Cefazolin

General

  • Type: 1st gen Cephalosporin
  • Dosage Forms: powder for injection
  • Dosage Strengths: 500mg; 1, 2, 10, 20, 100, 300g
  • Routes of Administration: IV, IM
  • Common Trade Names: Ancef

Adult Dosing

General

  • Mild: 250-500mg IM/IV 8h
  • Mod-Severe: 500-1000mg IM/IV q6-8h
  • Life Threatening: 1-1.5g IM/IV q6h
  • Max: 12g/day

UTI, Uncomplicated

  • 1g IM/IV q12

Pneumococcal Pneumonia

  • 500mg IM/IV q12

Endocarditis Prophylaxis, Dental

  • 1g IM/IV x1 (30-60 min before procedure)

Pediatric Dosing

General (<7 Days)

  • 40mg/kg/day IM/IV divided q12h
  • First Dose: 20mg/kg IM/IV x 1
  • Max 6g/day

General (>7 Days - 1 Month)

  • <2000g
    • 40mg/kg/day IM/IV divided q12h
    • First Dose: 20mg/kg IM/IV x 1
    • Max 6g/day
  • >2000g
    • 60mg/kg/day IM/IV divided q8h
    • First Dose: 20mg/kg IM/IV x 1
    • Max 6g/day

General (>1 Month)

  • 25-100mg/kg/day IM/IV divided q6-8h
  • First Dose: 20-33mg/kg IM/IV x 1
  • Max 6g/day

Community Acquired Pneumonia (>3 Months)

  • 150mg/kg/day IM/IV divided q8h x 10 days
  • First Dose: 50mg/kg IM/IV x 1
  • May switch to PO regimen when able

Special Populations

  • Pregnancy: B
  • Lactation: Safe
  • Renal
    • Adult
      • CrCl 35-54: give q8
      • CrCl 11-34: give usual dose x1, then decrease dose 50% and give q12h
      • CrCl <10: give usual dose x1, then decrease dose 50% and give q18-24h
      • Hemodialysis: give 0.5-1g supplement
      • Peritoneal dialysis: 500mg q12h
    • Pediatric
      • CrCl 40-70: give usual dose x 1, then decrease daily dose 40% and give q12h
      • CrCl 20-39: give usual dose x 1, then decrease daily dose 75% and give q12h
      • CrCl 5-19: give usual dose x 1, the decerase daily dose 90% and give q24h
      • CrCl <5: not defined
      • Hemodialysis: give supplement
      • Peritoneal dialysis: no supplement
  • Hepatic (Adult & Pediatric)
    • Not defined

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

  • Diarrhea
  • Rash
  • Nausea and Vomiting
  • Abdominal Pain
  • Anorexia
  • Transaminitis
  • Urticaria
  • Thrombophlebitis

Pharmacology

  • Half-life: 1.8h (3.7 ESRD)
  • Metabolism: minimally metabolized in liver; CYP450
  • Excretion: Urine
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumX1
MSSAS
MRSAR
CA-MRSAR
Staph. EpidermidisI
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeS
N. meningitidisR
Moraxella catarrhalisI
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negR
Enterobacter sp, AmpC posR
Serratia spR
Serratia marcescensX1
Salmonella spX1
Shigella spX1
Proteus mirabilisS
Proteus vulgarisR
Providencia sp.R
Morganella sp.R
Citrobacter freundiiR
Citrobacter diversusR
Citrobacter sp.R
Aeromonas spR
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaR
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaX1
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisR
Prevotella melaninogenicaX1
Clostridium difficileX1
Clostridium (not difficile)X1
Fusobacterium necrophorumX1
Peptostreptococcus sp.X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014
  • Epocrates
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