What is the recommended dose of cefuroxime for an adult patient with normal kidney function and an uncomplicated urinary tract infection (UTI), 750mg three times a day (tds) or 1.5g tds?

Cefuroxime Dosing for UTI: 750mg TDS is the Recommended Dose

For uncomplicated urinary tract infections in adults with normal renal function, cefuroxime 750mg three times daily (every 8 hours) is the FDA-approved and guideline-supported dose, not 1.5g TDS. 1

FDA-Approved Dosing for UTI

The FDA label for cefuroxime explicitly states that for uncomplicated urinary tract infections, a 750mg dose every 8 hours is recommended 1. The higher dose of 1.5g every 8 hours is reserved for severe or complicated infections, bone and joint infections, and life-threatening infections 1.

Guideline Support for Oral Cefuroxime

• The European Association of Urology guidelines recommend oral cephalosporins like cefuroxime 500mg twice daily for 10-14 days as step-down therapy for complicated UTIs 2
• For uncomplicated UTIs, research supports cefuroxime 250mg three times daily for 7 days as clinically and bacteriologically effective 3

Key Distinctions by Infection Severity

Uncomplicated UTI (cystitis):

• Standard dose: 750mg every 8 hours IV/IM 1
• Oral alternative: 250mg three times daily 3

Complicated UTI:

• Standard dose: 1.5g every 8 hours IV 1
• Oral step-down: 500mg twice daily for 10-14 days 2, 4

Severe/life-threatening infections:

• Maximum dose: 1.5g every 6 hours (not every 8 hours) 1

Clinical Efficacy Data

• Research demonstrates that cefuroxime 250mg three times daily achieves 75% bacteriological cure rates in uncomplicated UTI, with clinical cure in 100% of patients 3
• The drug shows excellent activity against common uropathogens including E. coli (85% of cases) and Klebsiella pneumoniae 3
• Oral bioavailability is 68% after a meal, with peak plasma concentrations of 7.9 mg/L after 500mg dosing 5

Critical Dosing Errors to Avoid

• Never use 1.5g TDS for uncomplicated UTI - this represents overdosing and is not supported by FDA labeling or clinical evidence 1
• Do not use doses smaller than 750mg every 8 hours for standard UTI - the FDA label explicitly states that doses smaller than indicated should not be used 1
• Oral cephalosporins achieve significantly lower blood and urinary concentrations than IV route, so ensure appropriate route selection 6

Renal Dose Adjustments

For patients with renal impairment, dosing must be reduced 1:

• Creatinine clearance >20 mL/min: 750mg-1.5g every 8 hours
• Creatinine clearance 10-20 mL/min: 750mg every 12 hours
• Creatinine clearance <10 mL/min: 750mg every 24 hours
• Post-hemodialysis: Give additional 750mg dose after dialysis 1

Treatment Duration

• Uncomplicated UTI: 7-10 days 5, 3
• Complicated UTI: 10-14 days 2, 4
• Continue therapy for minimum 48-72 hours after patient becomes asymptomatic 1

When to Consider Alternative Agents

• If local fluoroquinolone resistance is <10%, ciprofloxacin 500-750mg twice daily for 7 days or levofloxacin 750mg once daily for 5 days are preferred first-line options for uncomplicated pyelonephritis 6, 7
• Oral β-lactams including cefuroxime generally achieve lower efficacy rates than fluoroquinolones for complicated UTIs 4
• If no clinical improvement within 72 hours on cefuroxime, reevaluate and consider imaging to rule out complications 4