What is the appropriate dosing and administration of Injection Zociv (cefuroxime) 1 g in adult patients for treatment of serious bacterial infections and surgical prophylaxis, including renal dose adjustments and contraindications?

Cefuroxime (Zociv) 1g Injection: Dosing and Administration

Standard Surgical Prophylaxis Dosing

For most surgical procedures requiring cefuroxime prophylaxis, administer 1.5g IV as a slow infusion 30-60 minutes before surgical incision, with re-injection of 0.75g if the procedure exceeds 2 hours, limited to the operative period only (maximum 24 hours). 1

Key Timing Requirements

• Complete the infusion within 60 minutes before surgical incision, ideally 30 minutes prior, to ensure adequate tissue concentrations at the moment of bacterial contamination 2, 3
• The injection must be given as a slow IV infusion, not as a rapid bolus 1

Intraoperative Re-dosing Protocol

• Re-inject 0.75g IV if surgery duration exceeds 2 hours to maintain therapeutic tissue levels throughout prolonged procedures 1, 2
• This re-dosing interval is shorter than cefazolin (which requires re-dosing at 4 hours), reflecting cefuroxime's pharmacokinetic profile 1

Duration Limits

• Prophylaxis should be limited to the operative period only, with a maximum of 24 hours total 1, 2
• Do not extend prophylaxis postoperatively for uncomplicated procedures, as this converts prophylaxis to therapeutic treatment and increases antibiotic resistance risk 2, 3

Specific Surgical Indications

Orthopedic Surgery

• Joint prosthesis (upper/lower limb): 1.5g IV slow, re-inject 0.75g if duration >2 hours 1
• Foreign material implantation (resorbable/non-resorbable, cement, bone graft): Same dosing as above 1
• Joint arthrotomy: 1.5g IV slow as single dose 1

Trauma Surgery

• Closed fracture with intrafocal osteosynthesis: 1.5g IV slow, re-inject 0.75g if duration >2 hours 1
• Open fracture stage I: Same dosing, limited to operative period (24 hours max) 1
• Articular wounds: 1.5g IV slow, re-inject 0.75g if duration >2 hours 1

Cardiac Surgery

• Cardiac procedures: 1.5g IV + 0.75g in priming solution, with re-injection of 0.75g every 2 hours intraoperatively 1

Vascular Surgery

• Aortic/arterial surgery with endoprosthesis: 1.5g IV slow, re-inject 0.75g if duration >2 hours 1
• Carotid surgery with patch: Same dosing as above 1

Gynecologic Surgery

• Hysterectomy: 1.5g IV slow as single dose 30-60 minutes before incision, re-inject 0.75g if duration >2 hours 2

Hernia Repair

• Hernioplasty with mesh: 1.5g IV slow as single dose, re-inject 0.75g if duration >2 hours 4
• Hernia without mesh: No antibiotic prophylaxis required 4

Ophthalmic Surgery

• Cataract surgery: 1mg intracameral injection (0.1mL of 10mg/mL solution) at the end of the procedure, not 1g IV 1

Renal Dose Adjustments

While the provided guidelines do not specify exact renal dosing for cefuroxime, standard pharmacokinetic data indicates:

• Normal renal function: Peak serum concentrations of 16-25 mcg/mL occur 1 hour after 750mg IM, with levels <4 mcg/mL at 8 hours 5
• Renal impairment: Dose reduction is necessary as cefuroxime is renally eliminated; no accumulation occurs with normal renal function 5
• Monitor renal function closely during therapy, particularly in patients receiving concurrent nephrotoxic agents 6

Contraindications and Allergy Management

Beta-Lactam Allergy Alternatives

If the patient has documented beta-lactam allergy, substitute with clindamycin 900mg IV slow infusion PLUS gentamicin 5 mg/kg IV as single doses. 1, 2, 3

• Re-dose clindamycin with 600mg if procedure duration exceeds 4 hours 1
• Avoid cefuroxime in patients with immediate hypersensitivity to penicillins due to cross-reactivity risk 2

Vancomycin Indications (Not Routine)

Vancomycin 30 mg/kg over 120 minutes should be reserved for specific situations only: 1

• Documented beta-lactam allergy
• Suspected or proven MRSA colonization
• Reoperation in a patient hospitalized in a unit with MRSA ecology
• Previous antibiotic therapy failure

Target Organisms

Cefuroxime provides coverage against: 3, 7, 8

• Gram-positive: Staphylococcus aureus (methicillin-sensitive), Staphylococcus epidermidis, Streptococcus pneumoniae, Streptococcus pyogenes
• Gram-negative: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Haemophilus influenzae (including beta-lactamase producing strains), Moraxella catarrhalis, Neisseria gonorrhoeae
• Resistance: Beta-lactamase resistant, making it effective against many organisms resistant to first-generation cephalosporins 8

Critical Pitfalls to Avoid

• Never administer prophylaxis after the incision is made—efficacy depends entirely on pre-incision timing to ensure adequate tissue concentrations 2
• Do not use rapid IV push—cefuroxime must be given as a slow infusion to minimize adverse reactions 1
• Do not extend prophylaxis based on drain presence—surgical drains are not an indication for prolonged antibiotics 3
• Do not confuse intracameral dosing (1mg) with IV dosing (1.5g)—the ophthalmic dose is 1,500 times smaller 1
• Do not use cefuroxime for Pseudomonas aeruginosa or Bacteroides fragilis infections—it has no activity against these organisms 8

Tolerability Profile

Cefuroxime is generally well tolerated with: 7, 9, 5

• Adverse reactions typically mild and transient (primarily gastrointestinal disturbances including diarrhea, nausea, vomiting)
• Rash incidence approximately 0.7% 6
• No nephrotoxicity when given alone at usual dosages 8
• Safe administration in penicillin-allergic patients reported, though cross-reactivity remains a theoretical concern 6