What is the recommended dose of cefuroxime (Cefuroxime) for surgical prophylaxis?

Cefuroxime Surgical Prophylaxis Dosing

Standard Dose Recommendation

For most surgical procedures, administer cefuroxime 1.5 g IV as a single dose within 30-60 minutes before surgical incision, with re-dosing of 0.75 g every 2 hours intraoperatively if the procedure is prolonged. 1

Procedure-Specific Dosing

Cardiac Surgery

• Initial dose: 1.5 g IV plus 0.75 g in the CPB priming solution 1
• Intraoperative re-injection: 0.75 g every 2 hours during the procedure 1
• Alternative cardiac surgery protocol: 1.5 g IV at induction of anesthesia, then every 12 hours for a total of 6 grams 2

Vascular Surgery (Aorta, Lower Limb Arteries, Supra-aortic Trunks)

• Initial dose: 1.5 g IV slow infusion 1
• Re-injection: 0.75 g if procedure duration exceeds 2 hours 1
• Single dose only for arterial endoprosthesis and carotid surgery with patch 1

Cataract Surgery

• Intracameral injection: 1 mg in 0.1 mL at the end of the procedure 1
• This represents a unique route and dose specific to ophthalmology 1

General Clean-Contaminated or Potentially Contaminated Procedures

• Initial dose: 1.5 g IV administered one-half to 1 hour before initial incision 2
• Prolonged procedures: 750 mg IV or IM every 8 hours 2

Critical Timing Considerations

• Optimal administration window: 30-60 minutes before incision to ensure adequate tissue concentrations at the time of potential contamination 1, 3
• Maximum acceptable timing: Infusion must be completed no later than the beginning of the intervention 1
• Do not administer too early: Giving prophylaxis more than 120 minutes before incision is unnecessary and potentially dangerous 3

Intraoperative Re-dosing Guidelines

• Re-dose when: Surgical duration exceeds 2 hours (approximately two half-lives of cefuroxime) 1, 3
• Re-dosing amount: 0.75 g IV 1
• Cardiac surgery exception: Re-inject 0.75 g every 2 hours intraoperatively 1

Duration of Prophylaxis

• Standard duration: Single preoperative dose is adequate for most procedures 3
• Maximum duration: Should not exceed 24 hours postoperatively 4, 3
• Cardiac surgery exception: May continue up to 6 grams total over multiple doses 2
• Important caveat: Postoperative doses beyond the operative period provide no additional benefit and increase antibiotic resistance risk 3

Special Populations

Renal Impairment

• Creatinine clearance >20 mL/min: 750 mg to 1.5 g every 8 hours 2
• Creatinine clearance 10-20 mL/min: 750 mg every 12 hours 2
• Creatinine clearance <10 mL/min: 750 mg every 24 hours 2
• Hemodialysis patients: Give an additional dose at the end of dialysis 2

Pediatric Patients (>3 Months)

• Standard dose: 50-100 mg/kg/day divided every 6-8 hours 2
• Severe infections: 100 mg/kg/day (not exceeding maximum adult dosage) 2
• Bone and joint infections: 150 mg/kg/day divided every 8 hours (not exceeding maximum adult dosage) 2
• Pediatric cardiac surgery: 25 mg/kg pre-CPB is sufficient; a second dose in the CPB prime solution provides no additional advantage 5

Morbidly Obese Patients

• Standard 1.5 g dose distributes adequately into interstitial fluid of muscle and subcutaneous adipose tissue 6
• Important limitation: Concentrations may be sufficient for Gram-positive organisms but potentially insufficient for Gram-negative organisms 6
• Obese patients ≥120 kg: May require higher doses to achieve adequate tissue concentrations 3

Pharmacokinetic/Pharmacodynamic Targets

Coverage for Staphylococcus aureus

• Target: Unbound plasma concentrations of 2-8 mg/L 7, 8
• Standard dosing (1.5 g every 2.5 hours) achieves this target in most patients 7

Coverage for Escherichia coli

• Target: Unbound plasma concentrations of 8-32 mg/L 7, 8
• Standard dosing is insufficient for E. coli coverage in >50% of patients 7
• Optimized regimen for E. coli: 1.5 g bolus followed by continuous infusion of 3 g over 3 hours 7
• Alternative: Continuous infusion of 1 g/hour after a 1 g bolus achieves concentrations up to 32 mg/L 8

Clinical Caveats and Pitfalls

Common Errors to Avoid

• Do not continue prophylaxis beyond 24 hours unless specifically indicated (certain cardiac/vascular procedures), as this increases resistance without benefit 3
• Do not use inadequate dosing in obese patients, as tissue penetration may be compromised 3, 6
• Do not administer too early (>120 minutes before incision) 3

High-Risk Situations Requiring Prophylaxis

• Nasal surgery: Use 1.5 g IV cefuroxime if preoperative crusting, purulent secretion, or Staphylococcus aureus colonization is present 9
• Prolonged procedures: These significantly increase infection risk and require re-dosing 9

Postoperative Considerations

• Cardiac surgery postoperative phase: Most patients do not reach adequate concentrations (>2 mg/L) with standard dosing 8
• To improve postoperative coverage: Consider continuous infusion of 0.125-0.25 g/hour as an alternative to bolus dosing 8