Cefuroxime Dosing at eGFR 26 mL/min
For an adult patient with eGFR 26 mL/min, cefuroxime should be dosed at 750 mg every 12 hours for most infections, or 750 mg every 24 hours for severe renal impairment depending on infection severity. 1
FDA-Approved Dosing Adjustment
The FDA label for cefuroxime provides clear guidance for renal dose adjustment based on creatinine clearance 1:
- Creatinine clearance 10-20 mL/min: 750 mg every 12 hours
- Creatinine clearance <10 mL/min: 750 mg every 24 hours
Since your patient has an eGFR of 26 mL/min, the recommended dose is 750 mg every 12 hours. 1 This falls into the moderate-to-severe renal impairment category where the dosing interval must be extended to prevent drug accumulation and potential toxicity.
Pharmacokinetic Rationale
The elimination half-life of cefuroxime increases dramatically with declining renal function 2:
- Normal renal function: 1.5-2 hours 3
- Creatinine clearance 23 mL/min: 4.2 hours 2
- Creatinine clearance 5 mL/min: 22.3 hours 2
At eGFR 26 mL/min, cefuroxime clearance is primarily dependent on residual renal function, as approximately 86% of drug elimination occurs through glomerular filtration 3. The extrarenal clearance is minimal at 8.24 mL/min 2, making dose adjustment essential to avoid accumulation.
Clinical Considerations
Loading Dose
No reduction in the initial loading dose is required. 1 The first dose should be 750 mg to achieve therapeutic concentrations rapidly, particularly for serious infections.
Infection Severity Adjustment
- For severe or life-threatening infections at eGFR 26: Consider maintaining 750 mg every 12 hours rather than extending to every 24 hours 1
- For uncomplicated infections: 750 mg every 12 hours is appropriate 1
- The FDA label does not recommend doses below 750 mg in renal impairment 1
Dialysis Considerations
If the patient requires hemodialysis, administer an additional 750 mg dose after each dialysis session 1, as cefuroxime is dialyzable and approximately 63% of the dose can be removed during intermittent hemofiltration 3.
Monitoring Parameters
Monitor the following to ensure safe and effective therapy 2:
- Renal function: Serial creatinine and eGFR measurements, as further decline may necessitate additional dose adjustment 2
- Clinical response: Symptoms should improve within 3-4 days 2
- Adverse effects: Cefuroxime is generally well-tolerated even in severe renal impairment, with primarily mild gastrointestinal side effects 4, 2
- Hematological parameters: No significant changes expected, but baseline monitoring is prudent 2
Common Pitfalls to Avoid
Do not use the normal dosing regimen (750 mg-1.5 g every 8 hours) at eGFR 26 mL/min 1, as this will lead to drug accumulation and increased risk of toxicity. The dosing interval must be extended based on the degree of renal impairment.
Do not confuse cefuroxime with third-generation cephalosporins like ceftazidime, which have different renal dosing requirements 5. Each beta-lactam antibiotic requires individualized dose adjustment based on its specific pharmacokinetic profile.
Avoid concomitant nephrotoxic agents when possible 2, though furosemide has been shown not to impair renal function or cause nephrotoxicity when used with cefuroxime 2.