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Second-Generation Cephalosporin

Cefuroxime 1.5g IV

Brand names: Zinacef

Adult dose

Dose: Surgical prophylaxis: 1.5g IV at induction of anaesthesia. Repeat 1.5g IV every 8h for up to 24h post-operatively (open fractures: 72h per local protocol).
Route: Intravenous (slow IV injection over 3–5 min, or IV infusion)
Frequency: Single dose at induction (clean arthroplasty); every 8h for open fractures (72h maximum)
Max: 1.5g per dose; 4.5g/day (prophylaxis)
BOAST guidelines for open fractures: cefuroxime 1.5g IV at scene/ED, then every 8h for 72h. For penicillin allergy: use teicoplanin 400mg IV + gentamicin 5mg/kg IV. Always check allergy status before administration.

Paediatric dose

Dose: 30 mg/kg
Route: IV
Frequency: Every 8h (prophylaxis/open fracture)
Max: 1.5g per dose
Concentration: 750 mg/vial, 1.5 g/vial (reconstitute with water for injection) mg/ml
Children: 30 mg/kg per dose IV (max 1.5g). Neonates <1 week: 30 mg/kg every 12h. Prophylaxis: single dose 30 mg/kg at induction (max 1.5g).

Dose adjustments

Renal

eGFR 10–20: 750mg every 12h. eGFR <10: 750mg every 24h. Consider alternative in severe renal failure.

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Children: 30 mg/kg per dose IV (max 1.5g). Neonates <1 week: 30 mg/kg every 12h. Prophylaxis: single dose 30 mg/kg at induction (max 1.5g).

Clinical pearls

  • Standard choice for arthroplasty prophylaxis in UK — covers Staphylococcus aureus and Gram-negative organisms; superior to cefazolin in some local guidelines
  • BOAST (British Orthopaedic Association Standards for Trauma): cefuroxime 1.5g IV is the standard antibiotic of choice for open fractures — give within 1–3h of injury regardless of wound contamination grade
  • Penicillin allergy cross-reactivity: true cross-reactivity between penicillins and cephalosporins is rare (~1%) with second/third generation; however, avoid in anaphylaxis history and use teicoplanin + gentamicin
  • NICE SSI guidelines: prophylactic antibiotics should be given within 60 minutes of skin incision — cefuroxime IV is the most common choice in UK orthopaedics
  • Do not continue beyond 24h for clean arthroplasty — extended prophylaxis does not reduce infection rates and increases C. difficile risk

Contraindications

  • Cephalosporin hypersensitivity
  • History of immediate hypersensitivity to penicillin (anaphylaxis) — cross-reactivity ~1% (use teicoplanin + gentamicin instead)

Side effects

  • Hypersensitivity reactions (rash, urticaria, anaphylaxis)
  • Clostridioides difficile diarrhoea
  • Nausea/vomiting
  • Elevated transaminases
  • Thrombophlebitis (peripheral IV site)

Interactions

  • Aminoglycosides — additive nephrotoxicity (separate administration; monitor renal function)
  • Probenecid — reduces renal tubular excretion of cefuroxime (increases levels)
  • Anticoagulants — may prolong PT/INR (monitor warfarin)

Monitoring

  • Allergy status (before each dose — document clearly)
  • Renal function (if prolonged use or combined with nephrotoxic agents)
  • Signs of surgical site infection (wound check at 6 weeks)

Reference: BNFc; BNF; BOAST Open Fracture Guidelines 2017; NICE NG125 (Surgical Site Infections); BNF for Children. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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