What is the appropriate oral therapeutic dose of cefuroxime (cefuroxime axetil) for infants, children, adults, and patients with renal impairment?

Cefuroxime Therapeutic Dosing

Cefuroxime axetil (oral) should be dosed at 125 mg twice daily for infants 1-24 months, 250 mg twice daily for children 2-12 years, and 250-500 mg twice daily for adults, with dose reductions required when creatinine clearance falls below 30 mL/min. 1

Oral Dosing (Cefuroxime Axetil)

Pediatric Patients

• Infants 1-24 months: 125 mg twice daily (every 12 hours) 1, 2
• Children 2-12 years: 250 mg twice daily (every 12 hours) 1, 2
• Alternative weight-based dosing: 20-50 mg/kg/day divided into two doses, maximum 500 mg per dose 2, 3

Adults

• Standard infections: 250 mg twice daily 3, 4
• Severe lower respiratory tract infections or pneumonia: 500 mg twice daily 3, 4, 5
• Uncomplicated gonorrhea: Single 1000 mg dose 4
• Early Lyme disease: 500 mg twice daily for 14-21 days 3
• Maximum daily dose: 4000 mg/day 3

Critical administration note: Cefuroxime axetil must be taken with food to optimize absorption 3

Intravenous Dosing (Cefuroxime Sodium)

Pediatric Patients

• Neonates <7 days: 30 mg/kg IV every 12 hours 2
• Neonates >7 days: 30 mg/kg IV every 8 hours 2
• Infants >1 month: 100-150 mg/kg/day divided every 6-8 hours 2
• General pediatric dosing: 20-30 mg/kg three times daily (every 8 hours), maximum 1500 mg per dose 1, 2
• Complicated intra-abdominal infections: 150 mg/kg/day divided every 6-8 hours 2
• Bacterial meningitis: 200-240 mg/kg/day divided every 6-8 hours (though third-generation cephalosporins are preferred) 2

Adults

• Standard infections: 750 mg IV every 8 hours 3
• Severe infections: 750-1500 mg IV every 8 hours 3
• Surgical prophylaxis: 1500 mg IV single dose pre-incision, with 750 mg re-dosing every 2 hours intraoperatively if procedure exceeds 2 hours 3

The every-8-hour dosing interval for IV administration is essential to maintain therapeutic serum concentrations for serious infections, unlike the twice-daily oral regimen. 3

Renal Impairment Dosing

For patients with creatinine clearance <30 mL/min, reduce the oral cefuroxime dose by approximately 50%. 2 This adjustment extrapolates from parenteral dosing recommendations and is critical to prevent drug accumulation 2.

Sequential IV-to-Oral Therapy

For hospitalized patients with community-acquired pneumonia, a validated approach involves:

• Initial IV therapy: Cefuroxime 750 mg IV 2-3 times daily for 2-5 days 5, 6
• Transition to oral: Cefuroxime axetil 500 mg twice daily for 3-8 days 5
• Pediatric sequential therapy: IV cefuroxime 75 mg/kg/day in three divided doses for 48-72 hours, followed by oral suspension 30 mg/kg/day in two divided doses 6

This sequential approach demonstrated equivalent efficacy to full parenteral courses and other combination regimens 5, 6.

Common Pitfalls to Avoid

• Do not use 250 mg oral dose in infants <24 months: The guideline-specified dose for this age group is 125 mg twice daily regardless of weight 7
• Do not confuse dosing intervals: IV cefuroxime requires every-8-hour dosing for serious infections, while oral formulations are dosed every 12 hours 1, 3
• Do not substitute first-generation cephalosporins for Lyme disease: Cephalexin is ineffective against Borrelia burgdorferi 3
• Do not forget food requirement: Oral cefuroxime axetil absorption is significantly enhanced when taken with food 3

Adverse Effects Monitoring

The most common adverse effects are mild gastrointestinal symptoms including nausea, vomiting, abdominal pain, and diarrhea 1, 2, 4. Any patient developing diarrhea during or after cefuroxime therapy requires evaluation for Clostridioides difficile infection. 2 Hypersensitivity reactions including rash may occur 2.