Recommended Infusion Time for Cefuroxime
Cefuroxime should be administered as a slow IV infusion, with specific infusion times depending on the clinical context: for standard prophylactic use, administer over 30-60 minutes; for vancomycin (as an alternative in allergic patients), infuse over 120 minutes. 1
Standard Infusion Times by Clinical Context
- Cardiac surgery: Cefuroxime 1.5g should be administered as a slow IV infusion, with an additional 0.75g in priming solution 1
- Thoracic surgery: Cefuroxime 900mg should be administered as a slow IV infusion 1
- Orthopedic surgery: Cefuroxime 1.5g should be administered as a slow IV infusion 1
- Cataract surgery: Cefuroxime 1mg should be administered as an intracameral injection (into the anterior chamber) at the end of the procedure 1
- Neurosurgery: When used as an alternative to cefazolin, cefuroxime should be administered as a slow IV infusion 2
Re-dosing Guidelines
- Re-dosing during surgery: For procedures lasting longer than 2 hours, re-inject 0.75g of cefuroxime to maintain adequate antibiotic levels 1, 3
- For cardiac surgery: Re-inject 0.75g every 2 hours intraoperatively 1
- For neurosurgery: In a study of clean neurosurgery, for procedures lasting more than 3 hours, cefuroxime 750mg was given intravenously 8 hours after the initial dose 2
Special Considerations
- Continuous infusion: For critically ill patients, particularly those on continuous venovenous hemofiltration, a continuous infusion of 3000mg over 24 hours may be more appropriate to maintain steady-state plasma concentrations 4
- Pharmacokinetic considerations: Cefuroxime has an elimination half-life of approximately 90 minutes (range 77-103 minutes) in critically ill patients on CVVH, which influences the timing of re-dosing 4
- Optimal dosing for surgical prophylaxis: A physiologically based pharmacokinetic model suggests that standard dosing of 1.5g preoperatively with follow-up doses every 2.5 hours is effective against Staphylococcus aureus but may be insufficient for Escherichia coli coverage 3
Common Pitfalls and Caveats
- Vancomycin timing: When vancomycin is used as an alternative in allergic patients, the infusion must last 120 minutes and should end at the latest by the beginning of the intervention, ideally 30 minutes before 1, 5
- Inadequate infusion time: Administering cefuroxime too rapidly may increase the risk of adverse reactions and fail to achieve optimal tissue concentrations 3
- Insufficient re-dosing: Failure to re-dose during lengthy procedures can result in subtherapeutic antibiotic levels and increased risk of surgical site infections 3
- Inappropriate use of continuous infusion: While continuous infusion may be beneficial in certain critically ill patients, standard intermittent dosing remains appropriate for most surgical prophylaxis 4, 3