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ArticleClinical pharmacokinetics2026

Population Pharmacokinetics of Intravenous Cefuroxime in Plasma and Bone of Patients with Prosthetic Joint Infection: Is There Room for Dose Optimization?

Gerbert Coen de Waard, Qiaolin Zhao, Ewout S Veltman, Jakob van Oldenrijk, P Koen Bos, Soma Bahmany, Anouk Muller, Tim Preijers, Birgit C P Koch

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Article in Clinical pharmacokinetics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

Authors and funding

9 authors.

Gerbert Coen de WaardDepartment of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Qiaolin ZhaoDepartment of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Ewout S VeltmanDepartment of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Jakob van OldenrijkDepartment of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
P Koen BosDepartment of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Soma BahmanyDepartment of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Anouk MullerCATOR, Center for Antimicrobial Optimized Treatment Rotterdam, Rotterdam, The Netherlands.
Tim PreijersDepartment of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Birgit C P KochDepartment of Hospital Pharmacy, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. b.koch@erasmusmc.nl.ORCID 0000-0002-1202-3643

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectiveProsthetic joint infections are serious infections that require perioperative antibiotic prophylaxis. Cefuroxime may be used as prophylaxis, and this study aims to evaluate the current dosing regimen to prevent infection during the perioperative period by performing population pharmacokinetic (PK) analysis of plasma and bone in patients with prosthetic joint infection (PJI).

methodsBoth plasma and bone samples were taken perioperatively and analyzed using NONMEM. Monte Carlo simulations were performed to determine the probability of target attainment (PTA) in both plasma and bone of various dosing regimens.

resultsA total of 44 plasma and 38 bone samples from 25 patients were included. The median bone concentration at 30-60 min after administration was 18.2 (9.9-25.3) mg/L and the bone-to-plasma ratio was 0.269 (interquartile range [IQR] 0.179-0.269), while the median bone concentration at 90-120 min after administration was 12.6 (5.9-18.6) mg/L and the bone-to-plasma ratio was 0.125 (IQR 0.073-0.160). A two-compartment model with allometric scaling and proportional errors best described plasma and bone concentrations. Only estimated glomerular filtration rate could partly explain the inter-individual variability (IIV) of clearance (CL). A single dose of 1500 mg cefuroxime failed to maintain bone concentrations above target concentrations for Staphylococcus aureus beyond 3.83 h post administration.

conclusionA population PK model was developed to characterize the disposition of cefuroxime in both plasma and bone compartments. Although adequate cefuroxime bone penetration within 1 h was observed in patients with PJI with rapid clearance, simulations predicted less optimal levels of cefuroxime after 3.5 h. The clinical implications need to be researched and confirmed.

Indexed as

Anti-Bacterial AgentsBone and BonesCefuroximeProsthesis-Related InfectionsAdministration, IntravenousAgedAged, 80 and overAntibiotic ProphylaxisDose-Response Relationship, DrugFemaleHumansMaleMiddle AgedModels, BiologicalMonte Carlo MethodAnti-Bacterial AgentsCefuroxime

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.