Cefuroxime Pediatric Dosing by Weight
For pediatric patients requiring intravenous cefuroxime, administer 100-150 mg/kg/day divided every 6-8 hours for most infections, with higher doses of 200-240 mg/kg/day reserved for bacterial meningitis. 1
Intravenous (IV) Dosing by Age
Neonates
- Less than 7 days old: 30 mg/kg IV every 12 hours 1
- Greater than 7 days old: 30 mg/kg IV every 8 hours 1
Infants and Children (>1 month to 12 years)
- Standard infections: 100-150 mg/kg/day divided every 6-8 hours 1
- Severe infections: Up to 200 mg/kg/day divided every 6-8 hours (maximum 1500 mg per dose) 1
- Bacterial meningitis: 200-240 mg/kg/day divided every 6-8 hours 1, 2
- Bone and joint infections: 150 mg/kg/day divided every 8 hours 2
The FDA label confirms that 50-100 mg/kg/day in equally divided doses every 6-8 hours has been successful for most susceptible infections, with 100 mg/kg/day (not exceeding maximum adult dosage) used for more severe infections 2. Research supports these ranges, with studies demonstrating efficacy at 75 mg/kg/day for pneumonia 3 and 30-100 mg/kg/day for respiratory tract infections 4.
Oral Dosing (Cefuroxime Axetil)
Children 1-24 months
- 125 mg twice daily (oral) 5
Children 2-12 years
When transitioning from IV to oral therapy, cefuroxime axetil can be dosed at 20-50 mg/kg/day divided every 12 hours with a maximum of 500 mg per dose 1. Studies demonstrate good tolerability at doses of 10-20 mg/kg every 8-12 hours when stepping down from parenteral therapy 7.
Critical Dosing Considerations
Maximum dose limitations: Pediatric doses should not exceed adult maximum doses (1500 mg per dose IV, or 500 mg per dose orally) 1, 2
Renal impairment: Reduce dosing frequency consistent with adult recommendations based on creatinine clearance 2
MRSA coverage: If staphylococcal infection (particularly MRSA) is suspected, add vancomycin or clindamycin, as cefuroxime alone is insufficient 1
Common Pitfalls to Avoid
- Do not underdose severe infections: Use the higher end of the dosing range (100-150 mg/kg/day) for serious infections rather than the lower 50 mg/kg/day dose 1, 2
- Do not use cefuroxime as monotherapy for meningitis: Third-generation cephalosporins (ceftriaxone, cefotaxime) are generally preferred for bacterial meningitis 1
- Avoid in beta-lactam allergies: Consider alternative agents based on allergy severity 1
The evidence strongly supports weight-based dosing rather than fixed dosing in pediatric patients, as pharmacokinetic studies demonstrate that children achieve appropriate serum concentrations and time above MIC90 with these regimens 3, 8.