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Second-Generation Cephalosporin — Respiratory / Surgical Prophylaxis Pregnancy: Safe — cephalosporins generally considered safe in pregnancy

Cefuroxime

Brand names: Zinacef (IV), Zinnat (oral)

Adult dose

Dose: Oral (Zinnat): 250–500 mg twice daily; IV: 750 mg–1.5 g every 8 hours; Surgical prophylaxis: 1.5 g IV at induction
Route: Oral or IV
Frequency: Twice daily (oral); every 8 hours (IV)
Max: 6 g/day IV (severe infections)
Second-generation cephalosporin with broader gram-negative cover than cefalexin. Used for CAP, LRTI, UTI, surgical prophylaxis. Oral prodrug (Zinnat) — absorbed as cefuroxime axetil; take with food (absorption improved 40%). IV formulation: Zinacef. Not active against MRSA, Pseudomonas, Enterococcus, atypicals.

Paediatric dose

Dose: 10–15 mg/kg mg/kg
Route: IV or oral
Frequency: Every 8 hours (IV); twice daily (oral)
Max: 1.5 g per dose IV
BNFc: available as 125 mg/5 mL oral suspension; widely used in paediatric respiratory and UTI

Dose adjustments

Renal

CrCl 10–20 mL/min: 750 mg every 12 hours IV; CrCl <10: 750 mg every 24 hours IV

Hepatic

No adjustment required

Paediatric weight-based calculator

BNFc: available as 125 mg/5 mL oral suspension; widely used in paediatric respiratory and UTI

Clinical pearls

  • Cefuroxime bridges gram-positive and gram-negative coverage — covers H. influenzae, M. catarrhalis, and most community respiratory pathogens; often used in CAP/LRTI where cover of both is needed
  • Surgical prophylaxis: standard for orthopaedic, abdominal, vascular procedures — single 1.5 g IV dose at induction; add metronidazole for bowel surgery
  • Oral: prodrug (cefuroxime axetil) — must be taken with food for adequate absorption; bitter taste in suspension may be an issue in children
  • MRSA coverage absent — not suitable for MRSA infection; confirm sensitivities

Contraindications

  • Cephalosporin hypersensitivity
  • Penicillin anaphylaxis (cross-reactivity)

Side effects

  • GI disturbance (nausea, diarrhoea)
  • Elevated LFTs
  • Eosinophilia
  • Rash
  • Phlebitis (IV)
  • C. difficile

Interactions

  • Warfarin — enhanced effect
  • Probenecid — increases levels
  • Oral contraceptives — theoretical reduction in efficacy (unproven but advise additional precautions during course)

Monitoring

  • Renal function
  • LFTs (if prolonged course)
  • C. difficile if diarrhoea
  • Surgical site infection monitoring (prophylaxis context)

Reference: BNFc; BNF 90; PHE Antibiotic Guidelines; NICE CAP Guideline NG138; NICE Surgical Site Infection NG125. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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