cefazolin

Contraindicated in:

Hypersensitivity to cephalosporins;
Serious hypersensitivity to penicillins.

Use Cautiously in:

Renal impairment (dose ↓ and/or ↑ dosing interval recommended if CCr <55 mL/min [adults] or <70 mL/min [children]);
History of GI disease, especially colitis;
Renal or hepatic impairment, poor nutritional state, extended antibiotic therapy, or previously stabilized on anticoagulant therapy (may ↑ risk of bleeding);
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Geri: Dose adjustment due to age-related ↓ in renal function may be necessary in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash, pruritus, STEVENS-JOHNSON SYNDROME (SJS), urticaria

GI: diarrhea, nausea, vomiting, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), cramps

Hemat: leukopenia, neutropenia, thrombocytopenia

Local: pain at IM site, phlebitis at IV site

Neuro: SEIZURES(HIGH DOSES)

Misc: HYPERSENSITIVITY REACTIONS(INCLUDING ANAPHYLAXIS AND SERUM SICKNESS), superinfection

Interactions ⬆ ⬇

Drug-drug:

Probenecid↓ excretion and ↑ levels of renally excreted cephalosporins.
May potentiate the effects of anticoagulants and ↑ the risk of bleeding.

Route/Dosage ⬆ ⬇

IM IV (Adults ): Moderate to severe infections: 500 mg–1 g every 6–8 hr. Mild infections with gram-positive cocci: 250–500 mg every 8 hr.Uncomplicated urinary tract infection: 1 g every 12 hr.Pneumococcal pneumonia: 500 mg every 12 hr.Severe, life-threatening infections (e.g., infective endocarditis or septicemia): 1–1.5 g every 6 hr.
IV (Adults ≥120 kg): Perioperative prophylaxis: 3 g within 30–60 min prior to incision (an additional 500 mg–1 g should be given for surgeries ≥ 2 hr). 500 mg–1 g should then be given for all surgeries every 6–8 hr for 24 hr following the surgery.
IV (Adults <120 kg): Perioperative prophylaxis: 1–2 g within 30–60 min prior to incision (an additional 500 mg–1 g should be given for surgeries ≥ 2 hr). 500 mg–1 g should then be given for all surgeries every 6–8 hr for 24 hr following the surgery.
IV (Children ≥10 yr and ≥50 kg): Perioperative prophylaxis: 2 g within 30–60 min prior to incision (an additional 500 mg–1 g should be given for surgeries ≥ 2 hr). 500 mg–1 g should then be given for all surgeries every 6–8 hr for 24 hr following the surgery.
IV (Children ≥10 yr and <50 kg): Perioperative prophylaxis: 1 g within 30–60 min prior to incision (an additional 500 mg–1 g should be given for surgeries ≥ 2 hr). 500 mg–1 g should then be given for all surgeries every 6–8 hr for 24 hr following the surgery.
IV (Children ): Mild to moderate infections: 25–50 mg/kg/day divided into 3 or 4 equal doses. Severe infections: 100 mg/kg/day divided into 3 or 4 equal doses.

Renal Impairment

IV (Adults ): CCr 35–54 mL/min: 1–2 g every 8–12 hr; CCr 11–34 mL/min: 1 g every 12 hr; CCr ≤10 mL/min: 500 mg–1 g every 24 hr. Hemodialysis: 500 mg–1 g every 24 hr (on hemodialysis days, give dose after dialysis). Peritoneal dialysis: 500 mg every 12 hr or 1 g every 24 hr.

Renal Impairment

(Children ): CCr 40–70 mL/min: Give 60% of normal daily dose in 2 divided doses (every 12 hr). CCr 20–40 mL/min: Give 25% of normal daily dose in 2 divided doses (every 12 hr). CCr 5–20 mL/min: Give 10% of normal daily dose every 24 hr.

Availability ⬆ ⬇

(Generic available)

Powder for injection: 500 mg/vial; 1 g/vial; 2 g/vial; 3 g/vial; 10 g/vial; 20 g/vial; 100 g/vial; 300 g/vial
Premixed containers: 1 g/50 mL 4% dextrose in water; 2 g/50 mL 3% dextrose in water; 3 g/50 mL 2% dextrose in water

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; ↑ WBC) before and throughout therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction.
Monitor bowel function. Report diarrhea, abdominal cramping, fever, and bloody stools to health care professional promptly as signs of CDAD. May begin up to several wk following cessation of therapy.
Assess patient for skin rash frequently during therapy. Discontinue at first sign of rash; may be life-threatening. SJS may develop. Treat symptomatically; may recur once treatment is stopped.

Lab Test Considerations:

May cause positive results for Coombs' test in patients receiving high doses or in neonates whose mothers were given cephalosporins before delivery.
- May ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and serum creatinine.
- May rarely cause leukopenia, neutropenia, thrombocytopenia, and eosinophilia.

Implementation ⬆ ⬇

Do not confuse cefazolin with cefotetan, cefoxitin, ceftazidime, or ceftriaxone.
IM: Reconstitution: Reconstitute with 2 mL or 2.5 mL of sterile water for injection.Concentration: 225–330 mg/mL.
- Inject deep into a well-developed muscle mass; massage well.

IV Administration:

IV: Monitor site frequently for thrombophlebitis (pain, redness, swelling). Change sites every 48–72 hr to prevent phlebitis.
- Do not use solutions that are cloudy or contain a precipitate.
- If aminoglycosides are administered concurrently, administer in separate sites, if possible, >1 hr apart. If 2nd site is unavailable, flush line between medications.
IV Push: Diluent: Dilute with sterile water for injection. Do not use preparations containing benzyl alcohol for neonates.Concentration: 100 mg/mL.
Rate: Administer slowly over 3–5 min.
Intermittent Infusion: Diluent: Reconstituted solution may be further diluted with 0.9% NaCl, D5W, D10W, D5/0.25% NaCl, D5/0.45% NaCl, D5/0.9% NaCl, D5/LR, or LR solution. Solution is stable for 24 hr at room temperature and 10 days if refrigerated.
Concentration: 20 mg/mL.
Rate: Administer over 30–60 min.
Y-Site Compatibility:
- acetaminophen
- acyclovir
- allopurinol
- alprostadil
- amifostine
- aminocaproic acid
- aminophylline
- amphotericin B lipid complex
- amphotericin B liposomal
- anidulafungin
- argatroban
- arsenic trioxide
- ascorbic acid
- atracurium
- atropine
- azithromycin
- aztreonam
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- cefiderocol
- cefotetan
- cefoxitin
- ceftazidime
- ceftolozane/tazobactam
- ceftriaxone
- cefuroxime
- chloramphenicol
- cisplatin
- clindamycin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dactinomycin
- daptomycin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- docetaxel
- doxorubicin liposomal
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- esmolol
- etoposide
- etoposide phosphate
- fentanyl
- filgrastim
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- foscarnet
- fosphenytoin
- furosemide
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- heparin
- hetastarch
- hydrocortisone
- ifosfamide
- imipenem/cilastatin
- indomethacin
- insulin, regular
- irinotecan
- isoproterenol
- ketamine
- ketorolac
- LR
- letermovir
- leucovorin calcium
- lidocaine
- linezolid
- lorazepam
- mannitol
- melphalan
- meperidine
- meropenem
- meropenem/vaborbactam
- mesna
- methadone
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- morphine
- multivitamins
- nafcillin
- nalbuphine
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- ondansetron
- oxacillin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- penicillin G
- phenobarbital
- phenylephrine
- phytonadione
- plazomicin
- potassium acetate
- potassium chloride
- procainamide
- propofol
- propranolol
- remifentanil
- rituximab
- sargramostim
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- sulbactam/durlobactam
- tacrolimus
- tedizolid
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- topotecan
- trastuzumab
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- voriconazole
- zoledronic acid
Y-Site Incompatibility:
- alemtuzumab
- azathioprine
- calcium chloride
- caspofungin
- cefotaxime
- chlorpromazine
- dacarbazine
- dantrolene
- daunorubicin
- diazepam
- diazoxide
- diphenhydramine
- dobutamine
- dopamine
- doxorubicin hydrochloride
- doxycycline
- erythromycin
- ganciclovir
- gemtuzumab ozogamicin
- haloperidol
- hydralazine
- hydroxyzine
- idarubicin
- isavuconazonium
- levofloxacin
- minocycline
- mitomycin
- mitoxantrone
- mycophenolate
- papaverine
- pemetrexed
- pentamidine
- pentobarbital
- phentolamine
- phenytoin
- prochlorperazine
- protamine
- pyridoxine
- tobramycin
- trimethoprim/sulfamethoxazole
- vinorelbine.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if rash or fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.
Rep: Advise women of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

ROUTE	ONSET	PEAK	DURATION
IM	rapid	0.5–2 hr	6–12 hr
IV	rapid	5 min	6–12 hr

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇