ceFAZolin (Monograph)
Brand name: Ancef
Drug 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 ceFAZolin
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† [off-label], S. bovis† [off-label], S. pneumoniae† [off-label], S. pyogenes, or groups B, C, and G streptococci† [off-label] 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† [off-label] 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
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
ceFAZolin 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
IV100 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 IMA single dose of 50 mg/kg given 0.5–1 hour prior to the procedure.104
Perioperative Prophylaxis
Various Surgical Procedures
IV30 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 IM1–1.5 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 IMA single 1-g dose given 0.5–1 hour prior to the procedure.104
Respiratory Tract Infections
Pneumococcal Pneumonia
IV or IM500 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 IM1 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 IMManufacturers 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
Clcr (mL/minute) |
Dosage After Initial Loading Dose |
---|---|
35–54 |
Full doses at intervals ≥8 hours |
11–34 |
50% of usual dose every 12 hours |
≤10 |
50% of usual dose every 18–24 hours |
Clcr (mL/minute) |
Dosage After Initial Loading Dose |
---|---|
40–70 |
60% of usual daily dosage in divided doses every 12 hours |
20–40 |
25% of usual daily dosage in divided doses every 12 hours |
5–20 |
10% of usual daily dosage once every 24 hours |
Cautions for ceFAZolin
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
Drug Interactions
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 |
ceFAZolin 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
Parenteral
Solution Compatibility
Compatible |
---|
Amino acids 4.25%, dextrose 25%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 |
Sodium bicarbonate 5%100 |
Drug Compatibility
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 |
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.
Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.
* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name
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
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 2024, Selected Revisions March 3, 2015. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.
† Off-label: 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. http://www.ncbi.nlm.nih.gov/pubmed/22996382?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/23327981?dopt=AbstractPlus
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. http://www.ncbi.nlm.nih.gov/pubmed/17446442?dopt=AbstractPlus
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.
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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. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=1784814&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/9894177?dopt=AbstractPlus
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