Cefazolin

General

• Type: 1st gen Cephalosporin
• Dosage Forms: IV, IM
• Common Trade Names: Ancef

Adult Dosing

General

• Mild: 250-500mg IM/IV 8h
• Mod-Severe: 500-1000mg IM/IV q6-8h
• Life Threatening: 1-1.5g IM/IV q6h
• Max: 12g/day

UTI, Uncomplicated

• 1g IM/IV q12

Pneumococcal Pneumonia

• 500mg IM/IV q12

Endocarditis Prophylaxis, Dental

• 1g IM/IV x1 (30-60 min before procedure)

Pediatric Dosing

General (<7 Days)

• 40mg/kg/day IM/IV divided q12h
• First Dose: 20mg/kg IM/IV x 1
• Max 6g/day

General (>7 Days - 1 Month)

• <2000g
  • 40mg/kg/day IM/IV divided q12h
  • First Dose: 20mg/kg IM/IV x 1
  • Max 6g/day
• >2000g
  • 60mg/kg/day IM/IV divided q8h
  • First Dose: 20mg/kg IM/IV x 1
  • Max 6g/day

General (>1 Month)

• 25-100mg/kg/day IM/IV divided q6-8h
• First Dose: 20-33mg/kg IM/IV x 1
• Max 6g/day

Community Acquired Pneumonia (>3 Months)

• 150mg/kg/day IM/IV divided q8h x 10 days
• First Dose: 50mg/kg IM/IV x 1
• May switch to PO regimen when able

Special Populations

• Pregnancy: B
• Lactation: Safe
• Renal
  • Adult
    • CrCl 35-54: give q8
    • CrCl 11-34: give usual dose x1, then decrease dose 50% and give q12h
    • CrCl <10: give usual dose x1, then decrease dose 50% and give q18-24h
    • Hemodialysis: give 0.5-1g supplement
    • Peritoneal dialysis: 500mg q12h
  • Pediatric
    • CrCl 40-70: give usual dose x 1, then decrease daily dose 40% and give q12h
    • CrCl 20-39: give usual dose x 1, then decrease daily dose 75% and give q12h
    • CrCl 5-19: give usual dose x 1, the decerase daily dose 90% and give q24h
    • CrCl <5: not defined
    • Hemodialysis: give supplement
    • Peritoneal dialysis: no supplement
• Hepatic (Adult & Pediatric)
  • Not defined

Contraindications

• Allergy to class/drug

Adverse Reactions

Serious

• Neutropenia
• Thrombocytopenia
• Anaphylaxis
• Stevens-Johnson Syndrome
• Nephrotoxicity
• Seizures
• Clostridium difficile

Common

• Diarrhea
• Rash
• Nausea and Vomiting
• Abdominal Pain
• Anorexia
• Transaminitis
• Urticaria
• Thrombophlebitis

Pharmacology

• Half-life: 1.8h (3.7 ESRD)
• Metabolism: other; CYP450
• Excretion: Urine
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	X1
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	S
	N. meningitidis	R
	Moraxella catarrhalis	I
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	X1
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	S
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	X1
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	X1

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)

References

• Epocrates

Authors

Ross Donaldson