What are the recommended cefuroxime dosing regimens for healthy adults, children, and patients with impaired renal function, including oral and injectable formulations?

Cefuroxime Dosage Guidelines

Adult Dosing

For most bacterial infections in adults, cefuroxime is dosed at 750 mg to 1.5 grams intravenously every 8 hours, or 250-500 mg orally (as cefuroxime axetil) twice daily, with the specific dose and route determined by infection severity and site. 1

Intravenous Cefuroxime Dosing by Indication

• Uncomplicated infections (urinary tract infections, skin/soft tissue infections, uncomplicated pneumonia): 750 mg IV every 8 hours 1
• Severe or complicated infections: 1.5 grams IV every 8 hours 1
• Bone and joint infections: 1.5 grams IV every 8 hours 1
• Life-threatening infections or less susceptible organisms: 1.5 grams IV every 6 hours 1
• Bacterial meningitis: Up to 3 grams IV every 8 hours (maximum dose) 1
• Uncomplicated gonorrhea: 1.5 grams IM as a single dose at two different sites, given with 1 gram oral probenecid 1

Oral Cefuroxime Axetil Dosing by Indication

• Most infections: 250 mg twice daily 2, 3
• Urinary tract infections: 125 mg twice daily has proven effective 2
• Pneumonia or severe lower respiratory tract infections: 500 mg twice daily 2, 3
• Early Lyme disease (erythema migrans): 500 mg twice daily for 14-21 days 4, 5
• Uncomplicated gonorrhea: 1 gram as a single dose 2

Cefuroxime axetil should be taken with food to increase absorption. 5

Surgical Prophylaxis

• Clean-contaminated or potentially contaminated procedures: 1.5 grams IV administered 30-60 minutes before initial incision, then 750 mg IV/IM every 8 hours for prolonged procedures 1
• Open heart surgery: 1.5 grams IV at induction of anesthesia, then every 12 hours for a total of 6 grams 1

Pediatric Dosing (Children >3 Months)

For children over 3 months of age, cefuroxime is dosed at 50-100 mg/kg/day IV divided every 6-8 hours for most infections, with higher doses required for severe infections and meningitis. 1

Intravenous Dosing by Severity

• Most susceptible infections: 50-100 mg/kg/day IV in divided doses every 6-8 hours 1
• Severe or serious infections: 100 mg/kg/day IV (not to exceed maximum adult dosage) 1
• Bone and joint infections: 150 mg/kg/day IV (not to exceed maximum adult dosage) in divided doses every 8 hours 1
• Bacterial meningitis: 200-240 mg/kg/day IV in divided doses every 6-8 hours 1

Oral Cefuroxime Axetil Dosing

• Children 1-24 months: 125 mg twice daily 5
• Children 2-12 years: 250 mg twice daily 5
• Children ≥8 years with Lyme disease: 30 mg/kg/day in 2 divided doses (maximum 500 mg per dose) 4

Renal Impairment Dosing

Dose reduction is mandatory in renal impairment, with dosing frequency adjusted based on creatinine clearance. 1, 6

Adult Dosing Adjustments

Creatinine Clearance	Dose	Frequency
>20 mL/min	750 mg - 1.5 grams	Every 8 hours
10-20 mL/min	750 mg	Every 12 hours
<10 mL/min	750 mg	Every 24 hours

1

Patients on hemodialysis require an additional dose after each dialysis session. 1

The elimination half-life increases dramatically with declining renal function, ranging from 4.2 hours (creatinine clearance 23 mL/min) to 22.3 hours (creatinine clearance 5 mL/min). 6

Pediatric Renal Impairment

In pediatric patients with renal insufficiency, modify dosing frequency consistent with adult recommendations. 1

Treatment Duration

• Most infections: 5-10 days 1, 3
• Streptococcus pyogenes infections: Minimum 10 days to prevent rheumatic fever or glomerulonephritis 1
• Early Lyme disease: 14-21 days 4, 5
• Chronic urinary tract infections: May require several months of treatment 1

Continue therapy for a minimum of 48-72 hours after the patient becomes asymptomatic or after bacterial eradication is documented. 1

Sequential IV-to-Oral Therapy

For community-acquired pneumonia, sequential therapy with IV cefuroxime (750 mg 2-3 times daily for 2-5 days) followed by oral cefuroxime axetil (500 mg twice daily for 3-8 days) is effective. 3

This approach provides similar efficacy to other sequential regimens and allows earlier hospital discharge. 3

Critical Dosing Considerations

• Do not use doses smaller than those indicated, as subtherapeutic dosing promotes resistance 1
• Surgical drainage is required when indicated for staphylococcal and other infections involving pus collections 1
• Cefuroxime axetil absorption increases by approximately 68% when taken with food, making food administration essential 5, 2
• First-generation cephalosporins (e.g., cephalexin) are inactive against Borrelia burgdorferi and should never be substituted for cefuroxime in Lyme disease 4
• For animal bites requiring parenteral therapy, use IV cefuroxime 1 gram every 8 hours; when oral therapy is appropriate, use cefuroxime axetil 500 mg twice daily 5

Common Pitfalls

• Avoid twice-daily dosing for serious infections: Every 8-hour dosing is necessary to maintain consistent therapeutic serum and tissue concentrations for severe infections 5
• Do not rely on serum creatinine alone in elderly patients: Calculate estimated GFR, as age-related muscle loss can mask renal impairment 7
• Verify renal function before initiating therapy, especially in patients receiving concomitant nephrotoxic agents like furosemide, though cefuroxime itself shows no evidence of nephrotoxicity 6