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cefazolin (Rx)Brand and Other Names:

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

powder for injection

  • 500mg
  • 1g
  • 2g
  • 10g
  • 20g
  • 100g
  • 300g
more...

Moderate-to-Severe Infections

0.5-1 g IV q6-8hr

Mild Infections With Gram-Positive Cocci

250-500 mg IV q8hr

Mild-to-Moderate Cholecystitis

1-2 g IV q8hr for 4-7 days

Uncomplicated Urinary Tract Infection

1 g IV q12hr

Preparation for Surgery

Prophylaxis against infection

Preoperatively: 1-2 g IV/IM ≤60 minutes before procedure (may be repeated in 2-5 hours intraoperatively)

Postoperatively: 0.5-1 g IV q6-8hr for 24 hours

Surgical infection

  • Cardiac procedures, hysterectomy, oral or pharyngeal procedures, craniotomy, joint replacement, thoracic procedures, arterial procedures, amputation, traumatic wounds; high-risk esophageal, gastroduodenal, or biliary tract procedures: 1-2 g IV
  • Colorectal procedures: 1-2 g IV plus metronidazole 0.5 g IV
  • High-risk cesarean section, 2nd trimester abortion: 1 g IV
  • Ophthalmic procedures: 100 mg subconjunctivally

Endocarditis

  • 1 g IV/IM 30-60 minutes before procedure
  • American Heart Association (AHA) guidelines: Endocarditis prophylaxis recommended only for high-risk patients

Bacterial Keratitis (Off-label)

1 drop instilled into affected eye(s) q1-2hr; typically alternated every other hour with antibiotic providing gram-negative coverage (eg, tobramycin)

Extemporaneous compounded fortified cefazolin 50 mg/mL

  • Dilute 500 mg parenteral cefazolin powder in sterile water to form 10 mL solution
  • Store refrigerated; preparation expires in 7 days

Dosing Modifications

Renal impairment

  • CrCl 35-54 mL/min: Give full dose at intervals >8hr
  • CrCl 10-35 mL/min: Give therapeutic dose q12hr
  • CrCl ≤10 mL/min: Give therapeutic dose q24hr

Hepatic impairment

  • Not studied

Dosing Considerations

Susceptible organisms

  • Streptococcus pneumoniae, Klebsiella, Haemophilus influenzae, Staphylococcus aureus, group A beta-hemolytic streptococcus, Escherichia coli, Proteus mirabilis, Enterobacter (some strains)

Dosage Forms & Strengths

powder for injection

  • 500mg
  • 1g
  • 2g
  • 10g
  • 20g
  • 100g
  • 300g
more...

Infections With Gram-Positive Cocci

Neonates (<28 days)

  • <7 days: 40 mg/kg/day IV/IM divided q12hr  
  • >7 days, <2 kg: 40 mg/kg/day IV/IM divided q12hr
  • >7 days, >2 kg: 60 mg/kg/day IV/IM divided q8hr

Infants & children

  • 25-100 mg/kg/day IV/IM divided q6-8hr; not to exceed 6 g/day

Endocarditis

Prophylaxis

50 mg/kg IV/IM ≤30-60 minutes before procedure; not to exceed 1 g 

AHA guidelines: Endocarditis prophylaxis recommended only for high-risk patients

Community-Acquired Pneumonia

>3 months and children: 150 mg/kg/day IV/IM divided q8hr (moderate to severe infections, methicillin susceptible S.Aureus preferred

Dosing Considerations

Cefazolin 2 g for Injection USP and Dextrose Injection USP is not recommended for use in pediatric patients; to avoid unintentional overdose, 1 g cefazolin for Injection USP and dextrose Injection USP should only be used in pediatric patients who require entire contents of 1 g dose and not any fraction of it

There are no dosing recommendations for pediatric patients for perioperative prophylaxis or for pediatric patients with renal impairment

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Interactions

Interaction Checker

cefazolin and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Anorexia

            Diarrhea

            Eosinophilia

            Fever

            Increased transaminases

            Leukopenia

            Nausea and vomiting

            Neutropenia

            Oral candidiasis

            Pain at injection site

            Phlebitis

            Pseudomembranous colitis

            Seizure

            Stevens-Johnson syndrome

            Thrombocytopenia

            Thrombocytosis

            Transient elevation of hepatic enzymes

            Vaginitis

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            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            Endocarditis prophylaxis recommended only for high-risk patients, per AHA guidelines

            Dose must be adjusted in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy

            Prolonged treatment, hepatic or renal disease, or nutritional deficiency may be associated with increased international normalized ratio (INR)

            Prolonged use is associated with fungal or bacterial superinfection

            Use with caution in patients with seizure disorder (high levels are associated with increased risk of seizures)

            Use with caution in renal impairment

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            Pregnancy & Lactation

            Pregnancy category: B

            Lactation: Drug excreted in breast milk; use with caution (American Academy of Pediatrics committee states that drug is compatible with nursing)

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            First-generation semisynthetic cephalosporin that binds to 1 or more penicillin-binding proteins, thereby arresting bacterial cell-wall synthesis and inhibiting bacterial replication; has poor capacity to cross blood-brain barrier; primarily active against skin flora, including S aureus

            Absorption

            Peak plasma time: 0.5-2 hr (IM); 5 min (IV)

            Distribution

            Crosses placenta; penetrates CSF poorly

            Protein bound: 74-86%

            Metabolism

            Minimally metabolized in liver

            Elimination

            Half-life: 90-150 min

            Excretion: Urine (80-100% as unchanged drug)

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            Administration

            IV and IM dosing regimens are similar; drug is primarily active against skin flora, including S aureus, and is typically used alone for skin and skin-structure coverage

            IV Incompatibilities

            Additive: Amikacin, gentamicin

            Syringe: Cimetidine, lidocaine

            Y-site: Amiodarone(?), amphotericin B

            Not specified: Erythromycin, norepinephrine, pentobarbital, tetracycline

            IV Compatibilities

            Additive: Cimetidine, verapamil

            Y-site: Aminophylline, amiodarone(?), calcium gluconate, lidocaine, vitamins B and C

            Not specified: Ampicillin, diazepam, hydrocortisone, potassium chloride

            IV Preparation

            Reconstitute 500 mg or 1 g with 2 mL or 2.5 mL SWI, respectively, to provide solutions containing approximately 225 or 330 mg/mL

            IV push: Further dilute in approximately 5 mL of SWI or according to manufacturer's directions

            Infusion: Dilute reconstituted 500 mg or 1 g solution in 50-100 mL NS or D5W

            IM Preparation

            Reconstitute 500 mg or 1 g with 2 mL or 2.5 mL SWI, respectively, to provide solutions containing approximately 225 or 330 mg/mL

            IV Administration

            IV push

            • Administer directly into vein, and infuse over 3-5 minutes or slowly into tubing of compatible IV infusion solution
            • Solution is usually light-yellow to yellow
            • Discard if precipitate is present

            Infusion: volume control set or piggyback container

            • IV infusion stable for 24 hours at room temperature and 96 hours refrigerated

            IM Administration

            Inject deep into large muscle mass

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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