Intramuscular, Intravenous Biliary tract infections, Bone and joint infections, Endocarditis, Genitourinary infections, Respiratory tract infections, Septicaemia, Skin and soft tissue infections
Adult: Mild cases: 250-500 mg 8 hourly. Moderate to severe cases: 500-1,000 mg 6-8 hourly. Severe, life-threatening cases: 1,000-1,500 mg 6 hourly. Max: 12,000 mg daily. Doses are given via deep IM inj, slow IV inj over 3-5 minutes, or intermittent or continuous IV infusion. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines). Child: >1 month Mild to moderately severe cases: 25-50 mg/kg daily in 3 or 4 divided doses. Severe cases: Up to 100 mg/kg daily may be given in 3 or 4 divided doses. Doses are given via deep IM inj, slow IV inj over 3-5 minutes, or intermittent or continuous IV infusion. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Adult: 1,000 mg 12 hourly to be given via deep IM inj, slow IV inj over 3-5 minutes, or intermittent or continuous IV infusion. Max: 12,000 mg daily. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Intramuscular, Intravenous Prophylaxis of surgical infections
Adult: Peri-operative dose: 1,000 mg given 30-60 minutes prior to surgery. For long surgeries (≥2 hours): Additional doses of 500-1,000 mg may be given during the surgery. Post-operative doses: 500-1,000 mg 6-8 hourly for 24 hours. Doses are given via deep IM inj, slow IV inj over 3-5 minutes, or intermittent or continuous IV infusion. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Intramuscular, Intravenous Pneumonia
Adult: 500 mg 12 hourly to be given via deep IM inj, slow IV inj over 3-5 minutes, or intermittent or continuous IV infusion. Max: 12,000 mg daily. Dosage and treatment recommendations may vary among countries and individual products (refer to specific product guidelines).
Renal Impairment
Adult:
Dosage recommendations apply after an initial loading dose is administered.
CrCl (mL/min)
Dosage
≤10
Half the usual dose 18-24 hourly.
11-34
Half the usual dose 12 hourly.
35-54
Usual dose 8 hourly.
Respiratory tract infections; Genitourinary infections; Skin and soft tissue infections; Biliary tract infections; Bone and joint infections; Septicaemia; Endocarditis:
Child:
Dosage recommendations apply after an initial loading dose is administered.
CrCl (mL/min)
Dosage
5-20
10% of the normal daily dose 24 hourly.
20-40
25% of the normal daily dose in 2 divided doses.
40-70
60% of the normal daily dose in 2 divided doses.
Reconstitution
Add 2 mL, 2.5 mL, or 5 mL of sterile water for inj to the vial labelled as 500 mg, 1 g, or 2 g respectively, to provide a solution containing approx 225 mg/mL, 330 mg/mL or 333 mg/mL. Further dilute the reconstituted solution in approx 10 mL of sterile water for inj to be used for IV inj or in 50-100 mL of compatible IV solution for IV infusion. Instructions for reconstitution may vary among countries and individual products. Refer to specific product guidelines.
Incompatibility
Incompatible with ascorbic acid, amikacin disulfate, amobarbital Na, bleomycin sulfate, Ca gluceptate, Ca gluconate, cimetidine hydrochloride, colistimethate Na, erythromycin gluceptate, kanamycin sulfate, oxytetracycline hydrochloride, pentobarbital Na, polymyxin B sulfate, and tetracycline hydrochloride.
Contraindications
Hypersensitivity to cefazolin, other cephalosporin antibiotics, or any other β-lactam antibiotic (e.g. penicillin, monobactam, carbapenem).
Special Precautions
Patients with history of gastrointestinal disease (e.g. colitis), seizure disorder, allergic reactivity (e.g. allergic rhinitis, bronchial asthma). Patients with poor nutritional state. Renal impairment. Neonates and children. Pregnancy and lactation.
Adverse Reactions
Significant: Increased INR, prolonged prothrombin time; bacterial or fungal superinfection; seizures (high doses in patients with renal impairment). Gastrointestinal disorders: Loss of appetite, diarrhoea, nausea, vomiting. General disorders and administration site conditions: Pain at the site of IM inj, induration; thrombophlebitis (IV). Immune system disorders: Erythema multiforme, angioedema, drug-induced fever and interstitial pneumonia or pneumonitis. Infections and infestations: Oral candidiasis (prolonged use). Skin and subcutaneous tissue disorders: Rash. Potentially Fatal: Hypersensitivity reactions, Clostridioides difficile-associated diarrhoea, pseudomembranous colitis.
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Evaluate the patient's allergy history before treatment initiation. Monitor renal function, LFTs, and CBC. Assess for signs of anaphylaxis during 1st dose.
Overdosage
Symptoms: Pain, inflammation, and phlebitis at the inj site; seizures, dizziness, paraesthesia, and headache. Management: Symptomatic and supportive treatment. If seizures occur, discontinue treatment; administer anticonvulsant if clinically indicated. Protect the patient's airway and support ventilation and perfusion. Monitor and maintain the patient's vital signs, blood gases and serum electrolytes within acceptable limits.
Drug Interactions
Increased and prolonged plasma concentration with probenecid. Increased nephrotoxic effects of aminoglycosides, colistin, polymyxin B, iodine-containing contrast agents, organoplatinum compounds, high dose methotrexate, certain antivirals, pentamidine, ciclosporin, tacrolimus and diuretics. May enhance the therapeutic effect of anticoagulants. May diminish the therapeutic effect of typhoid vaccine.
Food Interaction
May cause a disulfiram-like reaction with alcohol.
Lab Interference
Positive direct and indirect Coombs' test. False-positive results on urinary glucose tests based on Benedict's copper reduction reaction or Fehling's solution. False-positive results for tests on urine creatinine with Jaffe reaction.
Action
Description: Mechanism of Action: Cefazolin, a 1st-generation cephalosporin, is an antibiotic. It inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls by binding to 1 or more of the penicillin-binding proteins, thereby inhibiting cell wall biosynthesis and causing eventual bacterial lysis. Pharmacokinetics: Absorption: Time to peak plasma concentration: 0.5-2 hours (IM); within 5 minutes (IV). Distribution: Widely distributed into most body tissues and fluids, including gallbladder, liver, kidneys, bone, sputum, bile, pleural, and synovial; CSF (low concentrations). Crosses the placenta; enters breast milk (low concentrations). Plasma protein binding: Approx 70-90%. Excretion: Via urine (70-80% as unchanged drug). Elimination half-life: Approx 2 hours (IM); approx 1.8 hours (IV).
Chemical Structure
Cefazolin Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 33255, Cefazolin. https://pubchem.ncbi.nlm.nih.gov/compound/Cefazolin. Accessed Aug. 14, 2023.
J01DB04 - cefazolin ; Belongs to the class of first-generation cephalosporins. Used in the systemic treatment of infections.
References
Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH. "Tables of Antibacterial Drug Dosages", Red Book: 2021-2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics [online]. Accessed 12/04/2023.AFT Pharmaceuticals Ltd. Cefazolin-AFT Powder for Injection data sheet 16 February 2023. Medsafe. http://www.medsafe.govt.nz. Accessed 12/04/2023.Anon. Cefazolin (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 12/04/2023.Anon. Cefazolin. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 12/04/2023.Anon. Cefazolin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 12/04/2023.Buckingham R (ed). Cefazolin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 12/04/2023.Cefavex 1 g Powder for Injection (Sannovex Pharmaceutical Distributor). MIMS Philippines. http://www.mims.com/philippines. Accessed 12/04/2023.Cefazolin 1 g Powder for Solution for Injection and Infusion (Noridem Enterprises Ltd.). MHRA. https://products.mhra.gov.uk. Accessed 12/04/2023.Cefazolin Injection, Powder for Solution (Fresenius Kabi USA, LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Cefazolin Injection, Powder for Solution (Hikma Pharmaceuticals USA Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Cefazolin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 12/04/2023.Fazef 1 g Powder for Injection (Zerss Pharmaceutical Pvt. Ltd.). MIMS Philippines. http://www.mims.com/philippines. Accessed 12/04/2023.Fazlin 1 g Powder for Injection (NCPC Hebei Huamin Pharmaceutical Company Limited). MIMS Philippines. http://www.mims.com/philippines. Accessed 12/04/2023.Joint Formulary Committee. Cefazolin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 12/04/2023.Paediatric Formulary Committee. Cefazolin. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 12/04/2023.
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