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Generic Name: Cefazolin Sodium
Class: First Generation Cephalosporins
CAS Number: 27164-46-1

Introduction

Antibacterial; β-lactam antibiotic; first generation cephalosporin.100 115 116 117 119 a

Uses for Ancef

Biliary Tract Infections

Treatment of biliary tract infections caused by susceptible Escherichia coli,100 115 116 117 119 Klebsiella,115 116 Proteus mirabilis,100 115 116 117 119 Staphylococcus aureus,100 115 116 117 119 or various streptococci.100 115 116 117 119

Bone and Joint Infections

Treatment of bone and joint infections caused by susceptible S. aureus.100 115 116 117 119

Endocarditis

Treatment of endocarditis caused by susceptible Streptococcus pyogenes.100 113 114 115 116 117 119 AHA recommends cefazolin as an alternative for treatment of staphylococcal endocarditis113 114 or endocarditis caused by viridans streptococci, S. bovis, S. pneumoniae, S. pyogenes, or groups B, C, and G streptococci in penicillin-allergic individuals; should not be used in those with immediate-type penicillin hypersensitivity (see Cross-hypersensitivity under Cautions).113

Alternative for prevention of α-hemolytic (viridans group) streptococcal endocarditis in individuals undergoing certain dental or upper respiratory tract procedures who have cardiac conditions that put them at highest risk.104 Oral amoxicillin is usual drug of choice for such prophylaxis;104 cefazolin (or ceftriaxone) is an alternative in penicillin-allergic individuals or when an oral anti-infective cannot be used.104 Should not be used in those with immediate-type penicillin hypersensitivity (see Cross-hypersensitivity under Cautions).104 Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with highest risk of endocarditis and which procedures require prophylaxis.104

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Respiratory Tract Infections

Treatment of respiratory infections caused by susceptible S. pneumoniae,100 115 116 117 119 S. pyogenes (group A β-hemolytic streptococci),100 115 116 117 119 S. aureus (including penicillin-resistant strains),100 115 116 117 119 Klebsiella,115 116 or Haemophilus influenzae.115 116

Septicemia

Treatment of septicemia caused by susceptible S. pneumoniae,100 115 116 117 119 S. aureus (including penicillinase-producing strains),100 115 116 117 119 E. coli,100 115 116 117 119 Klebsiella,115 116 or P. mirabilis.100 115 116 117 119

Skin and Skin Structure Infections

Treatment of skin and skin structure infections caused by susceptible S. aureus (including penicillinase-producing strains),100 115 116 117 119 S. pyogenes,100 115 116 117 119 or other streptococci.100 115 116 117 119

Urinary Tract Infections (UTIs) and Urogenital Infections

Treatment of UTIs caused by susceptible E. coli,100 115 116 117 119 P. mirabilis,115 116 117 119 Klebsiella,115 116 some strains of Enterobacter,115 116 or some strains of enterococci.115 116

Treatment of prostatitis or epididymitis caused by susceptible E. coli,100 115 116 117 119 Klebsiella,115 116 P. mirabilis,100 115 116 117 115 116 119 or some strains of enterococci.115 116

Prevention of Perinatal Group B Streptococcal Disease

Alternative to penicillin G or ampicillin for prevention of perinatal group B streptococcal (GBS) disease (early-onset neonatal GBS disease) in penicillin-allergic pregnant women who do not have immediate-type penicillin hypersensitivity (see Cross-hypersensitivity under Cautions).111

Intrapartum anti-infective prophylaxis to prevent early-onset neonatal GBS disease is indicated in women identified as GBS carriers during routine prenatal GBS screening (vaginal and rectal cultures) performed at 35–37 weeks during the current pregnancy, women who have GBS bacteriuria identified at any time during the current pregnancy, and women with a previous infant diagnosed with invasive GBS disease.111

Prophylaxis also indicated in women with unknown GBS status at onset of labor (i.e., culture not done, incomplete, or results unknown) if delivery is at <37 weeks of gestation, duration of amniotic membrane rupture is ≥18 hours, intrapartum temperature is ≥38°C, or woman has a positive intrapartum GBS nucleic acid amplification test (NAAT).111

Perioperative Prophylaxis

Perioperative prophylaxis to reduce incidence of infection in patients undergoing certain cardiac surgery, noncardiac thoracic surgery, vascular surgery, head and neck surgery, neurosurgery, orthopedic surgery, GI surgery, GU surgery, and gynecologic and obstetric surgery.100 102 106 107 108 109 110 115 116 117 119

Drug of choice for perioperative prophylaxis for a wide variety of contaminated or potentially contaminated surgical procedures.102 103 Also recommended as drug of choice for perioperative prophylaxis for heart, lung, heart-lung, pancreas, and pancreas-kidney transplantation.103

For perioperative prophylaxis in patients undergoing certain GI procedures (e.g., colorectal surgery, appendectomy) that might involve exposure to Bacteroides fragilis or other anaerobic bowel bacteria or in patients undergoing head and neck surgery involving incisions through oral or pharyngeal mucosa; used in conjunction with metronidazole to provide anaerobic coverage.102 103

Consult published guidelines and protocols for perioperative prophylaxis for recommendations regarding specific procedures.102 103

Ancef Dosage and Administration

Administration

Administer by IV injection or infusion or by deep IM injection.100 115 116 117 119

Duplex drug delivery system containing cefazolin and dextrose injection in separate chambers117 and the commercially available premixed cefazolin injection (frozen) should be used only for IV infusion.119

For solution and drug compatibility information, see Compatibility under Stability

IV Injection

Reconstitution and Dilution

Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL, respectively, of sterile water for injection to provide solutions containing approximately 225 or 330 mg/mL, respectively.100 115 Then further dilute reconstituted solution in approximately 5 mL of sterile water for injection.100 115

Rate of Administration

Inject directly into a vein over a period of 3–5 minutes or slowly into the tubing of a freely flowing compatible IV solution.100 115

IV Infusion

Reconstitution and Dilution

Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL, respectively, of sterile water for injection to provide solutions containing approximately 225 or 330 mg/mL, respectively.100 115 Then further dilute reconstituted solution in 50–100 mL of a compatible IV solution.100 115

Reconstitute 10- or 20-g pharmacy bulk packages according to the manufacturers' directions and then further dilute in a compatible IV solution prior to IV infusion.100 116

Reconstitute (activate) commercially available Duplex drug delivery system containing 1 or 2 g of cefazolin and 50 mL of dextrose injection in separate chambers according to the manufacturer's directions.117

Thaw the commercially available premixed injection (frozen) at room temperature (25°C) or under refrigeration (5°C); do not thaw by immersion in a water bath or by exposure to microwave radiation.119 A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature.119 Discard thawed injection if solution is cloudy or contains an insoluble precipitate or if container seals or outlet ports are not intact or leaks are found.119 Do not use in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.119

IM Injection

Inject IM deeply into a large muscle mass.100 115

Reconstitution

Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL, respectively, of sterile water for injection to provide solutions containing approximately 225 or 330 mg/mL, respectively.100 115 Shake well until dissolved.100 115

Dosage

Available as cefazolin sodium; dosage expressed in terms of cefazolin.100 115 116 117 119

Do not use cefazolin available in Duplex drug delivery system or the premixed injection (frozen) in patients who require less than entire 1- or 2-g dose in the container.117 119

Pediatric Patients

General Dosage for Neonates
IM or IV

Neonates ≤7 days of age: AAP recommends 25 mg/kg every 12 hours, regardless of weight.105

Neonates 8–28 days of age: AAP recommends 25 mg/kg every 12 hours in those weighing ≤2 kg and 25 mg/kg every 8 hours in those weighing >2 kg.105

Manufacturers state safety and efficacy not established in premature infants or neonates ≤1 month of age.100 115 116

General Dosage for Infants and Children
IV or IM

Children >1 month of age: 25–50 mg/kg daily in 3 or 4 equally divided doses for mild to moderate infections.100 115 116 Dosage may be increased to 100 mg/kg daily in divided doses for severe infections.100 115 116

Children beyond neonatal period: AAP recommends 25–50 mg/kg daily given in 3 equally divided doses for treatment of mild to moderate infections and 100–150 mg/kg daily given in 3 equally divided doses for treatment of severe infections.105

Endocarditis
Treatment of Staphylococcal Endocarditis
IV

100 mg/kg daily (up to 6 g daily) in 3 or 4 equally divided doses.114

For native valve endocarditis, duration of treatment is 6 weeks (with or without gentamicin given during the first 3–5 days).113 114

For endocarditis involving prosthetic valves or other prosthetic materials, duration of treatment is ≥6 weeks (with or without rifampin given for ≥6 weeks).114

Prevention of Endocarditis in Patients Undergoing Certain Dental or Respiratory Tract Procedures
IV or IM

A single dose of 50 mg/kg given 0.5–1 hour prior to the procedure.104

Perioperative Prophylaxis
Various Surgical Procedures
IV

30 mg/kg103 within 60 minutes before surgical incision.102 103

If procedure is prolonged (>4 hours) or if major blood loss occurs, additional intraoperative doses may be given every 4 hours.102 103 Duration of prophylaxis should be <24 hours for most procedures;102 no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.102 103

If used in patients undergoing certain GI procedures (e.g., colorectal surgery, appendectomy) that might involve exposure to B. fragilis or other bowel anaerobes or in patients undergoing head and neck surgery involving incisions through oral or pharyngeal mucosa, give usual cefazolin dose in conjunction with IV metronidazole (15 mg/kg)103 within 60 minutes before surgical incision.102 103

Adults

Mild Infections Caused by Gram-positive Bacteria
IV or IM

250–500 mg every 8 hours.100 115 116 117 119

Moderate to Severe Infections
IV or IM

500 mg–1 g every 6–8 hours.100 115 116 117 119

Severe, Life-threatening Infections
IV or IM

1–1.5 g every 6 hours.100 115 116 117 119 Dosage up to 12 g daily has been used.100 115 116 117 119

Endocarditis
Treatment of Endocarditis
IV or IM

1–1.5 g every 6 hours.100 115 116 117 119 Dosage up to 12 g daily has been used.100 115 116 117 119

AHA recommends 2 g IV every 8 hours for 4–6 weeks for native valve staphylococcal endocarditis (with or without gentamicin during the first 3–5 days).113

Prevention of Endocarditis in Patients Undergoing Certain Dental or Upper Respiratory Tract Procedures
IV or IM

A single 1-g dose given 0.5–1 hour prior to the procedure.104

Respiratory Tract Infections
Pneumococcal Pneumonia
IV or IM

500 mg every 12 hours.100 115 116 117 119

Septicemia
IV or IM

1–1.5 g every 6 hours.100 115 116 117 119 Doses up to 12 g daily have been used.100 115 116 117 119

Urinary Tract Infections (UTIs)
Acute Uncomplicated Infections
IV or IM

1 g every 12 hours.100 115 116 117 119

Prevention of Perinatal Group B Streptococcal (GBS) Disease
IV

An initial 2-g dose (at onset of labor or rupture of membranes) followed by 1 g every 8 hours until delivery.111

Perioperative Prophylaxis
Various Surgical Procedures
IV or IM

Manufacturers recommend 1 or 2 g given 0.5–1 hour prior to surgery, 0.5–1 g during surgery for lengthy procedures (e.g., ≥2 hours), and 0.5–1 g every 6–8 hours for 24 hours postoperatively.100 115 116 117 119 Manufacturers also recommend that prophylaxis be continued for 3–5 days following surgery where the occurrence of infection may be particularly devastating (e.g., open-heart surgery, prosthetic arthroplasty).100 115 116 117 119

Some experts recommend 1 g in adults weighing <80 kg and 2 g in those weighing ≥80 kg given within 60 minutes of surgical incision and suggest that morbidly obese patients may need higher dosage.102 Other experts suggest 2 g for most adults and 3 g for those weighing ≥120 kg.103

If procedure is prolonged (>4 hours) or if major blood loss occurs, additional intraoperative doses may be given every 4 hours.102 103 Duration of prophylaxis should be <24 hours for most procedures;102 no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.102 103

If used in patients undergoing certain GI procedures (e.g., colorectal surgery, appendectomy) that might involve exposure to B. fragilis or other bowel anaerobes or in patients undergoing head and neck surgery involving incisions through oral or pharyngeal mucosa, give usual cefazolin dose in conjunction with IV metronidazole (0.5 g) within 60 minutes before surgical incision.102 103

Special Populations

Hepatic Impairment

No dosage recommendations.100 115 116 117 119

Renal Impairment

Dosage adjustments recommended in patients with Clcr <55 mL/minute.100 115 116 117 119

Administer an initial loading dose appropriate for the severity of the infection, followed by dosage based on the degree of renal impairment.100 115 116 117 119

Dosage for Adults with Renal Impairment100115116117119

Clcr (mL/minute)

Dose

Frequency

35–54

Full dose

≥8-hour intervals

11–34

50% of usual dose

Every 12 hours

≤10

50% of usual dose

Every 18–24 hours

Dosage for Children >1 Month of Age with Renal Impairment100115116119

Clcr (mL/minute)

Dose

Frequency

40–70

60% of usual dose

Every 12 hours

20–40

25% of usual dose

Every 12 hours

5–20

10% of usual dose

Every 24 hours

Cautions for Ancef

Contraindications

  • Known hypersensitivity to cefazolin or other cephalosporins.100 115 116 117 119

  • Premixed injection (frozen) containing cefazolin in dextrose injection may be contraindicated in patients with known allergy to corn or corn products.119 (See Hypersensitivity Reactions under Cautions.)

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Diarrhea and Colitis

Possible emergence and overgrowth of nonsusceptible organisms, especially Enterobacter, Pseudomonas, enterococci, or Candida.a Careful observation of the patient is essential.100 115 116 117 119 Institute appropriate therapy if superinfection occurs.100 115 116 117 119

Treatment with anti-infectives may permit overgrowth of Clostridium difficile.100 115 116 117 119 120 C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) reported with nearly all anti-infectives, including cefazolin, and may range in severity from mild diarrhea to fatal colitis.100 115 116 117 119 120 C. difficile produces toxins A and B which contribute to development of CDAD;115 116 117 119 120 hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.115 116 117 119

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.100 115 116 117 119 120 Obtain careful medical history since CDAD may occur as late as 2 months or longer after anti-infective therapy is discontinued.115 116 117 119 120

If CDAD is suspected or confirmed, discontinue anti-infectives not directed against C. difficile whenever possible.115 116 117 119 120 Initiate appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.100 115 116 117 119 120

Sensitivity Reactions

Hypersensitivity Reactions

Possible hypersensitivity reactions such as urticaria, pruritus, rash (maculopapular, erythematous, morbilliform), fever and chills, eosinophilia, joint pain or inflammation, edema, erythema, genital and anal pruritus, angioedema, shock, hypotension, vasodilatation, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis, and anaphylaxis.a

Hypersensitivity reactions, including anaphylaxis, reported with dextrose-containing solutions;117 usually reported in patients receiving high dextrose concentrations (i.e., 50% dextrose), but also reported when corn-derived dextrose solutions administered to patients with or without history of hypersensitivity to corn products.117

If an allergic reaction occurs, discontinue cefazolin and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway, oxygen).100 a

Cross-hypersensitivity

Partial cross-sensitivity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins.100 a

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs.100 Cautious use recommended in individuals hypersensitive to penicillins:100 avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction and administer with caution in those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction.a

General Precautions

History of GI Disease

Use with caution in those with a history of GI disease, particularly colitis.100 a (See Superinfection/Clostridium difficile-associated Diarrhea and Colitis under Cautions.)

Prolonged PT

Prolonged PT reported with some cephalosporins.100

Monitor PT in patients at risk, including those with renal or hepatic impairment, poor nutritional state, receiving prolonged therapy, or stabilized on anticoagulant therapy.100 Administer vitamin K when indicated.100

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of cefazolin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.100

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.100 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.100

Patients with Diabetes

Like other dextrose-containing solutions, use Duplex drug delivery system containing cefazolin and dextrose injection and commercially available premixed cefazolin injection (frozen) with caution in patients with overt or known subclinical diabetes mellitus or in patients with carbohydrate intolerance for any reason.117 119

Sodium Content

Contains approximately 48 mg (2 mEq) of sodium per g of cefazolin.100 115 116 117

Specific Populations

Pregnancy

Category B.100 115 116 117 119

Lactation

Distributed into milk;100 115 116 117 119 use with caution.100 115 116 117 119

Pediatric Use

Safety and efficacy not established in premature infants or neonates ≤1 month of age.100 115 116 119

To avoid unintentional overdosage, do not use cefazolin available in Duplex containers or the cefazolin premixed injection (frozen) in pediatric patients who require less than entire 1- or 2-g dose in the container.117 119

Geriatric Use

No overall differences in safety and efficacy in those ≥65 years of age compared with younger adults, but the possibility of increased sensitivity in some geriatric individuals cannot be ruled out.115 116 117 119

Substantially eliminated by kidneys; risk of toxicity may be greater in those with impaired renal function.115 116 117 119 Select dosage with caution and consider monitoring renal function because of age-related decreases in renal function.115 116 117 119 (See Renal Impairment under Dosage and Administration.)

Renal Impairment

Possible increased serum concentrations and serum half-life.a

Possibility of seizures if inappropriately high dosage used in patients with impaired renal function.100 115 116 117 119

Use with caution and reduce dosage.100 115 116 117 119 (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

GI effects (diarrhea, nausea, vomiting, stomach cramps, oral candidiasis),115 116 117 119 hypersensitivity reactions.115 116 117 119

Interactions for Ancef

Specific Drugs and Laboratory Tests

Drug

Interaction

Comments

Nephrotoxic Drugs

Potential for increased risk of nephrotoxicitya

Avoid concomitant use of nephrotoxic agents (e.g., aminoglycosides, colistin, polymyxin B, vancomycin) if possiblea

Probenecid

Decreased renal clearance and increased concentrations of cefazolin100

Tests for glucose

Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution100

Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix)100

Ancef Pharmacokinetics

Absorption

Bioavailability

Not appreciably absorbed from GI tract; must be administered parenterally.100

After IM injection, peak serum concentrations attained within 1–2 hours.a

Distribution

Extent

Widely distributed into tissues and fluids,a including synovial fluid.100

Only low concentrations distribute into CSF.a

Crosses the placenta100 and is distributed into milk.100

Plasma Protein Binding

74–86%.a

Elimination

Metabolism

Not appreciably metabolized.a

Elimination Route

Excreted unchanged in urine.100 Approximately 60% of a dose excreted within 6 hours and 70–80% excreted within 24 hours in those with normal renal impairment.100

Half-life

Serum half-life approximately 1.8 hours after IV administration and 2 hours after IM administration.100

Special Populations

Half-life increased in renal impairment.100

Stability

Storage

Parenteral

Powder for Injection or IV Infusion

20–25°C;100 115 116 protect from light.100 115 116

Powder and reconstituted solutions may darken; does not indicate loss of potency.100 115 117

Reconstituted solutions containing 225 or 330 mg of cefazolin per mL prepared using sterile or bacteriostatic water for injection or sodium chloride injection are stable for 24 hours at room temperature or 10 days at 5°C.100 115

For Injection, for IV Infusion

Duplex drug delivery system containing cefazolin and dextrose injection: 20–25°C (may be exposed to 15–30°C).117 After reconstitution (activation), use within 24 hours if stored at room temperature or within 7 days if stored in refrigerator; do not freeze.117

Injection (Frozen) for IV Infusion

-20°C or lower.119 Thawed solutions stable for 48 hours when stored at room temperature (25°C) or 30 days under refrigeration (5°C).119

Do not refreeze after thawing.119

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility

Compatible

Amino acids 4.25%, dextrose 25%b

Dextrose 5 or 10%100 b

Dextrose 5% in Ringer’s injection, lactated100 b

Dextrose 5% in sodium chloride 0.2, 0.45, or 0.9%100

Ionosol B in dextrose 5% in waterb

Normosol M in dextrose 5% in waterb

Plasma-Lyte in dextrose 5% in waterb

Ringer’s injection, lactated100 b

Sodium bicarbonate 5%100

Sodium chloride 0.9%100 b

Drug Compatibility
Admixture Compatibilityb

Compatible

Aztreonam

Clindamycin phosphate

Famotidine

Fluconazole

Linezolid

Meperidine HCl

Metronidazole

Metronidazole HCl with sodium bicarbonate

Verapamil HCl

Incompatible

Amikacin sulfate

Atracurium besylate

Bleomycin sulfate

Clindamycin phosphate with gentamicin sulfate

Ranitidine HCl

Variable

Cimetidine HCl

Y-Site Compatibilityb

Compatible

Acyclovir sodium

Allopurinol sodium

Amifostine

Atracurium besylate

Aztreonam

Bivalirudin

Calcium gluconate

Cefpirome sulfate

Cyclophosphamide

Dexmedetomidine HCl

Diltiazem HCl

Docetaxel

Doxapram HCl

Doxorubicin HCl liposome injection

Enalaprilat

Esmolol HCl

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Filgrastim

Fluconazole

Fludarabine phosphate

Foscarnet sodium

Gatifloxacin

Gemcitabine HCl

Granisetron HCl

Heparin sodium

Hetastarch in lactated electrolyte injection (Hextend)

Insulin, regular

Labetalol HCl

Lidocaine HCl

Linezolid

Magnesium sulfate

Melphalan HCl

Meperidine HCl

Midazolam HCl

Milrinone lactate

Morphine sulfate

Multivitamins

Nicardipine HCl

Ondansetron HCl

Pancuronium bromide

Perphenazine

Propofol

Ranitidine HCl

Remifentanil HCl

Sargramostim

Tacrolimus

Teniposide

Theophylline

Thiotepa

Vecuronium bromide

Vitamin B complex with C (Berocca-C and Berocca-C 500)

Warfarin sodium

Incompatible

Amphotericin B cholesteryl sulfate complex

Idarubicin HCl

Pentamidine isethionate

Vinorelbine tartrate

Variable

Amiodarone HCl

Hetastarch in sodium chloride 0.9%

Hydromorphone HCl

Promethazine HCl

Vancomycin HCl

Actions and Spectrum

  • Based on spectrum of activity, classified as a first generation cephalosporin.a Has a limited spectrum of activity compared with second, third, and fourth generation cephalosporins.a

  • Usually bactericidal.a

  • Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.100 a

  • Spectrum of activity includes many gram-positive aerobic bacteria and some gram-negative aerobic bacteria; inactive against fungi and viruses.100 a

  • Gram-positive aerobes: active in vitro and in clinical infections against penicillinase-producing and nonpenicillinase-producing Staphylococcus aureus and S. epidermidis; Streptococcus pyogenes (group A β-hemolytic streptococci); S. agalactiae (group B streptococci); and S. pneumoniae.a 100 Enterococci and methicillin-resistant (oxacillin-resistant) staphylococci are resistant.100

  • Gram-negative aerobes: active in vitro and in clinical infections against some strains of Haemophilus influenzae, Escherichia coli, Klebsiella, Proteus mirabilis, and Enterobacter aerogenes.100 a Inactive against most other gram-negative bacteria, including Citrobacter, E. cloacae, Morganella, Providencia, Pseudomonas, and Serratia.100 a

Advice to Patients

  • Advise patients that antibacterials (including cefazolin) should only be used to treat bacterial infections; they do not treat viral infections (e.g., the common cold).100 115 116 117 119

  • Importance of completing full course of therapy, even if feeling better after a few days.100 115 116 117 119

  • Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefazolin or other antibacterials in the future.100 115 116 117 119

  • Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.115 116 117 119 Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.115 116 117 119

  • Importance of discontinuing cefazolin and informing clinician if an allergic reaction occurs.100 115 116 117 119

  • Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs.100 115 116 117 119

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.100 115 116 117 119

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cefazolin Sodium

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection

500 mg (of cefazolin)*

Cefazolin Sodium for Injection

1 g (of cefazolin)*

Cefazolin Sodium for Injection

10 g (of cefazolin) pharmacy bulk package*

Cefazolin Sodium for Injection

20 g (of cefazolin) pharmacy bulk package*

Cefazolin Sodium for Injection

For injection, for IV infusion

1 g (of cefazolin)*

Cefazolin for Injection (available in dual-chambered Duplex drug delivery system with 4% dextrose injection)

B Braun

2 g (of cefazolin)

Cefazolin for Injection (available in dual-chambered Duplex drug delivery system with 3% dextrose injection)

B Braun

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Cefazolin Sodium in Dextrose

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection (frozen), for IV infusion

20 mg (of cefazolin) per mL (1 g) in 4% Dextrose*

Cefazolin Sodium Iso-osmotic in Dextrose Injection (Galaxy [Baxter])

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions September 27, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. GlaxoSmithKline. Ancef (cefazolin) for injection prescribing information. Research Triangle Park, NC; 2005 Apr.

102. . Antimicrobial prophylaxis for surgery. Treat Guidel Med Lett. 2012; 10:73-8; quiz 79-80. [PubMed 22996382]

103. Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013; 70:195-283. [PubMed 23327981]

104. Wilson W, Taubert KA, Gewitz M et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007; 116:1736-54. [PubMed 17446442]

105. American Academy of Pediatrics. Red Book: 2012 Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.

106. Mangram AJ, Horan TC, Pearson ML et al. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999; 20:250-78. [PubMed 10219875]

107. Noyes N, Berkeley AS, Freedman K et al. Incidence of postpartum endomyometritis following single-dose antibiotic prophylaxis with either ampicillin/sulbactam, cefazolin, or cefotetan in high-risk cesarean section patients. Infect Dis Obstet Gynecol. 1998; 6:220-3. [PubMed 9894177]

108. Gonzalez RP, Holevar MR. Role of prophylactic antibiotics for tube thoracostomy in chest trauma. Am Surg. 1998; 64:617-20. [PubMed 9655270]

109. Aznar R, Mateu M, Miro JM et al. Antibiotic prophylaxis in non-cardiac thoracic surgery: cefazolin versus placebo. Eur J Cardiothorac Surg. 1991; 5:515-8. [PubMed 1756043]

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