Pediatric Dosing of Cefuroxime for Bacterial Infections
For pediatric patients with bacterial infections, administer cefuroxime intravenously at 20-30 mg/kg every 8 hours (three times daily) for children over 1 month of age, with higher doses of 30 mg/kg every 8 hours reserved for severe infections. 1, 2
Age-Specific Dosing Algorithm
Neonates (≤1 month)
- <7 days old: 30 mg/kg every 12 hours (twice daily) 1
- >7 days old: 30 mg/kg every 8 hours (three times daily) 1
Infants and Children (>1 month to 18 years)
- Standard dosing: 20-30 mg/kg every 8 hours IV 1, 2
- Severe infections: 30 mg/kg every 8 hours (up to maximum adult dose of 1.5 grams per dose) 1, 2
- Maximum daily dose: Do not exceed 6 grams per day total 2
Route-Specific Considerations
Intravenous Administration
- Preferred route for severe infections, bacteremia, or critically ill patients 2
- Administer over 3-5 minutes for direct IV push, or as intermittent infusion 2
- Dosing frequency is every 8 hours (three times daily) for most infections 1, 2
Oral Administration (Cefuroxime Axetil)
- 1-24 months: 125 mg twice daily 1
- 2-12 years: 250 mg twice daily 1
- Oral formulation is less reliably absorbed and may not achieve adequate tissue penetration for serious infections 3
Infection-Specific Dosing Guidance
Community-Acquired Pneumonia
- 75 mg/kg/day divided every 8 hours (25 mg/kg per dose) has demonstrated excellent efficacy 4, 5
- This regimen successfully treated pneumonia caused by Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus 5
- Clinical response typically occurs within 3 days, with complete resolution of respiratory symptoms by day 5 5
Soft Tissue Infections and Cellulitis
- 75 mg/kg/day divided every 8 hours (25 mg/kg per dose) 4
- Effective for preseptal cellulitis, buccal cellulitis, and bacteremic soft tissue infections 4
- All patients in clinical trials showed satisfactory response with this dosing 4
Severe or Life-Threatening Infections
- Use the higher end of the dosing range: 30 mg/kg every 8 hours 1, 2
- Consider increasing frequency to every 6 hours if infection is due to less susceptible organisms 2
Critical Dosing Pitfalls to Avoid
Do not underdose severe infections: The range of 20-30 mg/kg exists, but 20 mg/kg is appropriate only for mild-to-moderate infections 1. For hospitalized children or documented severe bacterial infections, always use 30 mg/kg every 8 hours 1, 2.
Do not use oral formulation for serious infections: Cefuroxime axetil (oral) shows variable absorption and may not achieve adequate tissue concentrations, particularly in respiratory infections 3. Reserve oral therapy for mild infections or step-down therapy after IV treatment 1.
Adjust for renal impairment: In pediatric patients with renal insufficiency, modify dosing frequency consistent with adult recommendations, though specific pediatric renal dosing guidelines are limited 2.
Avoid in meningitis: Cefuroxime does not achieve adequate CSF penetration and should not be used for bacterial meningitis 2. Use ceftriaxone or cefotaxime instead for CNS infections.
Practical Dosing Examples
- 10 kg child with pneumonia: 250 mg IV every 8 hours (25 mg/kg/dose) 4, 5
- 20 kg child with severe cellulitis: 600 mg IV every 8 hours (30 mg/kg/dose) 1, 4
- 30 kg child with bacteremia: 900 mg IV every 8 hours (30 mg/kg/dose) 1, 2