Adult Note: Cefuroxime axetil film-coated tablets and oral suspension are not bioequivalent and are not substitutable on a mg/mg basis. All oral doses listed are for tablet formulation: Acute bacterial maxillary sinusitis: Oral: 250 mg twice daily for 10 days Bone and joint infections: IM, IV: 1.5 g every 8 hours (adjunctive surgical intervention may be necessary); upon completion of parenteral therapy follow with oral antibiotic therapy if indicated. Acute bacterial exacerbations of chronic bronchitis: Oral: 250 to 500 mg every 12 hours for 10 days IV: 500 to 750 mg every 8 hours (complete therapy with oral dosing) Cholecystitis, mild to moderate (off-label): IV: 1.5 g every 8 hours for 4 to 7 days (provided source controlled) (IDSA [Solomkin 2010]) Intra-abdominal infection, complicated, community-acquired, mild to moderate (in combination with metronidazole): (off-label): IV: 1.5 g every 8 hours for 4 to 7 days (provided source controlled) (IDSA [Solomkin 2010]) Lyme disease (early): Oral: 500 mg twice daily for 20 days Pharyngitis/tonsillitis: Oral: 250 mg twice daily for 10 days Pneumonia, community-acquired: Note: Cefuroxime is considered an alternate therapy for CAP in adults caused by Streptococcus pneumoniae (with MICs <2 mcg/mL for penicillin); may also be used as outpatient empiric therapy in combination with a macrolide (preferred) or doxycycline (IDSA [Mandell 2007]). Oral (off-label route in US): 500 mg twice daily for a minimum of 5 days (patients should be afebrile for ≥48 hours and clinically stable before discontinuing therapy) (IDSA [Mandell 2007]) IM, IV: Manufacturer's labeling: IM, IV: 750 mg every 8 hours Alternate dosing: IV: 1.5 g every 8 hours. Note: This higher dose should be considered in hospitalized patients, especially if bacteremic (Caballero-Granado 1996) Severe or complicated infections: IV: 1.5 g every 8 hours (up to 1.5 g every 6 hours in life-threatening infections) Skin/skin structure infection, uncomplicated: Oral: 250 to 500 mg every 12 hours for 10 days IM, IV: 750 mg every 8 hours Surgical (perioperative) prophylaxis: IV: Manufacturer's labeling: 1.5 g 30 minutes to 1 hour prior to procedure (if procedure is prolonged can give 750 mg every 8 hours IV or IM) Open heart: IV: 1.5 g every 12 hours for a total of 4 doses starting at anesthesia induction Alternative recommendation: 1.5 g within 60 minutes prior to surgical incision. Doses may be repeated in 4 hours if procedure is lengthy or if there is excessive blood loss (Bratzler 2013). Urinary tract infection, uncomplicated: Oral: 250 mg twice daily for 7 to 10 days IV, IM: 750 mg every 8 hours Bite wounds (animal) (off-label use) (IDSA [Stevens 2014]): Oral: 500 mg twice daily in combination with clindamycin or metronidazole for anaerobic coverage Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric Note: Cefuroxime axetil film-coated tablets and oral suspension are not bioequivalent and are not substitutable on a mg/mg basis. Children ≥1 year: Surgical (perioperative) prophylaxis: IV: 50 mg/kg within 60 minutes prior to surgical incision (maximum dose: 1,500 mg). Doses may be repeated in 4 hours if procedure is lengthy or if there is excessive blood loss (Bratzler 2013). Infants ≥3 months and Children: Acute bacterial maxillary sinusitis, acute otitis media: Oral: Suspension: 30 mg/kg/day in 2 divided doses for 10 days (maximum dose: 1,000 mg/day); tablet: 250 mg twice daily for 10 days IM, IV: 75 to 150 mg/kg/day divided every 8 hours (maximum dose: 6 g/day) Bone and joint infection: IM, IV: 50 mg/kg/dose every 8 hours; maximum single dose: 1,500 mg. Upon completion of parenteral therapy follow with oral antibiotic therapy if indicated. Pharyngitis/tonsillitis: Oral: Suspension: 20 mg/kg/day (maximum: 500 mg/day) in 2 divided doses for 10 days IM, IV: 75 to 150 mg/kg day divided every 8 hours (maximum: 6 g/day) Skin and skin structure infection (impetigo): Oral: Suspension: 30 mg/kg/day in 2 divided doses for 10 days (maximum dose: 1,000 mg/day) Urinary tract infection, uncomplicated (off-label dosing): Infants and Children ≥2 months to 2 years: Oral: 20 to 30 mg/kg/day divided twice daily for 7 to 14 days (AAP 2011) Children ≥2 years: Moderate to severe disease (possible pyelonephritis): Oral: 20 to 30 mg/kg/day divided twice daily (maximum dose: 1,000 mg/day) (Bradley 2012; Red Book [AAP 2012]) Adolescents: Acute bacterial exacerbations of chronic bronchitis: Oral: 250 to 500 mg every 12 hours for 10 days. Acute bacterial maxillary sinusitis: Oral: 250 mg twice daily for 10 days. Bone and joint infection: IM, IV: Refer to adult dosing. Lyme disease (early): Oral: 500 mg twice daily for 20 days. Pharyngitis/tonsillitis: Oral: 250 mg every 12 hours for 10 days. Skin/skin structure infection, uncomplicated: Oral: 250 to 500 mg every 12 hours for 10 days. Urinary tract infection, uncomplicated: Oral: 250 mg twice daily for 7 to 10 days.

Cefuroxime is active against gram-negative and gram-positive organisms with minimum inhibitory concentrations (MICs) values of 0.25-125 ug/ml