Oral Cefuroxime Dosing in Pediatric Patients
The recommended oral dose of cefuroxime axetil in children is 20-50 mg/kg/day divided into two doses every 12 hours, with a maximum of 500 mg per dose, and for pneumonia or serious infections, use the higher end (40-50 mg/kg/day) rather than the minimal 20 mg/kg/day dose. 1
Standard Dosing Framework
- Administer 20-50 mg/kg/day divided every 12 hours (twice daily) with a maximum single dose of 500 mg 1
- The dose must not exceed adult dosing limits 1
- For most mild to moderate infections, 20-30 mg/kg/day is appropriate, but this lower range may be insufficient for serious infections 1
Infection-Specific Dosing
Community-Acquired Pneumonia
- Use 40-50 mg/kg/day divided twice daily for pneumonia, as the 20 mg/kg/day dose is inadequate for serious respiratory infections 1
- Cefuroxime is appropriate for pneumonia caused by Streptococcus pneumoniae with penicillin MIC <2.0 μg/mL 1
- It serves as an alternative to amoxicillin or amoxicillin/clavulanate for respiratory tract infections 1
Other Respiratory Infections
- Cefuroxime is effective for upper respiratory tract infections including otitis media, sinusitis, tonsillitis, and pharyngitis 1
- It provides coverage against beta-lactamase producing organisms, including Haemophilus influenzae 1
Critical Age-Related Considerations
- All infants <6 months with pneumonia require hospitalization regardless of antibiotic choice 1
- Oral cefuroxime is only appropriate for children >3 months of age 2
- In school-aged children (≥5 years) with suspected Mycoplasma pneumoniae, prefer a macrolide over cefuroxime 1
Important Dosing Distinctions
A critical pitfall is confusing oral versus IV dosing:
- Oral cefuroxime axetil: 20-50 mg/kg/day divided every 12 hours 1
- IV cefuroxime: 50-100 mg/kg/day divided every 6-8 hours for most infections 2
- IV cefuroxime for severe infections: 100-200 mg/kg/day divided every 6-8 hours, with maximum single dose of 1500 mg 1, 2
This represents a 2-4 fold difference in total daily dose between oral and parenteral formulations, reflecting the lower bioavailability of the oral ester form 1.
Clinical Context and Limitations
- Cefuroxime axetil has variable absorption in children, with absolute bioavailability of approximately 68% in adults 3
- Some studies have shown inadequate penetration into lower respiratory mucosa despite in vitro susceptibility, particularly at lower doses 4
- The drug is effective against beta-lactamase producing H. influenzae and Moraxella catarrhalis 1, 3
Practical Administration
- Administer with food to enhance absorption 3
- Available as tablets (125,250,500 mg) and oral suspension (125 mg/5 mL or 250 mg/5 mL) for pediatric use 3
- Treatment duration typically 5-10 days depending on infection severity 3
Common Pitfalls to Avoid
- Do not use 20 mg/kg/day for pneumonia or serious infections—this dose is insufficient and may lead to treatment failure 1
- Do not confuse oral and IV dosing—the oral dose is substantially lower than parenteral dosing 1
- Do not use in infants <3 months of age 2
- Adjust dosing frequency in renal insufficiency consistent with adult recommendations 2