Cefuroxime Dosing for Crush Finger Injury in a 38 kg Patient
For a 38 kg patient with a crush finger injury requiring antibiotic prophylaxis, administer cefuroxime 1.5 g IV as a single dose, with re-injection of 750 mg if the procedure duration exceeds 2 hours, up to a maximum of 48 hours. 1
Rationale for Dosing
The 2019 surgical antibiotic prophylaxis guidelines specifically address soft tissue injuries with contusion, including those with or without lesions of arteries, nerves, or tendons. 1 This clinical scenario directly applies to crush finger injuries, which typically involve soft tissue contusion with potential damage to underlying structures.
Standard Adult Dosing Protocol
- Initial dose: Cefuroxime 1.5 g IV administered slowly 1
- Re-injection: 750 mg IV if surgical duration exceeds 2 hours 1
- Maximum duration: 48 hours 1
The 38 kg patient weight does not require pediatric dosing adjustments, as this weight falls within the adult dosing range for surgical prophylaxis. 1 The guidelines do not specify weight-based adjustments for adults in this context, and the standard adult dose is appropriate. 1
Alternative for Penicillin Allergy
If the patient has a documented penicillin/cephalosporin allergy, the recommended alternative is:
- Clindamycin: 900 mg IV slow infusion 1
- Plus gentamicin: 5 mg/kg/day 1
- Re-injection: Clindamycin 600 mg if duration exceeds 4 hours 1
- Maximum duration: 48 hours 1
Target Organisms
The prophylaxis targets staphylococci, streptococci, H. influenzae, and enterobacteria, which are the primary pathogens associated with soft tissue injuries. 1 Cefuroxime provides appropriate coverage against these organisms, including beta-lactamase-producing strains. 2, 3
Important Clinical Considerations
Timing is critical: Administer the antibiotic 25-60 minutes before any surgical intervention or wound exploration. 4 This ensures adequate tissue concentrations at the time of bacterial contamination.
Duration caveat: The 48-hour maximum duration is specifically for prophylaxis. 1 If the wound shows signs of established infection (purulence, spreading cellulitis, systemic signs), this becomes treatment rather than prophylaxis, and longer courses with different dosing may be required. 5
Renal function: If the patient has impaired renal function (creatinine clearance <20 mL/min), dosing adjustments are necessary: reduce to 750 mg every 12 hours for creatinine clearance 10-20 mL/min, or 750 mg every 24 hours for creatinine clearance <10 mL/min. 5