The full, clinically endorsed dose recommendation should be obtained from Lareb.

Rationale for drug selection 

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

Pharmacokinetics of cefuroxime in pregnancy

Cefuroxime is primarily eliminated by the kidneys. Pregnancy increases the glomerular filtration and tubular secretion which leads to an increased renal clearance. Additionally, the extracellular volume expands in pregnancy. Therefore, it is likely that the current clinical doses that are used in pregnancy might fall below the therapeutic range, which may justify an increase in dosing frequency for this drug, especially during the second and third trimester. Placental transfer is significant, with cord concentrations around 50–80% of maternal levels. Pharmacokinetic studies consistently demonstrate lower maternal plasma levels and shorter half-life compared with non-pregnant women. Maternal PBPK models demonstrated reliable predictions of maternal concentrations in pregnancy, informing alternative dosing strategies, and supporting decision-making.

Benefits and risks with the proposed dose adjustments

The expected benefits and associated risk of increasing the cefuroxime dosing frequency during pregnancy.

In short 

Cefuroxime is an antibiotic prescribed to treat maternal infections. Pregnancy increases renal clearance and reduces cefuroxime exposure, especially later in gestation. Therefore, increasing the dose frequency during the second and third trimester may improve the likelihood of achieving the therapeutic targets. Based on the weighing of benefits and risks, the working committee derived an appropriate dose adjustments Consult Lareb for the model-informed dosing recommendations.