What is the maximum dose of cefuroxime (Cefuroxime) for pediatric patients with appendicitis for surgical prophylaxis?

From the FDA Drug Label

Pediatric Patients Above 3 Months of Age: Administration of 50 to 100 mg/kg/day in equally divided doses every 6 to 8 hours has been successful for most infections susceptible to cefuroxime The higher dosage of 100 mg/kg/day (not to exceed the maximum adult dosage) should be used for the more severe or serious infections. For preventive use for clean-contaminated or potentially contaminated surgical procedures, a 1. 5-gram dose administered intravenously just before surgery (approximately one-half to 1 hour before the initial incision) is recommended.

The maximum dose of cefuroxime for pediatric patients for appendicitis surgical prophylaxis is 100 mg/kg/day, not to exceed the maximum adult dosage, which can be administered as a single dose of 1.5 grams intravenously just before surgery. 1

From the Research

For pediatric surgical prophylaxis in appendicitis, the maximum recommended dose of cefuroxime is 50 mg/kg/dose, not to exceed the adult maximum dose of 1.5 grams per dose. This is typically administered as a single intravenous dose 30-60 minutes before surgical incision. For prolonged procedures (>4 hours) or significant blood loss, an additional intraoperative dose may be warranted. For children weighing more than 30 kg, the adult dosing of 1.5 grams is appropriate. Cefuroxime is effective for surgical prophylaxis because it provides good coverage against common pathogens involved in intra-abdominal infections, including gram-negative organisms and some anaerobes. It has a favorable safety profile in children and achieves adequate tissue concentrations at the surgical site. Discontinuation within 24 hours post-procedure is recommended to minimize the risk of antimicrobial resistance. For patients with beta-lactam allergies, alternative agents such as clindamycin plus gentamicin should be considered.

Key Considerations

• The choice of antibiotic prophylaxis should be based on the most recent and highest quality evidence, which in this case is the study by 2 that compared the effectiveness of different antibiotic regimens in preventing surgical site infections in children with uncomplicated appendicitis.
• The study by 3 provides guidance on the use of preoperative antibiotic prophylaxis in neonates and children undergoing abdominal surgery, including appendectomy.
• The study by 4 provides recommendations on antimicrobial prophylaxis for pediatric patients undergoing plastic surgery, but is not directly applicable to appendicitis.
• The study by 5 evaluated the impact of a switch from a combination of cefotaxime, metronidazole, and gentamicin to piperacillin/tazobactam as first-line regimen for complicated acute appendicitis in children, but did not provide information on the maximum recommended dose of cefuroxime.
• The study by 6 is outdated and not relevant to the current guidelines for pediatric surgical prophylaxis in appendicitis.

Recommendations

• Use cefuroxime as a single intravenous dose 30-60 minutes before surgical incision for pediatric surgical prophylaxis in appendicitis.
• Do not exceed the adult maximum dose of 1.5 grams per dose.
• Consider alternative agents such as clindamycin plus gentamicin for patients with beta-lactam allergies.
• Discontinue antibiotic prophylaxis within 24 hours post-procedure to minimize the risk of antimicrobial resistance.