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2nd Generation Cephalosporin

Cefuroxime

Brand names: Zinnat (oral), Zinacef (IV)

Cefuroxime is a second-generation cephalosporin used in children for respiratory, urinary and other infections, and for surgical prophylaxis, available in oral and parenteral forms.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Adults and children 40 kg and over: 750 mg to 1.5 g per dose depending on indication (parenteral cefuroxime sodium)
Route: Intravenous injection over 3 to 5 minutes directly into a vein or via a drip tube, or deep intramuscular injection — §4.2: 'Intramuscular injections should be injected well within the bulk of a relatively large muscle and not more than 750 mg should be injected at one site. For doses greater than 1.5 g intravenous administration should be used.' INJECTABLE ROUTE ONLY — no oral (cefuroxime axetil) source was fetched.
Frequency: Every 8 hours; severe infections 750 mg every 6 hours intravenously or 1.5 g every 8 hours intravenously
SCOPE: this dose line is the ADULT / ≥40 kg regimen — children under 40 kg are dosed by weight, see the paediatric dose. UK SPC §4.2 Table 1 (Adults and children ≥40 kg), verbatim by indication: community acquired pneumonia and acute exacerbations of chronic bronchitis '750 mg every 8 hours (intravenously or intramuscularly)'; soft-tissue infections (cellulitis, erysipelas and wound infections), intra-abdominal infections, and complicated urinary tract infections including pyelonephritis '1.5 g every 8 hours (intravenously or intramuscularly)'; severe infections '750 mg every 6 hours (intravenously)' or '1.5 g every 8 hours (intravenously)'. Surgical prophylaxis for gastrointestinal, gynaecological (including caesarean section) and orthopaedic operations: '1.5 g with the induction of anaesthesia. This may be supplemented with two 750 mg doses (intramuscularly) after 8 hours and 16 hours'. Surgical prophylaxis for cardiovascular and oesophageal operations: '1.5 g with induction of anaesthesia followed by 750 mg (intramuscularly) every 8 hours for a further 24 hours'. NO MAXIMUM DOSE is stated in the UK SPC, so maxDose is left empty — the live page's '9 g/day IV' appears in neither fetched label. The US cross-check states an indication-specific ceiling that is NOT carried across to this general dose line: 'In bacterial meningitis, the dosage should not exceed 3 grams every 8 hours'; it otherwise gives 'The usual adult dosage range for cefuroxime is 750 mg to 1.5 grams every 8 hours, usually for 5 to 10 days', '1.5 grams every 6 hours may be required' in life-threatening infections or infections due to less susceptible organisms, and for open heart surgery '1.5 gram dose administered intravenously at the induction of anesthesia and every 12 hours thereafter for a total of 6 grams'. ORAL DOSING IS UNSOURCED: this page also lists oral cefuroxime axetil (Zinnat) 250–500 mg BD; no oral SPC was fetched, so that regimen is neither confirmed nor published here — do not read the injectable figures above as oral doses.

Paediatric dose

Dose: 60 mg/kg/day
Route: Intravenous (UK SPC Table 2 gives intravenous dosing for children under 40 kg)
Frequency: Total daily dose given as 3 or 4 divided doses in infants and toddlers from 3 weeks of age and children under 40 kg; 2 or 3 divided doses in infants from birth to 3 weeks
THE FIGURE ABOVE IS A TOTAL DAILY DOSE, NOT A SINGLE DOSE — divide it by the number of doses per day (e.g. 60 mg/kg/day in 4 divided doses = 15 mg/kg per dose; a 12 kg child = 720 mg per day = 180 mg per dose). UK SPC §4.2 Table 2 (children under 40 kg), verbatim, covering community acquired pneumonia, complicated urinary tract infections including pyelonephritis, soft-tissue infections (cellulitis, erysipelas and wound infections) and intra-abdominal infections: infants and toddlers from 3 weeks and children under 40 kg — '30 to 100 mg/kg/day (intravenously) given as 3 or 4 divided doses; a dose of 60 mg/kg/day is appropriate for most infections'; infants from birth to 3 weeks — '30 to 100 mg/kg/day (intravenously) given as 2 or 3 divided doses'. The calculator uses the 60 mg/kg/day figure the SPC calls appropriate for most infections; the full sourced range is 30 to 100 mg/kg/day. Children weighing 40 kg or more receive the adult dosage above. No maximum paediatric dose is published because the ceilings in the sources are themselves per-kg values, which cannot safely cap a per-kg calculation: US cross-check, 'Pediatric Patients Above 3 Months of Age: Administration of 50 to 100 mg/kg/day in equally divided doses every 6 to 8 hours has been successful for most infections susceptible to cefuroxime. The higher dosage of 100 mg/kg/day (not to exceed the maximum adult dosage) should be used for the more severe or serious infections. In bone and joint infections, 150 mg/kg/day (not to exceed the maximum adult dosage) is recommended in equally divided doses every 8 hours... In cases of bacterial meningitis, a larger dosage of cefuroxime is recommended, 200 to 240 mg/kg/day intravenously in divided doses every 6 to 8 hours.' The US label adds 'Safety and effectiveness in pediatric patients below 3 months of age have not been established', whereas the UK SPC does dose infants from birth — the UK SPC governs here. Renal impairment in children (US label): 'the frequency of dosing should be modified consistent with the recommendations for adults'. No reconstituted concentration (mg/mL) is given in the fetched sections (§6.6 was not retrieved), so the volume calculation is disabled. INTRAVENOUS ONLY — oral cefuroxime axetil suspension is not covered by any fetched source. Verify all paediatric dosing against a children's formulary before administration.

Dose adjustments

Renal

UK SPC §4.2: 'Cefuroxime is primarily excreted by the kidneys. Therefore, as with all such antibiotics, in patients with markedly impaired renal function it is recommended that the dosage of cefuroxime should be reduced to compensate for its slower excretion.' Table 3, verbatim: creatinine clearance >20 mL/min/1.73 m² — 'It is not necessary to reduce the standard dose (750 mg to 1.5 g three times daily)'; 10–20 mL/min/1.73 m² — '750 mg twice daily'; <10 mL/min/1.73 m² — '750 mg once daily'; patients on haemodialysis — 'A further 750 mg dose should be given intravenously or intramuscularly at the end of each dialysis; in addition to parenteral use, cefuroxime sodium can be incorporated into the peritoneal dialysis fluid (usually 250 mg for every 2 litres of dialysis fluid)'; patients in renal failure on continuous arteriovenous haemodialysis (CAVH) or high-flux haemofiltration in intensive therapy units — '750 mg twice daily; for low-flux haemofiltration follow the dosage recommended under impaired renal function.' In children with renal insufficiency the US label directs that 'the frequency of dosing should be modified consistent with the recommendations for adults'.

Hepatic

No adjustment stated — UK SPC §4.2, verbatim: 'Cefuroxime is primarily eliminated by the kidney. In patients with hepatic dysfunction this is not expected to affect the pharmacokinetics of cefuroxime.'

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

THE FIGURE ABOVE IS A TOTAL DAILY DOSE, NOT A SINGLE DOSE — divide it by the number of doses per day (e.g. 60 mg/kg/day in 4 divided doses = 15 mg/kg per dose; a 12 kg child = 720 mg per day = 180 mg per dose). UK SPC §4.2 Table 2 (children under 40 kg), verbatim, covering community acquired pneumonia, complicated urinary tract infections including pyelonephritis, soft-tissue infections (cellulitis, erysipelas and wound infections) and intra-abdominal infections: infants and toddlers from 3 weeks and children under 40 kg — '30 to 100 mg/kg/day (intravenously) given as 3 or 4 divided doses; a dose of 60 mg/kg/day is appropriate for most infections'; infants from birth to 3 weeks — '30 to 100 mg/kg/day (intravenously) given as 2 or 3 divided doses'. The calculator uses the 60 mg/kg/day figure the SPC calls appropriate for most infections; the full sourced range is 30 to 100 mg/kg/day. Children weighing 40 kg or more receive the adult dosage above. No maximum paediatric dose is published because the ceilings in the sources are themselves per-kg values, which cannot safely cap a per-kg calculation: US cross-check, 'Pediatric Patients Above 3 Months of Age: Administration of 50 to 100 mg/kg/day in equally divided doses every 6 to 8 hours has been successful for most infections susceptible to cefuroxime. The higher dosage of 100 mg/kg/day (not to exceed the maximum adult dosage) should be used for the more severe or serious infections. In bone and joint infections, 150 mg/kg/day (not to exceed the maximum adult dosage) is recommended in equally divided doses every 8 hours... In cases of bacterial meningitis, a larger dosage of cefuroxime is recommended, 200 to 240 mg/kg/day intravenously in divided doses every 6 to 8 hours.' The US label adds 'Safety and effectiveness in pediatric patients below 3 months of age have not been established', whereas the UK SPC does dose infants from birth — the UK SPC governs here. Renal impairment in children (US label): 'the frequency of dosing should be modified consistent with the recommendations for adults'. No reconstituted concentration (mg/mL) is given in the fetched sections (§6.6 was not retrieved), so the volume calculation is disabled. INTRAVENOUS ONLY — oral cefuroxime axetil suspension is not covered by any fetched source. Verify all paediatric dosing against a children's formulary before administration.

Verify in a children's formulary

Contraindications

  • Hypersensitivity to cefuroxime or to any of the cephalosporins — UK SPC §4.3.
  • Previous immediate and/or severe hypersensitivity (e.g. anaphylactic reaction) to any other type of beta-lactam antibacterial agent (penicillins, monobactams and carbapenems) — UK SPC §4.3.
  • Product-specific (US premix only): 'Solutions containing dextrose may be contraindicated in patients with hypersensitivity to corn products' — applies to the cefuroxime-and-dextrose container, not to reconstituted cefuroxime sodium vials.
  • Not a contraindication but a §4.4 rule: if a patient has developed Stevens-Johnson syndrome, toxic epidermal necrolysis or DRESS with cefuroxime, 'treatment with cefuroxime must not be restarted in this patient at any time'.

Side effects

  • Most common (§4.8): neutropenia, eosinophilia, transient rise in liver enzymes or bilirubin (particularly in patients with pre-existing liver disease) and injection site reactions.
  • Common (§4.8): neutropenia, eosinophilia, decreased haemoglobin concentration; gastrointestinal disturbance; transient rise in liver enzymes; skin rash, urticaria and pruritus; injection site reactions which may include pain and thrombophlebitis.
  • Uncommon (§4.8): leukopenia, positive Coombs test; transient rise in bilirubin; Candida overgrowth and overgrowth of Clostridium difficile; pseudomembranous colitis.
  • Not known / rare (§4.8): thrombocytopenia, haemolytic anaemia; drug fever, interstitial nephritis, anaphylaxis, cutaneous vasculitis; erythema multiforme, toxic epidermal necrolysis and Stevens-Johnson syndrome, angioneurotic oedema, DRESS; elevations in serum creatinine and blood urea nitrogen with decreased creatinine clearance; Kounis syndrome.
  • Class effect (§4.8): 'Cephalosporins as a class tend to be absorbed onto the surface of red cell membranes and react with antibodies directed against the drug to produce a positive Coombs test (which can interfere with cross matching of blood) and very rarely haemolytic anaemia.' 'Pain at the intramuscular injection site is more likely at higher doses.' The paediatric safety-profile paragraph is truncated at the source-fetch limit.

Monitoring

  • Renal function — §4.4: 'Renal function should be monitored in the elderly and those with known pre-existing renal impairment', and cephalosporins at high dosage should be given with caution to patients on potent diuretics such as furosemide or aminoglycosides because renal impairment has been reported with these combinations.
  • Skin — §4.4: severe cutaneous adverse reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS) have been reported; 'At the time of prescription patients should be advised of the signs and symptoms and monitored closely for skin reactions.' Withdraw cefuroxime immediately if they appear.
  • Diarrhoea — §4.4: antibacterial-associated pseudomembranous colitis has been reported and 'should be considered in patients with diarrhoea during or subsequent to the administration of cefuroxime'; medicinal products that inhibit peristalsis should not be given.
  • Hypersensitivity — §4.4: establish before treatment whether the patient has a history of severe hypersensitivity to cefuroxime, other cephalosporins or any other beta-lactam; discontinue immediately and start emergency measures if a severe reaction occurs.
  • Superinfection — §4.4: prolonged use may result in overgrowth of Candida and of other non-susceptible organisms (e.g. enterococci, Clostridium difficile), which may require interruption of treatment.

Clinical monograph

How it works

It inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins, with useful activity against many Gram-positive and Gram-negative organisms and stability against some beta-lactamases.

Prescribing in practice

  • Check for penicillin or cephalosporin hypersensitivity before prescribing, as cross-reactivity can cause serious allergic reactions.
  • Dose by weight using a children's formulary, with adjustment in renal impairment, and take the oral form with food to improve absorption.
  • As with other broad-spectrum antibiotics, there is a risk of antibiotic-associated diarrhoea including Clostridioides difficile.

Monitoring

Monitor clinical response and watch for allergic reactions or persistent diarrhoea during treatment.

Counselling the patient

  • Give the oral medicine with food and complete the full course.
  • Report any rash, facial swelling or difficulty breathing straight away.
  • Mention any previous reaction to penicillins or cephalosporins.

Evidence & guidelines

Cefuroxime is an established cephalosporin used across a range of paediatric infections and surgical prophylaxis in UK practice.

Reference: NICE NG143; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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