cefazolin

REMS

Treatment of the following infections due to susceptible organisms:
- Skin and skin structure infections (including burn wounds),
- Pneumonia,
- Urinary tract infections,
- Biliary tract infections,
- Genital infections,
- Bone and joint infections,
- Septicemia,
- Bacterial endocarditis prophylaxis for dental and upper respiratory procedures.
Perioperative prophylaxis.
Not suitable for the treatment of meningitis.

Action ⬆ ⬇

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Active against many gram-positive cocci including:
- Streptococcus pneumoniae,
- Group A beta-hemolytic streptococci,
- Penicillinase-producing staphylococci.
Not active against:
- Methicillin-resistant staphylococci,
- Bacteroides fragilis,
- Enterococcus.
Active against some gram-negative rods including:
- Proteus mirabilis,
- Escherichia coli.

Pharmacokinetics ⬆ ⬇

Absorption: Well absorbed after IM administration. IV administration results in complete bioavailability.

Distribution: Widely distributed. Penetrates bone and synovial fluid well. Crosses the placenta and enters breast milk in low concentrations. Minimal CSF penetration.

Metabolism/Excretion: Excreted almost entirely unchanged by the kidneys.

Half-Life: Neonates: 3–5 hr; Adults: 90–150 min (↑ in renal impairment).

Time/Action Profile ⬆ ⬇

(plasma concentrations)

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

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity to cephalosporins;
Serious hypersensitivity to penicillins.

Use Cautiously in:

Renal impairment (dose ↓ and/or ↑ dosing interval recommended if CCr <50 mL/min [adults] or <70 mL/min [children]);
Hepatic impairment;
History of GI disease, especially colitis;
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 ⬆ ⬇

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

Derm: rash, pruritus, STEVENS-JOHNSON SYNDROME, urticaria

Hemat: leukopenia, neutropenia, thrombocytopenia

Local: pain at IM site, phlebitis at IV site

Neuro: SEIZURES(HIGH DOSES)

Misc: allergic reactions including anaphylaxis and , serum sicknesssuperinfection

Interactions ⬆ ⬇

Drug-drug:

Probenecid↓ excretion and ↑ levels of renally excreted cephalosporins.

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.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 30–49 mL/min: 1–2 g every 8–12 hr; CCr 10–29 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/100 mL 4% dextrose in water

Assessment ⬆ ⬇

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of 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 a sign of Clostridioides difficile-associated diarrhea (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. Stevens-Johnson syndrome 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 cause ↑ 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 IM doses with 2 mL or 2.5 mL of with 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, at least 1 hr apart. If second site is unavailable, flush line between medications.
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.

Patient/Family Teaching ⬆ ⬇

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 females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇