IV Cefuroxime Dosing for Urinary Tract Infection
For uncomplicated UTI, administer cefuroxime 750 mg IV every 8 hours; for severe or complicated UTI, use 1.5 grams IV every 8 hours, with treatment duration of 5-10 days. 1
Standard Dosing by Infection Severity
Uncomplicated UTI:
- 750 mg IV every 8 hours is the FDA-approved dose for uncomplicated urinary tract infections 1
- Treatment duration is typically 5-10 days 1
Complicated UTI:
- 1.5 grams IV every 8 hours is recommended for severe or complicated infections 1
- Consider extending treatment to 7-14 days, particularly in male patients where prostatitis cannot be excluded 2
Life-threatening infections or less susceptible organisms:
- May require 1.5 grams every 6 hours 1
Renal Dose Adjustments
The FDA label mandates dose reduction based on creatinine clearance: 1
- CrCl >20 mL/min: 750 mg to 1.5 grams every 8 hours (standard dosing) 1
- CrCl 10-20 mL/min: 750 mg every 12 hours 1
- CrCl <10 mL/min: 750 mg every 24 hours 1
- Hemodialysis patients: Give an additional 750 mg dose at the end of each dialysis session 1
Research confirms these adjustments are effective and safe, with elimination half-life increasing from 4.2 hours (CrCl 23 mL/min) to 22.3 hours (CrCl 5 mL/min) 3. Clinical efficacy remains good with appropriate dose adjustment, with symptoms resolving in 3-4 days and no nephrotoxicity observed 3.
Clinical Context and Positioning
Cefuroxime is NOT a first-line agent for complicated UTI in current guidelines. The European Urology guidelines recommend carbapenems, newer β-lactam/β-lactamase inhibitor combinations, or aminoglycosides as first-line empiric therapy for complicated UTI 2. Cefuroxime (listed as a 3rd generation cephalosporin alternative) can be used for step-down oral therapy at 500 mg PO every 12 hours for 10-14 days when the organism is susceptible 2.
For prophylaxis in urologic procedures, cefuroxime is not specifically recommended; guidelines favor cefazolin (1st generation cephalosporin) or fluoroquinolones 4.
Treatment Duration Principles
- Minimum 48-72 hours after patient becomes asymptomatic or evidence of bacterial eradication 1
- 7 days for uncomplicated UTI with prompt symptom resolution 2
- 14 days for complicated UTI or delayed clinical response, particularly in males where prostatitis cannot be excluded 2
- Chronic UTI may require several weeks of treatment and months of follow-up 1
Critical Monitoring and Pitfalls
Always obtain urine culture before starting antibiotics to guide targeted therapy, as complicated UTIs have broader microbial spectrum and increased antimicrobial resistance 2.
Common pitfall: Using doses smaller than indicated above should not be done 1. The FDA label explicitly warns against underdosing.
Surgical drainage must be performed when indicated, particularly in staphylococcal infections or collections of pus 1.
Monitor renal function closely during treatment, especially in patients with baseline renal impairment, as cefuroxime requires dose adjustment 1, 3.