Adult Dosing for Cefuroxime
Intravenous/Intramuscular Dosing
For complicated intra-abdominal infections and most serious infections, administer cefuroxime 1.5 g IV every 8 hours. 1
- Standard IV dosing for adults is 1.5 g every 8 hours for moderate to severe infections 1
- Alternative dosing ranges from 750 mg to 1500 mg IV every 8 hours depending on infection severity 1
- For community-acquired pneumonia requiring hospitalization, use 750-1500 mg IV every 8 hours 1
- Sequential therapy is effective: start with 750 mg IV 2-3 times daily for 2-5 days, then transition to oral cefuroxime axetil 500 mg twice daily for 3-8 days 2, 3
Oral Dosing (Cefuroxime Axetil)
For lower respiratory tract infections, prescribe cefuroxime axetil 500 mg orally twice daily; for upper respiratory tract infections and uncomplicated cases, use 250 mg orally twice daily. 1, 4
- Lower respiratory tract infections (pneumonia, acute bronchitis): 500 mg orally twice daily 1, 4, 5
- Upper respiratory tract infections (sinusitis, pharyngitis, otitis media): 250 mg orally twice daily 1, 4
- Mild urinary tract infections: 125 mg orally twice daily 4
- Uncomplicated gonorrhea: 1 g orally as a single dose 4
- Cefuroxime axetil 750 mg orally every 12 hours is an alternative for acute bacterial rhinosinusitis 1
Treatment Duration
- Most infections: 7-10 days 2, 4
- Acute otitis media or acute bronchitis: 5 days is as effective as 10 days 2, 3
- Community-acquired pneumonia (sequential therapy): 2-5 days IV followed by 3-8 days oral 2, 3
- Group A streptococcal pharyngitis: 10 days 3
Alternatives for Severe Beta-Lactam Allergy
For patients with severe beta-lactam allergy (anaphylaxis, angioedema, urticaria), use a respiratory fluoroquinolone as first-line therapy. 6
First-Line Alternatives:
- Levofloxacin 750 mg orally once daily for 5 days 6
- Moxifloxacin 400 mg orally once daily for 5 days 6
- Levofloxacin 750 mg IV every 24 hours for hospitalized patients 1
- Moxifloxacin 400 mg IV every 24 hours for hospitalized patients 1
Second-Line Alternatives:
- Doxycycline 100 mg orally twice daily for at least 7 days (81% clinical efficacy) 6
- Azithromycin 500 mg orally once daily for 3 days (or 500 mg day 1, then 250 mg daily for 4 days) 1, 6
- Clarithromycin 500 mg orally twice daily for 7-10 days 1
For Complicated Intra-Abdominal Infections with Beta-Lactam Allergy:
- Ciprofloxacin 400 mg IV every 12 hours plus metronidazole 500 mg IV every 8-12 hours 1
- Aminoglycoside-based regimen: gentamicin 5-7 mg/kg IV every 24 hours plus metronidazole 1
Critical Considerations
- Cefuroxime should be taken with food to optimize absorption of the oral formulation 2, 4
- Delayed penicillin allergy >1 year ago: cephalosporins have only 0.1% cross-reactivity risk and can be used safely 7
- Macrolides have significant limitations: bacterial failure rates of 20-25% are possible, with resistance rates of 5-8% among common pathogens 7, 6
- Avoid macrolides as first-line therapy in patients with multiple antibiotic allergies due to high resistance rates 6
- Monitor for QT prolongation with fluoroquinolones and macrolides, especially in patients on CYP3A4 inhibitors 7
- Aminoglycoside dosing should be based on lean body mass with serum drug-concentration monitoring 1