Therapeutic Dose for Cefuroxime BID
For adults with normal renal function and bacterial infections, the therapeutic dose of oral cefuroxime (cefuroxime axetil) is 250-500 mg twice daily, with 500 mg BID recommended for more severe infections such as pneumonia or lower respiratory tract infections. 1, 2
Standard Dosing Regimens
Oral Cefuroxime Axetil (Tablets/Suspension)
- Most infections: 250 mg twice daily is appropriate for uncomplicated cases 3, 4
- Severe lower respiratory tract infections or pneumonia: 500 mg twice daily should be used 1, 3, 4
- Uncomplicated urinary tract infections: 125 mg twice daily has proven effective 3
- Uncomplicated gonorrhea: Single 1-gram dose 3
Parenteral Cefuroxime (IV/IM)
- Standard dosing: 750 mg to 1.5 grams every 8 hours for 5-10 days 2
- Uncomplicated infections (UTI, skin/soft tissue, uncomplicated pneumonia): 750 mg every 8 hours 2
- Severe or complicated infections: 1.5 grams every 8 hours 2
- Life-threatening infections: 1.5 grams every 6 hours may be required 2
Duration of Therapy
- Typical course: 5-10 days for most infections 2, 4
- Shorter courses: 5-day regimens have proven as effective as 10-day courses in clinical trials 4
- Streptococcal infections: Minimum 10 days to prevent rheumatic fever or glomerulonephritis 2
Sequential IV-to-Oral Therapy
For community-acquired pneumonia, sequential therapy is highly effective: 4
- Initial IV phase: Cefuroxime 750 mg 2-3 times daily for 2-5 days
- Oral continuation: Cefuroxime axetil 500 mg twice daily for 3-8 days
- This approach provides similar efficacy to full parenteral courses while reducing hospitalization 4
Renal Impairment Adjustments
Dosage must be reduced when renal function is impaired: 2
- CrCl >20 mL/min: 750 mg to 1.5 grams every 8 hours (standard dosing)
- CrCl 10-20 mL/min: 750 mg every 12 hours
- CrCl <10 mL/min: 750 mg every 24 hours
- Hemodialysis patients: Give additional dose after dialysis 2
Clinical Efficacy Data
- Success rates: 89-91% clinical cure in lower respiratory tract infections including bronchopneumonia and post-operative pneumonia 5
- Acute exacerbations of chronic bronchitis: 89% success rate with 750 mg every 8 hours 5
- Acute urinary tract infections: 88% cure rate at 1 week with oral therapy 6
Common Pitfalls to Avoid
- Do not use doses smaller than indicated: Subtherapeutic dosing compromises efficacy, particularly in serious infections 2
- Do not underdose pneumonia: Always use 500 mg BID orally (or 750 mg every 8 hours IV) for suspected or confirmed pneumonia, not the lower 250 mg dose 1, 3
- Ensure adequate duration: Continue therapy 48-72 hours after clinical improvement or bacterial eradication 2
- Consider food intake: Oral absorption is enhanced when taken with food, achieving 68% bioavailability 3
Tolerability Profile
Cefuroxime is well-tolerated with primarily mild-to-moderate gastrointestinal adverse effects (diarrhea, nausea, vomiting) that are reversible upon discontinuation 3, 4. Only 0.7% of patients developed rash in large clinical trials, and penicillin-allergic patients were treated successfully 5.