The full, clinically endorsed recommendation should be obtained from Lareb [link].   

Clinical Overview  

Cefuroxime is a cephalosporin antibiotic used in pregnancy for the treatment of certain infections, including pyelonephritis, and for community-acquired pneumonia. Due to pregnancy-induced changes in the pharmacokinetics of certain drugs, dose adjustments may be necessary to maintain effective antibiotic concentrations during pregnancy.   

Pharmacokinetics of cefuroxime in pregnancy 

Cefuroxime is eliminated unchanged by the kidneys. Pregnancy increases renal clearance and distribution volume, leading to lower maternal plasma concentrations. Pharmacokinetic and modelling studies confirm reduced plasma concentrations of cefuroxime after administration in pregnant women compared to non-pregnant individuals. Cefuroxime crosses the placenta, with neonatal concentrations that are approximately 50-80% of maternal concentrations.   

Efficacy and safety of cefuroxime in pregnancy 

The efficacy of cefuroxime depends on the duration its concentration remains above the minimal inhibitory concentration (MIC). The MIC target is also applicable during pregnancy. Lower plasma concentrations of cefuroxime may reduce the time above the minimal inhibitory concentration in pregnancy. Safety studies are reassuring overall, with no consistent increase in congenital anomalies.  

Conclusion  

Pregnancy lowers cefuroxime concentrations through enhanced renal clearance, which may reduce its efficacy. Evidence for dose-related safety in pregnancy is limited, though overall safety data are reassuring.