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Cefuroxime is a second-generation cephalosporin antibiotic used in pediatrics for select respiratory and skin infections when clinically appropriate.
Dose 20–30 mg/kg/day divided every 12 hours (max 500 mg per dose) for most ENT infections.
Administer with food to improve absorption and minimize gastrointestinal upset.
Evaluate response after 48–72 hours; lack of improvement warrants culture review and potential therapy change.
Avoid for suspected atypical pathogens—consider macrolide or doxycycline options in age-appropriate patients.
Cefuroxime is a twice‑daily oral cephalosporin used in pediatrics as an alternative for common infections when aminopenicillins are unsuitable.
Most pediatric use is for AOM and sinusitis as an alternative choice; for GAS pharyngitis it is an option when penicillins cannot be used.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Acute otitis media | Infants ≥6 months and children | No | Use when amoxicillin or amoxicillin-clavulanate are contraindicated or not tolerated; target beta-lactamase-producing organisms. |
| Acute bacterial rhinosinusitis | Children and adolescents | No | Consider for short-course rescue therapy when first-line beta-lactams fail or cannot be used and susceptibility supports coverage. |
| Group A Streptococcal pharyngitis | Children and adolescents | No | Reserve for patients who cannot take penicillins; ensure 10-day course to eradicate Streptococcus pyogenes. |
| Uncomplicated skin and soft tissue infections | Children and adolescents | No | Covers MSSA and Streptococcus pyogenes; choose based on culture results and allergy profile. |
FDA-approved primary uses with Level A evidence
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Most side effects are mild and self‑limited. Gastrointestinal symptoms (diarrhea, nausea) and rash are most common in children. Serious reactions like anaphylaxis or C. difficile–associated diarrhea (CDAD) are rare but require urgent care.
Cefuroxime’s pediatric safety profile is similar to other oral cephalosporins. GI upset often improves if given with food. Allergic reactions can occur in those with beta‑lactam hypersensitivity.
Diarrhea
Common • mild
Nausea/Vomiting
Common • mild
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Rash (maculopapular)
Common • variable
Urticaria (hives)
Uncommon • moderate
Anaphylaxis
Rare • severe
Headache
Common • mild
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Practical guidance for giving cefuroxime safely to children.
Different formulations and concentrations
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Cefuroxime is a second-generation cephalosporin that inhibits bacterial cell wall synthesis with improved stability against beta-lactamases from respiratory pathogens.
It binds penicillin-binding proteins (PBPs), preventing peptidoglycan cross-linking. The oral prodrug cefuroxime axetil is hydrolyzed to active cefuroxime in the intestine.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Cefuroxime is a reliable beta-lactamase–stable option when first-line amoxicillin regimens fail. These pearls help clinicians use it effectively.
Focus on meal-paired dosing, allergy clarification, and stewardship to avoid unnecessary broad-spectrum use.
Cefuroxime axetil absorption improves by ~50% with food—advise families to give doses immediately after meals to maximiz…
Many 'penicillin allergies' are non-IgE rashes; document reaction type and timing. Cefuroxime is safe for most delayed r…
Once culture data are available, de-escalate to narrower therapy (e.g., amoxicillin) to preserve cefuroxime for future b…
Educate families about persistent watery diarrhea during or after therapy; counsel on hydration and prompt evaluation.
Core insights every provider should know
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Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Cefuroxime and monitor your child's response to treatment.
Yes. Taking doses with food can help reduce stomach upset and does not reduce effectiveness.
Most children begin to feel better within 48–72 hours. Call your clinician if symptoms worsen or do not improve by then.
Some children with penicillin allergy can still take cephalosporins safely, but those with immediate (anaphylactic) reactions may need an alternative. Discuss with your clinician.