What is the standard dose of IV cefuroxime (Cefuroxime) for an adult patient with normal renal function undergoing surgical prophylaxis?

Standard Dose of IV Cefuroxime for Surgical Prophylaxis

The standard dose of IV cefuroxime for surgical prophylaxis in adults with normal renal function is 1.5 g administered as a slow IV infusion 30-60 minutes before surgical incision, with re-dosing of 0.75 g every 2 hours if the procedure is prolonged. 1

Initial Dosing Protocol

• Administer 1.5 g IV as a slow infusion within 30-60 minutes before the surgical incision to ensure adequate tissue concentrations at the time of potential contamination 2, 1
• The infusion must be completed no later than the beginning of the intervention 1
• Do not administer more than 120 minutes before incision, as this is unnecessary and potentially dangerous 1

Intraoperative Re-dosing

• Re-inject 0.75 g IV when surgical duration exceeds 2 hours 2, 1
• Continue re-dosing 0.75 g every 2 hours throughout prolonged procedures 2, 1
• For cardiac surgery specifically, add 0.75 g to the cardiopulmonary bypass (CPB) priming solution in addition to the initial 1.5 g dose, then re-inject 0.75 g every 2 hours intraoperatively 1

Duration of Prophylaxis

• A single preoperative dose is adequate for most procedures 1
• Postoperative doses beyond the operative period provide no additional benefit and increase antibiotic resistance risk 1
• Maximum duration should not exceed 24 hours postoperatively in rare circumstances where post-procedural doses are required 1

Special Population Considerations

• Morbidly obese patients (≥120 kg) may require higher doses to achieve adequate tissue concentrations 1
• Research demonstrates that 1.5 g cefuroxime distributes into interstitial fluid of muscle and subcutaneous adipose tissue in morbidly obese patients, though concentrations may be insufficient against Gram-negative organisms 3

Procedure-Specific Variations

The 1.5 g initial dose applies across most surgical procedures including: 2

• Thoracic surgery (pulmonary resection, mediastinal surgery)
• Digestive surgery (gastroduodenal, biliary tract, hernia with prosthetic plate)
• Vascular surgery
• Cardiac surgery (with additional CPB priming dose)

Critical Pitfalls to Avoid

• Do not continue prophylaxis beyond 24 hours unless specifically indicated, as this increases resistance without benefit 1
• Do not use inadequate dosing in obese patients, as tissue penetration may be compromised 1
• Do not administer too early (>120 minutes before incision) 1
• Do not forget intraoperative re-dosing for procedures exceeding 2 hours, as cefuroxime has a half-life of only 1.5 hours in patients with normal renal function 4

Pharmacokinetic Rationale

• Cefuroxime achieves peak plasma concentrations of approximately 67 mcg/mL with 1.5 g dosing, with free concentrations in muscle ISF of 60 mcg/mL and subcutaneous adipose tissue of 39 mcg/mL 3
• The 2-hour re-dosing interval is based on the drug's half-life of 1.5 hours in patients with normal renal function 4
• Standard dosing of 1.5 g every 2.5 hours reaches pharmacokinetic/pharmacodynamic targets for Staphylococcus aureus but may be insufficient for Escherichia coli 5

FDA-Approved Dosing Context

For comparison, the FDA label indicates that for treatment (not prophylaxis) of infections, the usual adult dosage range is 750 mg to 1.5 g every 8 hours, with the preventive surgical dose being 1.5 g IV just before surgery (approximately 30-60 minutes before initial incision), followed by 750 mg IV or IM every 8 hours when the procedure is prolonged 6