Cefazolin: Indication, Dosage, Side Effect, Precaution

This information is not country-specific. Please refer to the Myanmar prescribing information.

Generic Medicine Info

Indications and Dosage

Parenteral
Susceptible infections

Adult: Mild: 0.25-0.5 g 8 hrly. Moderate to severe: 0.5-1 g 6-8 hrly. Severe, life-threatening: 1-1.5 g 6 hrly. Max: 12 g daily. All doses to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or continuous IV infusion.
Child: >1 yr 25-50 mg/kg daily in 3 or 4 divided doses to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or continuous IV infusion. Max: 100 mg/kg daily in divided doses for severe infections.

Parenteral
Acute uncomplicated urinary tract infections

Adult: 1 g 12 hrly to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or continuous IV infusion. Max: 12 g daily.
Child: >1 yr 25-50 mg/kg daily in 3 or 4 divided doses to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or continuous IV infusion. Max: 100 mg/kg daily in divided doses for severe infections.

Parenteral
Pneumonia

Adult: 500 mg 12 hrly to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or continuous IV infusion. Max: 12 g daily.
Child: >1 yr 25-50 mg/kg daily in 3 or 4 divided doses to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or continuous IV infusion. Max: 100 mg/kg daily in divided doses for severe infections.

Parenteral
Prophylaxis of surgical infections

Adult: 1 g given 30-60 min prior to surgery, followed by 0.5-1 g during surgery for lengthy procedures, then 0.5-1 g 6-8 hrly after surgery for 24 hr or up to 5 days. All doses to be given by deep IM inj, slow IV inj over 3-5 min, or intermittent or continuous IV infusion.

Renal Impairment

CrCl	Dosage
≤10	Half the usual dose 18-24 hrly.
11-34	Half the usual dose 12 hrly.
35-54	Usual dose at intervals of at least 8 hr.

Reconstitution

Add 2 or 2.5 mL of sterile water for inj to the vial labelled as 500 mg or 1 g, respectively, to provide soln containing approx 225 or 330 mg/mL. Further dilute in approx 5 mL of sterile water for inj to be used for IV inj or in 50-100 mL of compatible IV soln for IV infusion.

Incompatibility

Aminoglycosides. Y-site: Amphotericin B cholesteryl sulfate complex, caspofungin, idarubicin, pemetrexed, pentamidine, vinorelbine. Variable: Amiodarone, anakinra, cisatracurium, doxapram, hetastarch in NS, hydromorphone, pantoprazole, promethazine, vancomycin.

Contraindications

Hypersensitivity to cephalosporins.

Special Precautions

Patient w/ history of hypersensitivity to penicillins, GI disease particularly colitis, seizure disorder. Renal impairment. Pregnancy and lactation.

Adverse Reactions

Diarrhoea, oral candidiasis, vomiting, nausea, stomach cramps, anorexia; eosinophilia, itching, drug fever, skin rash, Stevens-Johnson syndrome; neutropenia, leucopenia, thrombocytopenia, thrombocythemia; transient elevation in SGOT, SGPT and alkaline phosphatase levels; hepatitis; increased BUN and creatinine levels, renal failure; phlebitis, induration; genital and anal pruritus (e.g. vulvar pruritus, genital moniliasis, vaginitis).
Potentially Fatal: Anaphylaxis, pseudomembranous colitis.

Pregnancy Category (US FDA)

IM/Intraocular/Intraperitoneal/IV/Parenteral: B

Monitoring Parameters

Monitor prothrombin time; renal, hepatic and haematological function; monitor for signs of anaphylaxis during 1st dose.

Drug Interactions

May enhance the anticoagulant effect of vit K antagonists (e.g. warfarin). May diminish the therapeutic effect of Na picosulfate, BCG and typhoid vaccine. May decrease the protein binding of fosphenytoin and phenytoin. Probenecid may decrease renal tubular secretion of cefazolin, resulting in increased and prolonged blood levels. May increase the nephrotoxic effects of aminoglycosides.

Food Interaction

Disulfiram-like reaction w/ alcohol.

Lab Interference

False-positive reaction in urinary glucose test using Benedict's soln, Fehling's soln or Clinitest tablets. Positive direct and indirect Coombs test.

Action

Description: Cefazolin binds to 1 or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell death.
Pharmacokinetics:
Absorption: Poorly absorbed from GI tract. Time to peak plasma concentration: 1 hr (IM).
Distribution: Diffuses into bone, ascitic, pleural and synovial fluids; CSF (small amount). Crosses the placenta and enters breast milk. Plasma protein-binding: Approx 85%.
Metabolism: Minimally hepatic.
Excretion: Via urine (80-100% as unchanged drug). Plasma half-life: Approx 1.8 hr.

Chemical Structure

Storage

Store between 20-25°C. Protect from light. Reconstituted soln/premixed inj: Store at or below -20°C.

MIMS Class

Cephalosporins

References

Anon. Cefazolin. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 09/10/2014.

Buckingham R (ed). Cefazolin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/10/2014.

Cefazolin Sodium Injection, Solution (Baxter Healthcare Corporation). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 09/10/2014.

McEvoy GK, Snow EK, Miller J et al (eds). Cefazolin Sodium. AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). https://www.medicinescomplete.com. Accessed 09/10/2014.

Preston CL (ed). Cefazolin Drug Interactions. Stockley’s Drug Interactions [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 09/10/2014.

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