What is the recommended pediatric dose of Ceftin (cefuroxime axetil) for children, including dosing for standard and severe infections and adjustments for renal impairment?

Pediatric Dosing of Ceftin (Cefuroxime Axetil)

For children, the recommended dose of cefuroxime axetil (Ceftin) is 30 mg/kg per day divided into two doses, with a maximum of 500 mg per dose.

Standard Dosing Algorithm

Age and Weight Considerations

• Cefuroxime axetil is dosed at 30 mg/kg per day in 2 divided doses for pediatric patients, with a maximum of 500 mg per dose (1,000 mg total daily). 1
• This dosing applies to children aged ≥3 months through adolescence. 2

Indication-Specific Dosing

Early Lyme Disease

• For early Lyme disease in children, administer 30 mg/kg per day in 2 divided doses with a maximum of 500 mg per dose. 1
• Treatment duration is typically 14–21 days depending on disease manifestation. 1

Respiratory Tract Infections

• For lower respiratory tract infections (bronchitis, pneumonia), use 30 mg/kg per day divided twice daily, maximum 500 mg per dose. 3
• For more severe lower respiratory tract infections, the dose remains 30 mg/kg per day in 2 divided doses (maximum 500 mg per dose), though clinical trials have shown variable absorption and penetration. 4

Upper Respiratory Tract Infections

• For otitis media, sinusitis, pharyngitis, and tonsillitis, the standard dose is 30 mg/kg per day in 2 divided doses (maximum 500 mg per dose). 3

Urinary Tract Infections

• For uncomplicated urinary tract infections, 125 mg twice daily has been shown effective in adults; pediatric dosing follows the standard 30 mg/kg per day in 2 divided doses approach. 3

Skin and Soft Tissue Infections

• For furunculosis, pyoderma, and impetigo, use 30 mg/kg per day in 2 divided doses (maximum 500 mg per dose). 3

Practical Dosing Examples

• 10 kg child: 150 mg twice daily (total 300 mg/day)
• 20 kg child: 300 mg twice daily (total 600 mg/day)
• ≥33 kg child: 500 mg twice daily (total 1,000 mg/day—maximum dose reached)

Administration Considerations

Timing with Food

• Cefuroxime axetil absorption is enhanced when taken with food; maximum plasma concentrations after a 500 mg dose with food are 7.9 mg/L compared to lower levels when fasting. 3
• Always administer with food to optimize bioavailability (68% absolute bioavailability with food). 3

Formulations Available

• Tablets: 125 mg, 250 mg, or 500 mg
• Oral suspension: 125 mg/5 mL or 250 mg/5 mL (for pediatric use) 3

Renal Impairment Adjustments

• For pediatric patients with renal insufficiency, reduce dosing frequency consistent with adult recommendations based on creatinine clearance. 2
• Creatinine clearance 10–20 mL/min: Reduce to once daily dosing
• Creatinine clearance <10 mL/min: Reduce to once every 24 hours 2

Treatment Duration

• Most infections: 5–10 days 3
• Streptococcal infections: Minimum 10 days to prevent rheumatic fever or glomerulonephritis 2
• Lyme disease: 14–21 days depending on manifestation 1

Common Pitfalls to Avoid

• Do not exceed 500 mg per dose regardless of weight; children ≥33 kg receive the maximum adult dose of 500 mg twice daily. 1
• Do not use first-generation cephalosporins (e.g., cephalexin) for Lyme disease or infections requiring broader gram-negative coverage, as they are inactive against Borrelia burgdorferi and many respiratory pathogens. 1
• Avoid underdosing in severe infections; maintain the full 30 mg/kg per day even in mild cases to ensure adequate tissue penetration. 4
• Do not use cefuroxime axetil as monotherapy for suspected atypical pneumonia (Mycoplasma, Chlamydia); macrolides are required for these pathogens. 1

Adverse Effects

• The most common adverse reactions are gastrointestinal disturbances (diarrhea, nausea, vomiting), which are generally mild and transient. 3
• Hypersensitivity reactions may occur in patients with penicillin allergy; cross-reactivity with cephalosporins is approximately 1–3%. 3

When Cefuroxime Axetil Is Not Appropriate

• Macrolides are less effective than cefuroxime, amoxicillin, or doxycycline for early Lyme disease and should not be used as first-line therapy. 1
• For severe or life-threatening infections, parenteral ceftriaxone (50–75 mg/kg IV once daily, maximum 2 g) is preferred over oral cefuroxime axetil. 1
• Pregnant or lactating patients with Lyme disease should avoid doxycycline but may use cefuroxime axetil at standard doses. 1