What is the recommended cefuroxime dosing for an uncomplicated urinary tract infection in an adult with normal renal function, including adjustments for impaired renal function and pediatric patients?

Cefuroxime Dosing for Urinary Tract Infections

For uncomplicated UTIs in adults with normal renal function, cefuroxime 250 mg orally twice daily for 7 days is the standard regimen, while complicated UTIs require 500 mg orally twice daily for 10–14 days. 1, 2

Adult Dosing by UTI Type

Uncomplicated UTI (Lower Tract)

• Oral cefuroxime axetil 250 mg twice daily for 7 days is effective for uncomplicated cystitis in women with normal renal function. 3, 4
• Single daily dosing of 250 mg at bedtime for 10 days has demonstrated 86% cure rates in clinical trials, though twice-daily dosing remains standard. 4
• Cefuroxime achieves adequate urinary concentrations with antimicrobial activity detectable 8–10 hours post-dose. 4

Complicated UTI (Upper Tract or Risk Factors)

• Oral cefuroxime 500 mg twice daily for 10–14 days is recommended for complicated UTIs when the pathogen is susceptible. 1, 2
• The 14-day duration is preferred for male patients (where prostatitis cannot be excluded), delayed clinical response, or underlying urological abnormalities. 1
• A 10-day course may suffice when prompt symptom resolution occurs and the patient is hemodynamically stable. 1

Parenteral Dosing (Severe Infections)

• Intravenous cefuroxime 750 mg every 8 hours is the standard dose for uncomplicated infections requiring hospitalization. 5
• Intravenous cefuroxime 1.5 grams every 8 hours is recommended for severe or complicated infections. 5
• Transition to oral therapy (500 mg twice daily) is appropriate once the patient is afebrile for ≥48 hours and clinically stable. 1

Renal Dose Adjustments

Dose reduction is mandatory when creatinine clearance falls below 20 mL/min to prevent drug accumulation. 5

• CrCl >20 mL/min: No adjustment needed; use standard dosing (750 mg–1.5 g IV every 8 hours or 250–500 mg PO twice daily). 5
• CrCl 10–20 mL/min: 750 mg IV/PO every 12 hours. 5
• CrCl <10 mL/min: 750 mg IV/PO every 24 hours. 5
• Hemodialysis patients: Administer an additional 750 mg dose after each dialysis session, as cefuroxime is dialyzable. 5

Pediatric Dosing (>3 Months of Age)

• Oral cefuroxime axetil 125 mg twice daily is effective for uncomplicated pediatric UTIs. 6
• Two-day therapy (125 mg twice daily for 2 days) demonstrated 67% bacteriologic success in children aged 2–11 years, though conventional 10-day therapy achieved 86% success. 6
• For severe infections: 50–100 mg/kg/day IV divided every 6–8 hours; use the higher end (100 mg/kg/day, not exceeding adult maximum) for serious infections. 5

Critical Clinical Considerations

When Cefuroxime Is Appropriate

• Oral β-lactams (including cefuroxime) demonstrate inferior efficacy compared to fluoroquinolones or trimethoprim-sulfamethoxazole for complicated UTIs, achieving only 70–85% success rates versus higher rates with fluoroquinolones. 1, 2
• Cefuroxime should be reserved for susceptibility-confirmed therapy or when fluoroquinolones/TMP-SMX are contraindicated. 2
• It is particularly valuable for β-lactamase–producing organisms (e.g., ampicillin-resistant E. coli) that remain cefuroxime-susceptible. 4, 7

Monitoring and Follow-Up

• Obtain urine culture before initiating therapy to enable targeted treatment, especially in complicated UTIs where resistance rates are higher. 1, 2
• Reassess at 72 hours if clinical improvement (defervescence, symptom resolution) is not evident; consider imaging to exclude obstruction or abscess. 1, 2
• Obtain follow-up urine culture after completing therapy to confirm bacteriologic cure, as reinfection rates of 11% have been documented. 2, 4

Common Pitfalls to Avoid

• Do not use cefuroxime empirically for complicated UTIs without culture guidance, as oral cephalosporins are less effective than fluoroquinolones or TMP-SMX. 1
• Do not use inadequate durations (<10 days for complicated UTIs or <7 days for uncomplicated UTIs), as shorter courses increase bacteriologic failure rates. 1, 2
• Do not omit renal dose adjustment in patients with CrCl <20 mL/min, as standard dosing risks toxicity. 5
• Replace indwelling catheters ≥2 weeks old at treatment initiation for catheter-associated UTIs to accelerate resolution and reduce recurrence. 1

Adverse Effects

• Gastrointestinal disturbances (diarrhea 4–5%, nausea/vomiting) are the most common adverse events. 3, 7
• Candida vaginitis occurs in approximately 8% of women treated for UTI. 4
• Drug-related adverse events occur in 10% of patients overall. 7