Second-Generation Cephalosporin — Respiratory / Surgical Prophylaxis Pregnancy: Limited data in pregnant women; animal studies show no reproductive toxicity. Should be prescribed to pregnant women only if the benefit outweighs the risk. Crosses the placenta. Excreted in human milk in small quantities; adverse reactions at therapeutic doses not expected, though a risk of diarrhoea and fungal mucosal infection cannot be excluded.

Cefuroxime

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

Used in: Acute Appendicitis

Cefuroxime is a second-generation cephalosporin used for respiratory, urinary, skin and other infections, and surgical prophylaxis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 750 mg - 1.5 g

Route: Intravenous or intramuscular

Frequency: Every 8 hours

Adults and children >=40 kg (parenteral cefuroxime sodium). SPC table: community acquired pneumonia and acute exacerbations of chronic bronchitis 750 mg every 8 hours (IV or IM); soft-tissue infections (cellulitis, erysipelas, wound infections), intra-abdominal infections and complicated UTI including pyelonephritis 1.5 g every 8 hours (IV or IM); severe infections 750 mg every 6 hours (IV) or 1.5 g every 8 hours (IV). Surgical prophylaxis for gastrointestinal, gynaecological (including caesarean section) and orthopaedic operations 1.5 g with induction of anaesthesia, may be supplemented with two 750 mg IM doses after 8 and 16 hours; for cardiovascular and oesophageal operations 1.5 g at induction followed by 750 mg IM every 8 hours for a further 24 hours. Method: give IV over 3-5 minutes directly into a vein or via drip tube, or by deep IM injection (no more than 750 mg per IM site); for doses greater than 1.5 g use IV administration. Paediatric (<40 kg): SPC gives weight-based dosing (30 to 100 mg/kg/day IV in 3-4 divided doses; 60 mg/kg/day appropriate for most infections; infants birth to 3 weeks 30 to 100 mg/kg/day in 2-3 divided doses) — verify paediatric dosing against a children's formulary.

Dose adjustments

Renal

Cefuroxime is primarily excreted by the kidneys; reduce dosage in markedly impaired renal function. SPC: creatinine clearance >20 mL/min/1.73m2 no reduction of standard dose (750 mg to 1.5 g three times daily); 10-20 mL/min/1.73m2 750 mg twice daily; <10 mL/min/1.73m2 750 mg once daily. Haemodialysis: a further 750 mg IV or IM at the end of each dialysis. Give cephalosporins at high dosage with caution alongside potent diuretics (e.g. furosemide) or aminoglycosides.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION This product is intended for intravenous administration only. Dosage: Adults: The usual adult dosage range for cefuroxime is 750 mg to 1.5 grams every 8 hours, usually for 5 to 10 days. In uncomplicated urinary tract infections, skin and skin-structure infections, disseminated gonococcal infections, and uncomplicated pneumonia, a 750 mg dose every 8 hours is recommended. In severe or complicated infections, a 1.5 gram dose every 8 hours is recommended. In bone and joint infections, a 1.5 gram dose every 8 hours is recommended. In clinical trials, surgical intervention was performed when indicated as an adjunct to cefuroxime therapy. A course of oral antibacterials …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2020-12-05. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to cefuroxime or to any of the cephalosporins
Previous immediate and/or severe hypersensitivity (e.g. anaphylactic reaction) to any other type of beta-lactam antibacterial agent (penicillins, monobactams and carbapenems)

Side effects

Neutropenia, eosinophilia, decreased haemoglobin concentration
Gastrointestinal disturbance
Transient rise in liver enzymes or bilirubin
Skin rash, urticaria and pruritus
Injection site reactions including pain and thrombophlebitis

Clinical monograph

How it works

A beta-lactam that inhibits bacterial cell-wall synthesis by binding penicillin-binding proteins, with greater stability to some beta-lactamases than first-generation agents.

Prescribing in practice

Use caution in penicillin allergy (cross-reactivity is low but more relevant after immediate or severe reactions).
Reduce the dose in significant renal impairment.
Like other antibiotics it can predispose to Clostridioides difficile infection.

Monitoring

Short courses need no routine monitoring; review response and adverse effects.

Counselling the patient

Complete the course.
Report a rash, or severe or prolonged diarrhoea.

Evidence & guidelines

Used per local antimicrobial guidance for the indications above.

Reference: PHE Antibiotic Guidelines; NICE CAP Guideline NG138; NICE Surgical Site Infection NG125; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways