Cefazolin Dosage

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Usual Adult Dose for Cholecystitis

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours; in rare cases, up to 12 g/day has been used

Usual Adult Dose for Joint Infection

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours; in rare cases, up to 12 g/day has been used

Usual Adult Dose for Osteomyelitis

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours; in rare cases, up to 12 g/day has been used

Usual Adult Dose for Skin or Soft Tissue Infection

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours; in rare cases, up to 12 g/day has been used

Usual Adult Dose for Bacterial Infection

Mild infections due to susceptible gram-positive cocci: 250 to 500 mg IV or IM every 8 hours
Moderate to severe infections: 500 mg to 1 g IV or IM every 6 to 8 hours
Severe, life-threatening infections (e.g., endocarditis, septicemia): 1 to 1.5 g IV every 6 hours; in rare cases, up to 12 g/day has been used

Usual Adult Dose for Septicemia

1 to 1.5 g IV every 6 hours; doses up to 12 g/day have been used

Usual Adult Dose for Endocarditis

1 to 1.5 g IV every 6 hours; doses up to 12 g/day have been used

American Heart Association (AHA) recommendation: 2 g IV every 8 hours

Duration (AHA recommendations):
Native valve infections due to oxacillin-susceptible strains of staphylococci in penicillin-allergic (nonanaphylactoid type) patients: 6 weeks; may be used with or without gentamicin (3 mg/kg/day IV or IM in 2 or 3 divided doses during the first 3 to 5 days)

Prosthetic valve infections due to oxacillin-susceptible strains of staphylococci in penicillin-allergic (nonanaphylactoid type) patients: 6 weeks or longer; should be used with gentamicin (3 mg/kg/day IV or IM in 2 or 3 divided doses during the first 2 weeks) and rifampin (900 mg/day IV or orally in 3 divided doses for 6 weeks or longer)

Due to susceptible Streptococcus pyogenes or S pneumoniae (as an alternative to penicillin): 4 weeks

Due to susceptible strains of group B, C, or G streptococci (as an alternative to penicillin): 4 to 6 weeks; some clinicians recommend using gentamicin during at least the first 2 weeks

Usual Adult Dose for Pneumonia

Pneumococcal pneumonia: 500 mg IV or IM every 12 hours

Usual Adult Dose for Urinary Tract Infection

Acute, uncomplicated urinary tract infections: 1 g IV or IM every 12 hours

Usual Adult Dose for Surgical Prophylaxis

Preoperative: 1 g IV or IM to 2 g IV 30 to 60 minutes prior to the start of surgery
Intraoperative (for procedures lasting 2 hours or more): 500 mg to 1 g IV or IM during surgery
Postoperative: 500 mg to 1 g IV or IM every 6 to 8 hours for 24 hours (3 to 5 days in high risk)

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

(Not approved by FDA)

AHA recommendation:
As an alternative in patients unable to take oral medication, with or without penicillin allergy (nonanaphylactoid type): 1 g IV or IM as a single dose 30 to 60 minutes before procedure

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease

(Not approved by FDA)

Centers for Disease Control and Prevention recommendation:
As an alternative for penicillin-allergic (nonanaphylactoid type) patients: 2 g IV once, followed by 1 g IV every 8 hours until delivery

Usual Adult Dose for Peritonitis

(Not approved by FDA)

1 to 2 g IV every 6 to 8 hours
Maximum dose: 12 g/day

Empiric therapy of CAPD-associated peritonitis: 1 g/2 L exchange plus ceftazidime 1 g/2 L per day intraperitoneally

Maintenance therapy of CAPD-associated peritonitis: 1 g/2 L exchange intraperitoneally as a loading dose, followed by 250 mg/2 L exchange continuously
Doses should be increased by 25% to 30% for nonanuric patients.

Duration: 10 to 14 days

Usual Pediatric Dose for Bacterial Infection

1 month or older:
Mild to moderate infections: 25 to 50 mg/kg/day IV or IM in 3 or 4 equally divided doses
Severe infections: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses
Maximum dose: 6 g/day

(Not approved by FDA)
Neonates:
Postnatal age of 7 days or less: 20 mg/kg every 12 hours

Postnatal age of greater than 7 days:
2000 g or less: 20 mg/kg every 12 hours
Greater than 2000 g: 20 mg/kg every 8 hours

Usual Pediatric Dose for Endocarditis

1 month or older: 100 mg/kg/day IV or IM in 3 or 4 equally divided doses
Maximum dose: 6 g/day

AHA recommendation: 100 mg/kg/day IV in 3 divided doses
Maximum dose: 6 g/day

Duration (AHA recommendations):
Native valve infections due to oxacillin-susceptible strains of staphylococci in penicillin-allergic (nonanaphylactoid type) patients: 6 weeks; may be used with or without gentamicin (1 mg/kg IV or IM every 8 hours during the first 3 to 5 days)

Prosthetic valve infections due to oxacillin-susceptible strains of staphylococci in penicillin-allergic (nonanaphylactoid type) patients: 6 weeks or longer; should be used with gentamicin (3 mg/kg/day IV or IM in 2 or 3 divided doses during the first 2 weeks) and rifampin (20 mg/kg/day IV or orally in 3 divided doses for 6 weeks or longer)

Due to susceptible S pyogenes or S pneumoniae (as an alternative to penicillin): 4 weeks

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

(Not approved by FDA)

AHA recommendation:
As an alternative in patients unable to take oral medication, with or without penicillin allergy (nonanaphylactoid type): 50 mg/kg (maximum 1 g) IV or IM as a single dose 30 to 60 minutes before procedure

Renal Dose Adjustments

Adults:
CrCl 35 to 54 mL/min: Normal doses may be given, but intervals should not be more often than every 8 hours.
CrCl 11 to 34 mL/min: An initial loading dose followed by 50% of the usual dose every 12 hours.
CrCl 10 mL/min or less: An initial loading dose followed by 50% of the usual dose every 18 to 24 hours.

Pediatrics:
CrCl 40 to 70 mL/min: An initial loading dose followed by 60% of the normal daily dose given in equally divided doses every 12 hours.
CrCl 20 to 40 mL/min: An initial loading dose followed by 25% of the normal daily dose given in equally divided doses every 12 hours.
CrCl 5 to 20 mL/min: An initial loading dose followed by 10% of the normal daily dose every 24 hours.

Liver Dose Adjustments

Data not available

Precautions

Serious and occasionally fatal hypersensitivity reactions have been reported with antibiotics. The drug should be discontinued immediately at the first appearance of a skin rash or other signs of hypersensitivity. Severe, acute hypersensitivity reactions may require treatment with epinephrine and other resuscitative measures including oxygen, intravenous fluids, antihistamines, corticosteroids, cardiovascular support and airway management as clinically indicated.

Dose adjustments are recommended in patients with significant renal impairment (CrCl 54 mL/min or less). Some cephalosporins have been associated with seizures in renally impaired patients with elevated serum concentrations. The drug should be discontinued if seizures occur. Nephrotoxicity has occurred with concomitant cephalosporins and aminoglycosides or potent diuretics. Renal function should be monitored, especially in elderly patients.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following cephalosporin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Cephalosporins may be associated with a fall in prothrombin activity. Risk factors include renal or hepatic impairment, poor nutritional state, a protracted course of antimicrobial therapy, and chronic anticoagulation therapy. Prothrombin times should be monitored and vitamin K therapy initiated if indicated.

Superinfection with nonsusceptible organisms (i.e., yeasts) may occur with prolonged cephalosporin therapy. Appropriate measures should be taken if superinfection occurs.

Caution is recommended in patients with a history of colitis or other gastrointestinal disorders.

Cephalosporins have been known to occasionally induce a positive direct Coombs' test and a false-positive urine glucose test (with Clinitest (R), Benedict's or Fehling's solution). A positive direct and indirect antiglobulin (Coombs') test may also occur in neonates of mothers who received cephalosporins before delivery.

To reduce the development of drug-resistant organisms, antibiotics should only be used for prophylaxis or treatment of infections that are proven or strongly suspected to be due to bacteria.

Safety and effectiveness have not been established in premature infants and neonates less than 1 month old.

Dialysis

Data not available

Other Comments

If necessary, cefazolin may be administered IM in the same dosage. The IV route is preferred for severe or life-threatening infections such as sepsis/septicemia, bacteremia, peritonitis, and for patients with reduced resistance (i.e., malnutrition, trauma, surgery, heart failure, malignancy, or shock).

The sodium content is 48 mg per 1 g of cefazolin sodium.

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