What is the recommended dose of cefuroxime (a second-generation cephalosporin antibiotic) for a 128kg female patient with normal renal function and a surgical wound?

Cefuroxime Dosing for Surgical Wound Treatment in a 128kg Female Patient

Administer cefuroxime 1.5g IV every 8 hours for treatment of an established surgical wound infection in this 128kg patient, assuming normal renal function. 1

Dosing Algorithm

For Active Infection Treatment (Not Prophylaxis)

The FDA-approved dosing for established infections differs from surgical prophylaxis:

• Standard treatment dose: 750mg to 1.5g IV every 8 hours for 5-10 days 1
• For severe or complicated infections: 1.5g IV every 8 hours is specifically recommended 1
• For life-threatening infections or less susceptible organisms: 1.5g every 6 hours may be required 1

Weight-Based Considerations

The standard adult dose of 1.5g every 8 hours does NOT require adjustment for this patient's 128kg body weight, as FDA labeling does not specify weight-based dosing adjustments for adults with normal renal function. 1

However, important context from research:

• A pharmacokinetic study in morbidly obese patients (BMI ≥40) undergoing abdominal surgery found that the standard 1.5g dose achieved adequate tissue penetration in subcutaneous adipose tissue and muscle 2
• The same study noted that concentrations may be sufficient for Gram-positive organisms but potentially insufficient for Gram-negative organisms in obese patients 2
• More recent cardiac surgery data suggests body weight should influence dosing optimization, though specific recommendations for wound infections in obese patients are not established 3

Critical Distinction: Treatment vs. Prophylaxis

Do not confuse surgical prophylaxis dosing with treatment dosing:

• Prophylaxis: 1.5g IV single dose 30-60 minutes before incision, with re-dosing of 750mg every 2 hours intraoperatively only 4, 5, 6
• Treatment: 1.5g IV every 8 hours continued for 5-10 days 1

Renal Function Adjustment

If creatinine clearance is reduced, mandatory dose adjustments are required: 1

• CrCl >20 mL/min: 750mg-1.5g every 8 hours (standard dosing)
• CrCl 10-20 mL/min: 750mg every 12 hours
• CrCl <10 mL/min: 750mg every 24 hours
• Hemodialysis patients: Give additional dose after dialysis 1

Common Pitfalls to Avoid

• Never use prophylactic dosing regimens for established infections - the single 1.5g dose with intraoperative re-dosing is only for prevention, not treatment 4, 5, 6
• Do not assume weight-based dosing is needed - unlike pediatric dosing (50-100 mg/kg/day), adult dosing is fixed regardless of weight in the FDA label 1
• Always verify renal function - failure to adjust for renal impairment can lead to drug accumulation and toxicity 1
• Consider inadequate Gram-negative coverage in obese patients - if clinical response is poor, consider that tissue concentrations may be suboptimal for Gram-negative pathogens 2

Duration and Monitoring

• Minimum treatment duration: Continue for 48-72 hours after the patient becomes asymptomatic or bacterial eradication is documented 1
• Typical course: 5-10 days for most infections 1
• Surgical drainage: Perform when indicated as adjunct to antibiotic therapy 1