2nd Generation Cephalosporin
Pregnancy: Compatible — cephalosporins widely used in pregnancy
Cefuroxime
Brand names: Zinnat (oral), Zinacef (IV)
Adult dose
Dose: Oral: 250–500 mg BD. IV: 750 mg–1.5 g every 6–8h
Route: Oral or IV
Frequency: BD (oral) or every 6–8h (IV)
Max: 9 g/day IV
For community-acquired pneumonia, skin/soft tissue infections, UTI, surgical prophylaxis
Paediatric dose
Dose: 10 mg/kg
Route: Oral or IV
Frequency: BD (oral) or every 6–8h (IV)
Max: 250 mg per oral dose; 1.5 g per IV dose
Concentration: 125 mg/5 mL suspension (oral); 250 mg vial (IV) mg/ml
BNF for Children: oral 10 mg/kg BD (max 250 mg BD) for mild-moderate infections. IV: 30–100 mg/kg/day in 3 divided doses (severe: up to 50 mg/kg every 6h). Neonates IV: 25 mg/kg every 12h. Meningitis: 50 mg/kg every 6–8h IV. Source: BNF for Children 2024; NICE NG143
Dose adjustments
Renal
Reduce dose if eGFR <20
Hepatic
No dose adjustment required
Paediatric weight-based calculator
BNF for Children: oral 10 mg/kg BD (max 250 mg BD) for mild-moderate infections. IV: 30–100 mg/kg/day in 3 divided doses (severe: up to 50 mg/kg every 6h). Neonates IV: 25 mg/kg every 12h. Meningitis: 50 mg/kg every 6–8h IV. Source: BNF for Children 2024; NICE NG143
Clinical pearls
- Oral cefuroxime axetil suspension has poor palatability in children — ensure adherence counselling
- Good tissue penetration — used for bone and joint infections
- Zinacef IV useful for surgical prophylaxis: given 30 min before surgical incision
- Do not confuse with cefuroxime sodium (IV) and cefuroxime axetil (oral) — different formulations
Contraindications
- Cephalosporin allergy
- Penicillin allergy with immediate hypersensitivity (cross-reactivity ~2%)
Side effects
- Diarrhoea
- Nausea
- Rash
- Pseudomembranous colitis (C. diff)
- Positive Coombs test
Interactions
- Anticoagulants — may enhance warfarin effect
- Loop diuretics — additive nephrotoxicity (rare)
Monitoring
- Clinical response
- Renal function in prolonged IV use
- C. diff risk factors
Reference: BNF for Children; NICE NG143; BNFC. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators