Cefuroxime Dosage

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Usual Adult Dose for Bronchitis

250 to 500 mg orally twice a day or 750 mg to 1.5 grams IV or IM every 8 hours for 5 to 10 days

Usual Adult Dose for Cystitis

Uncomplicated: 250 mg orally twice a day or 750 mg IV or IM every 8 hours for 7 to 10 days

Usual Adult Dose for Epiglottitis

1.5 g IV every 6 to 8 hours for 7 to 10 days, depending on the nature and severity of the infection

Usual Adult Dose for Gonococcal Infection - Disseminated

750 mg to 1.5 g IV every 8 hours

Parenteral therapy should be continued for 24 to 48 hours after clinical improvement is demonstrated. Oral therapy with cefixime or cefpodoxime may then be continued to complete a total course of at least 1 week.

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin (1 g) is also recommended to treat possible concurrent chlamydial infection.

The patient's sexual partner(s) should also be evaluated/treated.

Usual Adult Dose for Gonococcal Infection - Uncomplicated

Uncomplicated infections of the cervix, urethra, or rectum:
Oral: 1 g orally one time
Intramuscular: 1.5 g IM (0.75 g administered in two separate sites) one time with 1 g probenecid orally

Doxycycline therapy for 7 days (if not pregnant) or single dose azithromycin (1 g) is also recommended to treat possible concurrent chlamydial infection.

The patient's sexual partner(s) should also be evaluated/treated.

The Centers for Disease Control and Prevention suggest cefuroxime axetil may be effective as an oral alternative for the treatment of uncomplicated gonorrhea of the cervix, urethra, or rectum.

Usual Adult Dose for Joint Infection

1.5 g IV every 8 hours
Therapy should be continued for approximately 3 to 4 weeks, depending on the nature and severity of the infection. Longer therapy, 6 weeks or more, may be required for prosthetic joint infections. In addition, removal of the involved prosthesis is usually required.

Usual Adult Dose for Lyme Disease

500 mg orally twice a day for 20 days

The Infectious Diseases Society of America has recommended oral cefuroxime as an alternative to amoxicillin or doxycycline for the treatment of Lyme disease when oral therapy is appropriate (erythema chronicum migrans, cranial nerve palsy, first or second degree heart block, and arthritis). Febrile patients should also be evaluated/treated for human granulocytic ehrlichiosis (HGE) and babesiosis.

Usual Adult Dose for Meningitis

1.5 g IV every 6 hours or 3 g IV every 8 hours for 14 days

Usual Adult Dose for Osteomyelitis

1.5 g IV every 8 hours
Therapy should be continued for approximately four to six weeks depending on the nature and severity of the infection. Chronic osteomyelitis may require an additional one to two months of oral antimicrobial therapy.

Usual Adult Dose for Otitis Media

250 mg orally twice a day for 10 days

Usual Adult Dose for Peritonitis

750 mg to 1.5 g IV every 8 hours for 10 to 14 days

CAPD-associated peritonitis: 1 gram per 2 liters of dialysate intraperitoneally, followed by a continuous maintenance dosage of 150 to 400 mg per 2 liters of dialysate

Usual Adult Dose for Pneumonia

Uncomplicated: 750 mg IV or IM every 8 hours
Complicated: 1.5 g IV or IM every 8 hours

Once the patient responds clinically to parenteral therapy, cefuroxime 250 mg to 500 mg orally every 8 hours for 7 to 21 days may be administered. Duration of therapy is dependent upon the suspected causative organism's sensitivity to cefuroxime.

Usual Adult Dose for Pyelonephritis

750 mg to 1.5 g every 8 hours or 250 to 500 mg orally twice a day for 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Sepsis

1.5 g IV every 6 to 8 hours, in combination with an aminoglycoside
Therapy should be continued for 7 to 21 days depending on the nature and severity of the infection.

Usual Adult Dose for Sinusitis

250 mg orally twice a day for 10 to 14 days

Usual Adult Dose for Skin or Soft Tissue Infection

250 to 500 mg orally twice a day (uncomplicated infections) or 750 mg IV every 8 hours for 10 days

Usual Adult Dose for Surgical Prophylaxis

Preoperative: 1.5 g IV 30 to 60 minutes before the initial incision
Postoperative: 750 mg IV or IM every 8 hours when the procedure is prolonged
Open heart surgery: 1.5 g IV at induction and every 12 hours thereafter for a total of 6 g

Cefuroxime prophylaxis is recommended as alternative to cefazolin for cardiothoracic surgery, heart transplantation, and lung or heart-lung transplantation. Cefazolin is considered the drug of choice in clean operations because it is active against Staphylococcus aureus and S epidermidis, has a long duration of action, and is relatively inexpensive. Alternatively, vancomycin may be indicated in patients with severe beta-lactam hypersensitivity or for major surgeries at institutions with high rates of MRSA or MRSE infections.

Usual Adult Dose for Tonsillitis/Pharyngitis

250 mg orally twice a day for 10 days

Usual Adult Dose for Upper Respiratory Tract Infection

250 to 500 mg orally twice a day

Usual Adult Dose for Urinary Tract Infection

Uncomplicated: 250 mg orally twice a day for 7 to 10 days or 750 mg IV every 8 hours
Complicated: 1.5 g IV every 8 hours

Usual Pediatric Dose for Epiglottitis

3 months to 12 years: 50 to 100 mg/kg/day IV in divided doses every 6 to 8 hours (maximum 6 g/day) for 7 to 10 days, depending on the nature and severity of the infection

Usual Pediatric Dose for Joint Infection

3 months to 12 years: 50 mg/kg IV every 8 hours (maximum 6 g/day)
13 years or older: Adult dose

Usual Pediatric Dose for Osteomyelitis

3 months to 12 years: 50 mg/kg IV every 8 hours (maximum 6 g/day)
13 years or older: Adult dose

Usual Pediatric Dose for Meningitis

3 months to 12 years: 200 mg to 240 mg/kg/day IV in divided doses every 6 to 8 hours (maximum 9 g/day)
13 years or older: Adult dose

Usual Pediatric Dose for Otitis Media

3 months to 12 years: 250 mg tablet orally twice a day for 10 days or 15 mg/kg of the suspension twice a day for 10 days; maximum daily dose is 1000 mg
13 years or older: Adult dose

Usual Pediatric Dose for Sinusitis

3 months to 12 years: 250 mg tablet orally twice a day for 10 days or 15 mg/kg of the suspension orally twice a day for 10 to 14 days; maximum daily dose is 1000 mg
13 years or older: Adult dose

Usual Pediatric Dose for Skin and Structure Infection

3 months to 12 years: 15 mg/kg of the suspension orally twice a day for 10 days; maximum daily dose is 1000 mg

Usual Pediatric Dose for Impetigo

3 months to 12 years: 15 mg/kg of the suspension orally twice a day for 10 days; maximum daily dose is 1000 mg

Usual Pediatric Dose for Tonsillitis/Pharyngitis

3 months to 12 years: 10 mg/kg of the suspension twice a day for 10 days; maximum daily dose is 500 mg
13 years or older: Adult dose

Usual Pediatric Dose for Bacterial Infection

3 months to 12 years:
Parenteral: 50 to 100 mg/kg/day IV or IM in divided doses every 6 to 8 hours (maximum daily dose 6 g), depending on the nature and severity of the infection
Oral:
Suspension: 10 to 15 mg/kg orally twice a day (maximum dose 1000 mg/day)
Tablets: 250 mg orally twice a day

13 years or older: Adult dose

Renal Dose Adjustments

Oral: No dose adjustments are recommended.

Parenteral:
CrCl 10 to 20 mL/min: 750 mg every 12 hours
CrCl less than 10 mL/min: 750 mg every 24 hours

Liver Dose Adjustments

No adjustment recommended

Precautions

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following cephalosporin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Superinfection with nonsusceptible organisms (i.e., yeasts) may occur with prolonged cephalosporin therapy.

Patients with phenylketonuria should be aware that some formulations (e.g., oral suspension) contain phenylalanine.

Dosage adjustments are recommended in patients with renal insufficiency (CrCl less than 20 mL/min). Some cephalosporins have been associated with seizures in renally impaired patients with elevated serum concentrations. The drug should be discontinued if seizures occur. Nephrotoxicity has occurred with concomitant cephalosporins and aminoglycosides or potent diuretics. Renal function should be monitored, especially in elderly patients.

The oral tablets and suspension were not bioequivalent when tested in adults and should not be substituted for each other on a milligram-per-milligram basis.

Crushed tablets should not be given to pediatric patients due to their strong bitter taste.

To reduce the risk of development of drug resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria. Culture and susceptibility information should be considered when selecting treatment or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy. Patients should be advised to avoid missing doses and to complete the entire course of therapy.

Safety and efficacy have not been established in infants less than 3 months old.

Dialysis

Cefuroxime is dialyzable (25%). Patients on hemodialysis should be given an additional dose at the end of the dialysis.

Other Comments

Tablets and suspension are not bioequivalent and not substitutable on a mg/mg basis.

The oral suspension should be refrigerated immediately following reconstitution. It should be shaken well before each use and administered with food. Any remaining oral suspension should be discarded after 10 days.

Cefuroxime should be continued for a minimum of 48 to 72 hours after the patient becomes asymptomatic or after evidence of bacterial eradication has been obtained; a minimum of 10 days of treatment is recommended in infections caused by Streptococcus pyogenes in order to guard against the risk of rheumatic fever or glomerulonephritis.

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