Therapeutic Dose of Cefuroxime Oral Drops
For children aged 1-24 months, administer cefuroxime oral suspension 125 mg twice daily, and for children aged 2-12 years, administer 250 mg twice daily. 1, 2, 3
Pediatric Oral Dosing by Age
The dosing of oral cefuroxime (cefuroxime axetil suspension) follows a straightforward age-based algorithm:
- 1-24 months: 125 mg twice daily (every 12 hours) 1, 2
- 2-12 years: 250 mg twice daily (every 12 hours) 1, 2
- Children ≥8 years (alternative weight-based approach): 30 mg/kg/day divided into two doses, maximum 500 mg per dose 3
Administration Guidelines
Cefuroxime axetil suspension must be taken with food to increase absorption. 3 This is critical for achieving therapeutic serum concentrations, as bioavailability is significantly enhanced when administered with meals. 4
Duration of Therapy
Treatment duration varies by indication:
- Most common infections (otitis media, pharyngitis, sinusitis): 5-10 days 5
- Urinary tract infections: 10 days 6
- Early Lyme disease: 14-21 days 3
Shorter 5-day courses have proven as effective as 10-day courses for uncomplicated respiratory infections. 5
Adult Dosing
For adults, the standard oral dose is 250-500 mg twice daily, with 500 mg twice daily recommended for more severe infections such as pneumonia. 3 The maximum adult daily dose is 4000 mg/day. 3
Renal Impairment Adjustments
While the provided guidelines do not specify oral dosing adjustments for renal impairment in detail, cefuroxime is primarily renally excreted with a clearance of 150 ml/min/1.73m². 7 For patients with creatinine clearance <30 ml/minute receiving oral therapy, dose reduction by 50% is prudent based on parenteral dosing principles. 1
Important Clinical Considerations
First-generation cephalosporins (e.g., cephalexin) are ineffective against certain pathogens like Borrelia burgdorferi and should never be substituted for cefuroxime when treating Lyme disease. 3
The drug provides excellent coverage against beta-lactamase-producing strains of H. influenzae, S. pneumoniae, S. pyogenes, M. catarrhalis, and common enterobacteria. 1, 4 However, it does not cover methicillin-resistant S. aureus (MRSA), requiring additional coverage with vancomycin or clindamycin when MRSA is suspected. 2
Adverse Effects Monitoring
Monitor for gastrointestinal symptoms including nausea, vomiting, abdominal pain, and diarrhea, which are the most common adverse effects but typically mild and transient. 1, 4 Any patient developing diarrhea during or after therapy requires evaluation for Clostridioides difficile infection. 2 Cutaneous rash and allergic manifestations may occur. 2
Allergy Considerations
For patients with documented penicillin/cephalosporin allergy requiring parenteral therapy, the alternative is clindamycin 900 mg IV plus gentamicin 5 mg/kg/day. 8 The severity of the beta-lactam allergy should guide whether cefuroxime can be used, as cross-reactivity occurs in approximately 10% of penicillin-allergic patients. 2