vomiting) are most common but generally mild and transient 2
• Candida vaginitis occurred in 8% of patients in one trial 3
• Adverse events developed in approximately 23% of patients, with most being minor 3

Monitoring

• Obtain urine culture before initiating therapy and tailor treatment based on susceptibility results 4
• Follow-up cultures during and post-treatment are important to detect relapses and reinfections 5
• Clinical and bacteriological cure rates of 75-93% have been reported in various studies 5, 3