What is the recommended dose of cefuroxime (Cefuroxime) for pediatric patients?

Pediatric Cefuroxime Dosing

For pediatric patients over 3 months of age, administer cefuroxime IV at 100-200 mg/kg/day divided every 6-8 hours (maximum 1500 mg per dose), with higher doses of 200-240 mg/kg/day reserved for bacterial meningitis. 1, 2

IV Dosing by Age Group

Neonates

• Less than 7 days old: 30 mg/kg IV every 12 hours 1
• Greater than 7 days old: 30 mg/kg IV every 8 hours 1

Infants and Children Over 3 Months

• Standard infections: 50-100 mg/kg/day divided every 6-8 hours 2
• Most susceptible infections: 100-150 mg/kg/day divided every 6-8 hours 1
• Maximum single dose: 1500 mg 1

The FDA label supports 50-100 mg/kg/day for most infections, while clinical guidelines from the Journal of Microbiology, Immunology and Infection recommend the higher range of 100-200 mg/kg/day. 1, 2 For practical purposes, use 100 mg/kg/day as your starting point for moderate infections and escalate based on severity.

Indication-Specific Dosing

Severe or Complicated Infections

• Complicated intra-abdominal infections: 150 mg/kg/day divided every 6-8 hours 1
• Bone and joint infections: 150 mg/kg/day divided every 8 hours (not to exceed maximum adult dosage) 2

Bacterial Meningitis

• Dosing: 200-240 mg/kg/day divided every 6-8 hours 1, 2
• Maximum: Do not exceed 3 grams every 8 hours 2
• Important caveat: Third-generation cephalosporins (ceftriaxone, cefotaxime) are generally preferred over cefuroxime for meningitis 1

Pneumonia

• Clinical data supports 75 mg/kg/day divided every 8 hours as effective single-drug therapy for bacterial pneumonia in infants and children 3
• This lower dose achieved mean serum concentrations of 29.1 mcg/mL and successfully treated pneumococcal, H. influenzae, and staphylococcal pneumonia 3

Oral Step-Down Therapy (Cefuroxime Axetil)

Age-Based Dosing

• Children 1-24 months: 125 mg twice daily 1, 4
• Children 2-12 years: 250 mg twice daily 1, 4
• Alternative weight-based dosing: 20-50 mg/kg/day divided every 12 hours (maximum 500 mg per dose) 1, 4

Administration

• Must be taken with food to increase absorption 4
• Use the higher end of the dosing range (50 mg/kg/day) for more severe infections 4

Renal Impairment Adjustments

For pediatric patients with renal insufficiency, modify dosing frequency consistent with adult recommendations: 2

• CrCl >20 mL/min: Standard dosing every 8 hours
• CrCl 10-20 mL/min: Reduce frequency to every 12 hours
• CrCl <10 mL/min: Reduce frequency to every 24 hours
• Hemodialysis: Give additional dose after dialysis 2

Treatment Duration

• Minimum: Continue for 48-72 hours after patient becomes asymptomatic or bacterial eradication is documented 2
• Streptococcus pyogenes infections: Minimum 10 days to prevent rheumatic fever or glomerulonephritis 2
• Chronic urinary tract infections: May require several months of follow-up 2

Critical Pitfalls to Avoid

• Do not use cefuroxime as first-line for meningitis—third-generation cephalosporins are preferred 1
• Add MRSA coverage (vancomycin or clindamycin) if MRSA is suspected, as cefuroxime lacks activity against methicillin-resistant organisms 1
• Avoid in patients under 3 months for IV formulation unless using specific neonatal dosing 1, 2
• Do not mix with aminoglycosides in the same IV solution due to potential interaction 2