What is the prescription for cefuroxime IV?

Cefuroxime IV Prescription

For severe pneumonia in adults, prescribe cefuroxime 1.5 grams IV every 8 hours, administered as a slow IV infusion over 3-5 minutes for direct injection or via intermittent infusion. 1, 2, 3

Standard Dosing Regimens

Adults - General Infections

• Standard dose: 750 mg IV every 8 hours for most infections 3
• Severe infections/pneumonia: 1.5 grams IV every 8 hours 1, 2
• Life-threatening infections or septicemia: Use IV route preferentially at 1.5 grams every 8 hours 3

Pediatric Patients (>3 months)

• Standard infections: 50-100 mg/kg/day divided every 6-8 hours 3
• Severe infections: 100 mg/kg/day (not exceeding maximum adult dose) divided every 6-8 hours 3
• Bone/joint infections: 150 mg/kg/day divided every 8 hours 3
• Bacterial meningitis: 200-240 mg/kg/day divided every 6-8 hours 3

Preparation and Administration

Reconstitution

• 750 mg vial for IV: Add 8.3 mL Sterile Water for Injection, withdraw completely (concentration: 90 mg/mL) 3
• 1.5 gram vial for IV: Add 16 mL Sterile Water for Injection, withdraw completely (concentration: 90 mg/mL) 3

Administration Methods

• Direct IV injection: Slowly inject over 3-5 minutes 3
• Intermittent IV infusion: Administer through Y-type set; temporarily discontinue other solutions at same site during infusion 3
• Continuous IV infusion: May add to IV packs containing 0.9% NaCl, 5% or 10% Dextrose, 5% Dextrose/0.9% NaCl, 5% Dextrose/0.45% NaCl, or 1/6 M Sodium Lactate 3

Surgical Prophylaxis Dosing

Cardiac Surgery

• Initial dose: 1.5 grams as slow IV infusion 4
• Priming solution: Additional 0.75 grams 4
• Re-dosing: 0.75 grams every 2 hours intraoperatively 4

Orthopedic Surgery

• Dose: 1.5 grams as slow IV infusion 4
• Re-dosing: 0.75 grams for procedures >2 hours 4

Thoracic Surgery

• Dose: 900 mg as slow IV infusion 4

Critical Prescribing Considerations

Timing

• Prophylaxis: Administer 30-60 minutes before surgical incision 4
• Re-dosing interval: Every 2 hours for prolonged procedures 4
• Duration: Do not extend prophylaxis beyond 24 hours postoperatively 5

Contraindications and Alternatives

• Penicillin allergy with anaphylaxis/angioedema: Do NOT use cefuroxime; substitute with clindamycin 900 mg IV slow infusion or vancomycin 30 mg/kg IV over 120 minutes 5, 2
• Aminoglycoside co-administration: Never mix in same solution; administer separately due to potential interaction 3

Renal Insufficiency

• Modify dosing frequency consistent with adult renal dosing recommendations in pediatric patients with renal insufficiency 3

Common Pitfalls to Avoid

• Do not add cefuroxime to aminoglycoside solutions—administer separately to avoid inactivation 3
• Do not use oral cephalosporins for IV-to-oral switch; use co-amoxiclav 625 mg three times daily instead 1
• Do not inject IM preparation IV—the IM concentration creates a suspension (225 mg/mL vs 90 mg/mL for IV) 3
• Do not forget aspiration before IM injection to avoid inadvertent intravascular administration 3