Medically reviewed on Dec 10, 2018
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- Cefazolin Sodium
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous [preservative free]:
Generic: 1 g/50 mL in Dextrose 4% (50 mL); 2 g/100 mL in Dextrose 4% (100 mL)
Solution Reconstituted, Injection:
Generic: 500 mg (1 ea); 1 g (1 ea); 10 g (1 ea); 20 g (1 ea); 100 g (1 ea); 300 g (1 ea)
Solution Reconstituted, Injection [preservative free]:
Generic: 500 mg (1 ea); 1 g (1 ea); 10 g (1 ea)
Solution Reconstituted, Intravenous:
Generic: 1 g (1 ea); 1 g and Dextrose 4% (1 ea); 2 g and Dextrose 3% (1 ea)
- Antibiotic, Cephalosporin (First Generation)
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Widely into most body tissues and fluids including gallbladder, liver, kidneys, bone, sputum, bile, pleural, and synovial; CSF penetration is poor
Urine (70% to 80% as unchanged drug)
Time to Peak
Serum: IM: 0.5 to 2 hours; IV: Within 5 minutes
IM or IV: Neonates: 3 to 5 hours; Adults: 1.8 hours (IV); ~2 hours (IM) (prolonged with renal impairment)
80% (Marshall 1999)
Use: Labeled Indications
Biliary tract infections: Treatment of biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species and Staphylococcus aureus.
Bone and joint infections: Treatment of bone and joint infections due to S. aureus.
Endocarditis, treatment: Treatment of endocarditis due to S. aureus (penicillin-sensitive and penicillin-resistant) and group A beta-hemolytic streptococci (S. pyogenes).
Genital infections: Treatment of genital infections (ie, prostatitis, epididymitis) due to E. coli, P. mirabilis, and Klebsiella species.
Perioperative prophylaxis: To reduce the incidence of certain postoperative infections in patients undergoing surgical procedures.
Respiratory tract infections: Treatment of respiratory tract infections due to S. pneumoniae, Klebsiella species, Haemophilus influenzae, S. aureus (penicillin-sensitive and penicillin-resistant) and group A beta-hemolytic streptococci.
Septicemia: Treatment of septicemia due to Streptococcus pneumoniae, S. aureus (penicillin-sensitive and penicillin-resistant), P. mirabilis, E. coli and Klebsiella species.
Skin and skin structure infections: Treatment of skin and skin structure infections due to S. aureus (penicillin-sensitive and penicillin-resistant), group A beta-hemolytic streptococci and other strains of streptococci.
Urinary tract infections: Treatment of urinary tract infections due to E. coli, P. mirabilis, Klebsiella species and some strains of enterobacter.
Off Label Uses
Catheter-related bloodstream infections
IDSA clinical practice guidelines state that the use of cefazolin in catheter-related bloodstream infections may be appropriate when the infection is due to methicillin-susceptible S. aureus or methicillin-susceptible, coagulase-negative Staphylococcus species.
Based on the American Heart Association (AHA) guidelines for the prevention of infective endocarditis, cefazolin is effective and recommended for administration to patients with certain cardiac conditions who are unable to take oral medication or are allergic to penicillins or ampicillin and unable to take oral medication to provide prophylaxis against infective endocarditis associated with dental or respiratory tract procedures.
Group B streptococcus, maternal use (neonatal prophylaxis)
Based on the Centers for Disease Control and Prevention (CDC) prevention of perinatal group B streptococcal disease guidelines, cefazolin is effective and recommended at the time of delivery in mothers colonized with group B streptococcus (neonatal prophylaxis) for patients with nonanaphylactic penicillin allergy.
Skin and soft tissue necrotizing infections
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), cefazolin, is an effective and recommended alternative for treatment of necrotizing infections of the skin, fascia, and muscle due to methicillin-sensitive S. aureus.
Surgical site infection
Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), cefazolin is an effective and recommended option for treatment of surgical site infections occurring after surgery of the trunk or extremity (away from axilla or perineum). Systemic antibacterials are not routinely indicated for surgical site infections, but may be beneficial (in conjunction with suture removal plus incision and drainage) in patients with significant systemic response (eg, temperature >38.5ºC, heart rate >110 beats per minute, erythema/induration extending >5 cm from incision, WBC >12,000/mm3).
Hypersensitivity to cefazolin, other cephalosporin antibiotics, penicillins, other beta-lactams, or any component of the formulation.
Usual dosage range: IM, IV: 1 to 1.5 g every 8 hours, depending on severity of infection; maximum: 12 g daily
Catheter-related bloodstream infections (off-label use): IV: 2 g every 8 hours (IDSA [Mermel 2009])
Cholecystitis, mild-to-moderate: IV: 1 to 2 g every 8 hours for 4 to 7 days (provided source controlled)
Endocarditis, prophylaxis (off-label use): Dental and upper respiratory procedures: IM, IV: 1 g 30 to 60 minutes before procedure. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications.
Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Endocarditis, treatment: IV:
Manufacturer’s labeling: 1 to 1.5 g every 6 hours
Alternate dosing (AHA [Baddour 2015]): MSSA in penicillin-allergic (nonanaphylactoid) patients:
Native valve: 2 g every 8 hours for 6 weeks
Prosthetic valve: 2 g every 8 hours for a minimum of 6 weeks (in combination with rifampin for entire course of therapy and gentamicin for the first 2 weeks)
Group B streptococcus, maternal use (neonatal prophylaxis) (alternative agent) (off-label): IV: 2 g once, then 1 g every 8 hours until delivery (CDC [Verani 2010])
Intra-abdominal infection, complicated, community-acquired, mild-to-moderate (in combination with metronidazole): IV: 1 to 2 g every 8 hours for 4 to 7 days (provided source controlled)
Moderate to severe infections: IV: 500 mg to 1 g every 6 to 8 hours
Mild infection with gram-positive cocci: IV: 250 to 500 mg every 8 hours
Osteomyelitis, native vertebral (off-label dose): Staphylococci (oxacillin-susceptible): IV: 1 to 2 g every 8 hours for 6 weeks (IDSA [Berbari 2015])
Manufacturer’s labeling: IM, IV: 1 to 2 g initiated 30 to 60 minutes prior to surgery; may repeat after 2 hours if procedure is lengthy with 500 mg to 1 g intraoperatively, followed by 500 mg to 1 g every 6 to 8 hours for 24 hours postoperatively.
Guideline recommendations (off-label): IV: Note: For most surgical procedures, joint clinical practice guidelines from the American Society of Health-System Pharmacists, Infectious Diseases Society of America, Surgical Infection Society, and Society for Healthcare Epidemiology of America (ASHP/IDSA/SIS/SHEA) recommend a dose of 2 g within 60 minutes prior to surgical incision (for nonobese patients weighing <120 kg). For procedures requiring anaerobic coverage (eg, appendectomy, small bowel surgery with intestinal obstruction, colon procedures), combine cefazolin with metronidazole as an alternative to a second-generation cephalosporin with anaerobic activity (eg, cefoxitin or cefotetan). Cefazolin doses may be repeated intraoperatively in 4 hours if procedure is lengthy or if there is excessive blood loss (Bratzler 2013). For clean and clean-contaminated procedures, continued prophylactic antibiotics beyond surgical incision closure is not recommended, even in the presence of a drain (CDC [Berríos-Torres 2017]).
Obesity: The ASHP/IDSA/SIS/SHEA guidelines recommend that for patients weighing ≥120 kg, a dose of 3 g within 60 minutes prior to surgical incision should be administered (Bratzler 2013). Alternatively, for patients with BMI >40 kg/m2, a single 2 g dose may be sufficient for common general surgical procedures lasting <5 hours; patients enrolled in this multigroup study had a BMI up to a group mean of 55.7 kg/m2 (Ho 2012).
Cardiothoracic surgery: IV: 1 g (see "Note") initiated 30 to 60 minutes prior to surgery (usually at the time of anesthetic induction); repeat dose if the duration of operation exceeds 3 hours (Hillis 2011). The ASHP/IDSA/SIS/SHEA guidelines recommend the use of 2 g (single dose) administered within 60 minutes prior to surgical incision (Bratzler 2013). May either continue for ≤48 hours postoperatively or administer as a single dose preoperatively (may be preferred due to reduced cost and potential for antimicrobial resistance) (Bratzler 2013; Bucknell 2000; Douglas 2011; Edwards 2006; Hillis 2011).
Note: For patients weighing >60 kg, the Society of Thoracic Surgeons recommends a preoperative dose of 2 g administered within 60 minutes of skin incision. If the surgical incision remains open in the operating room, follow with 1 g every 3 to 4 hours unless cardiopulmonary bypass is to be discontinued within 4 hours then delay administration (Engelman 2007).
Peritonitis, treatment (off-label route; Li 2010): Intraperitoneal:
Intermittent exchange: 15 mg/kg per exchange every 24 hours in the long dwell (≥6 hours)
Continuous exchange: Loading dose: 500 mg per liter of dialysate. Maintenance: 125 mg per liter of dialysate.
Note: If patient has residual renal function (eg, >100 mL/day urine output), empirically increase each dose by 25%
Automated peritoneal dialysis: 20 mg/kg every 24 hours in the long day dwell; Note: Guidelines suggest nighttime levels of intraperitoneal cefazolin may fall below the MIC of most organisms and adding cefazolin to each exchange may be warranted
Pneumococcal pneumonia: IV: 500 mg every 12 hours
Prosthetic joint infection, Staphylococcal (oxacillin-susceptible): IV: 1 to 2 g every 8 hours for 2 to 6 weeks (in combination with rifampin) followed by oral antibiotic treatment and suppressive regimens (Osmon 2013)
Severe infection: IV: 1 to 1.5 g every 6 hours
Skin and soft tissue infection due to MSSA, including pyomyositis: IV: 1 g every 8 hours for 7 to 14 days; treat pyomyositis for 14 to 21 days (IDSA [Stevens 2014])
Skin and soft tissue necrotizing infection due to MSSA (off-label use): IV: 1 g every 8 hours; continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (IDSA [Stevens 2014])
Streptococcal skin infections: IV: 1 g every 8 hours (IDSA [Stevens 2014])
Surgical site infection (trunk or extremity [away from axilla or perineum]) (off-label use): IV: 500 mg to 1 g every 8 hours (IDSA [Stevens 2014])
UTI (uncomplicated): IM, IV: 1 g every 12 hours
Refer to adult dosing.
General dosing, susceptible infection (Red Book [AAP 2015]): Infants, Children, and Adolescents: IM, IV:
Mild to moderate infections: 25 to 50 mg/kg/day divided every 8 hours; maximum dose: 1,000 mg/dose
Severe infections: 100 to 150 mg/kg/day divided every 8 hours; maximum dose: 2,000 mg/dose
Prophylaxis for dental and upper respiratory procedures: Infants, Children, and Adolescents: IM, IV: 50 mg/kg 30 to 60 minutes before procedure; maximum dose: 1,000 mg/dose (AHA [Wilson 2007]). Note: AHA guidelines (Baltimore 2015) limit the use of prophylactic antibiotics to patients at the highest risk for infective endocarditis (IE) or adverse outcomes (eg, prosthetic heart valves, patients with previous IE, unrepaired cyanotic congenital heart disease, repaired congenital heart disease with prosthetic material or device during first 6 months after procedure, repaired congenital heart disease with residual defects at the site or adjacent to site of prosthetic patch or device, and heart transplant recipients with cardiac valvulopathy).
Treatment: Children and Adolescents: IV: 100 mg/kg/day in divided doses every 8 hours; usual adult dose: 2,000 mg/dose; maximum daily dose: 12 g/day; treat for at least 4 weeks; longer durations may be necessary; may use with or without gentamicin (AHA [Baltimore 2015])
Peritonitis (peritoneal dialysis) (ISPD [Warady 2012]): Limited data available: Infants, Children, and Adolescents:
Touch contamination of PD line: Intraperitoneal: 125 mg per liter
Invasive dental procedures: IV: 25 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 1,000 mg/dose
Gastrointestinal or genitourinary procedures: IV: 25 mg/kg administered 60 minutes before procedure; maximum dose: 2,000 mg/dose
Intermittent: 20 mg/kg every 24 hours in the long dwell
Continuous: Loading dose: 500 mg per liter of dialysate; maintenance: 125 mg per liter of dialysate
Pneumonia, community-acquired pneumonia (CAP), S. aureus, methicillin susceptible: Infants >3 months, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours (Bradley 2011); usual maximum dose for severe infections: 2,000 mg/dose (Red Book [AAP 2015])
Skin and soft tissue infections, S. aureus, methicillin susceptible (mild to moderate): (IDSA [Stevens 2014]): Infants, Children, and Adolescents:
S. aureus, methicillin susceptible skin and soft tissue infections including pyomyositis: IV: 50 mg/kg/day divided every 8 hours; maximum dose: 1,000 mg/dose; higher doses may be required in severe cases; duration of therapy at least 5 days, but longer may be necessary in some cases, eg, febrile and neutropenic patients: 7 to 14 days; pyomyositis: 14 to 21 days
S. aureus, methicillin susceptible necrotizing infection of skin, fascia, or muscle: IV: 100 mg/kg/day divided every 8 hours; maximum dose: 1,000 mg/dose; continue therapy until surgical debridement no longer necessary, clinical improvement and afebrile for 48 to 72 hours
Streptococcal, nonpurulent skin infection (cellulitis): IV: 100 mg/kg/day divided every 8 hours; maximum dose: 1,000 mg/dose; duration of therapy at least 5 days, but longer may be necessary in some cases
Surgical prophylaxis: Infants, Children, and Adolescents: IV: 30 mg/kg 30 to 60 minutes before procedure, may repeat in 4 hours for prolonged procedure or excessive blood loss (eg, >1,500 mL in adults); maximum dose dependent upon patient weight: Weight <120 kg: 2,000 mg/dose; weight ≥120 kg: 3,000 mg/dose (Bratzler 2013; Red Book [AAP] 2015)
Refer to indication-specific dosing for obesity-related information (may not be available for all indications).
Dilute 500 mg vial with 2 mL SWFI and 1 g vial with 2.5 mL SWFI; reconstituted solution may be directly injected after further dilution with 5 mL SWFI or further diluted for IV administration in 50 to 100 mL compatible solution (eg, D5W, NS); 10 g vial may be diluted with 45 mL to yield 1 g/5 mL or 96 mL to yield 1 g/10 mL.
IM: Inject deep IM into large muscle mass.
IV: Inject direct IV over 3 to 5 minutes or may infuse as an intermittent infusion over 30 to 60 minutes.
Some penicillins (eg, carbenicillin, ticarcillin and piperacillin) have been shown to inactivate aminoglycosides in vitro. This has been observed to a greater extent with tobramycin and gentamicin, while amikacin has shown greater stability against inactivation. Concurrent use of these agents may pose a risk of reduced antibacterial efficacy in vivo, particularly in the setting of profound renal impairment. However, definitive clinical evidence is lacking. If combination penicillin/aminoglycoside therapy is desired in a patient with renal dysfunction, separation of doses (if feasible), and routine monitoring of aminoglycoside levels, CBC, and clinical response should be considered.
Some products may contain sodium.
Store intact vials at room temperature and protect from temperatures exceeding 40°C. Reconstituted solutions of cefazolin are light yellow to yellow. Protection from light is recommended for the powder and for the reconstituted solutions. Reconstituted solutions are stable for 24 hours at room temperature and for 10 days under refrigeration. Stability of parenteral admixture in D5W, D5LR, D51/4NS, D51/2NS, D5NS, D10W, LR, or NS at room temperature (25°C) is 48 hours. Stability of parenteral admixture at refrigeration temperature (4°C) is 14 days.
DUPLEX: Store at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) prior to activation. Following activation, stable for 24 hours at room temperature and for 7 days under refrigeration.
GALAXY: Store at or below -20°C (-4°F). Thawed solution stable for 48 hours at room temperature and for 30 days under refrigeration. Do not refreeze.
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Avoid combination
Fosphenytoin: CeFAZolin may decrease the protein binding of Fosphenytoin. Monitor therapy
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Phenytoin: CeFAZolin may decrease the protein binding of Phenytoin. Monitor therapy
Probenecid: May increase the serum concentration of Cephalosporins. Monitor therapy
RifAMPin: Cephalosporins (N-methylthiotetrazole [NMTT] Side Chain Containing) may enhance the adverse/toxic effect of RifAMPin. Specifically, the risk for bleeding may be increased. Avoid combination
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents. Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
Positive direct and indirect Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction.
Some penicillin derivatives may accelerate the degradation of aminoglycosides in vitro, leading to a potential underestimation of aminoglycoside serum concentration.
Frequency not defined.
Cardiovascular: Localized phlebitis
Central nervous system: Seizure
Dermatologic: Pruritus, skin rash, Stevens-Johnson syndrome
Gastrointestinal: Abdominal cramps, anorexia, diarrhea, nausea, oral candidiasis, pseudomembranous colitis, vomiting
Hepatic: Hepatitis, increased serum transaminases
Hematologic: Eosinophilia, leukopenia, neutropenia, thrombocythemia, thrombocytopenia
Local: Pain at injection site
Renal: Increased blood urea nitrogen, increased serum creatinine, renal failure
Concerns related to adverse effects:
• Elevated INR: May be associated with increased INR, especially in nutritionally-deficient patients, prolonged treatment, hepatic or renal disease.
• Hypersensitivity reactions: Hypersensitivity reactions, including anaphylaxis, may occur. If an allergic reaction occurs, discontinue treatment and institute appropriate supportive measures.
• Penicillin allergy: Use with caution in patients with a history of penicillin allergy.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
• Gastrointestinal disease: Use with caution in patients with a history of gastrointestinal disease, particularly colitis.
• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required.
• Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
Renal function periodically, hepatic function tests, CBC; monitor for signs of anaphylaxis during first dose
Pregnancy Risk Factor
Cefazolin crosses the placenta.
Adverse events have not been reported in the fetus following administration of cefazolin prior to cesarean delivery.
Cefazolin is recommended for group B streptococcus prophylaxis in pregnant patients with a nonanaphylactic penicillin allergy. It is also one of the antibiotics recommended for prophylactic use prior to cesarean delivery and may be used in certain situations prior to vaginal delivery in women at high risk for endocarditis (ACOG 199 2018; ACOG 485 2011; CDC [Verani 2010]).
Due to pregnancy-induced physiologic changes, some pharmacokinetic parameters of cefazolin may be altered (Allegaert 2009; Elkomy 2014; Philipson 1987). In addition to pregnancy, obesity has been found to influence the pharmacokinetics of cefazolin (Pevzner 2011; Stitely 2013; Young 2015). Dose adjustments may be required in pregnant women who are obese (ACOG 199 2018).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience diarrhea or lack of appetite. Have patient report immediately to prescriber severe nausea, severe vomiting, bruising, bleeding, thrush, chills, pharyngitis, loss of strength and energy, seizures, injection site pain or irritation, urinary retention, change in amount of urine passed, vaginitis, signs of Stevens-Johnson syndrome/toxic epidermal necrolysis (red, swollen, blistered, or peeling skin [with or without fever]; red or irritated eyes; or sores in mouth, throat, nose, or eyes), or signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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- Drug class: first generation cephalosporins
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Other brands: Ancef