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  • Cefazolin
    (Cefazolin) - Various

    THERAPEUTIC CLASS

    Cephalosporin (1st generation)

    DEA CLASS

    RX

    INDICATIONS

    Treatment of respiratory tract, urinary tract, skin and skin structure, biliary tract, bone and joint, and genital infections, septicemia, and endocarditis caused by susceptible strains of microorganisms. Perioperative prophylaxis for surgical procedures classified as contaminated or potentially contaminated.

    ADULT DOSAGE

    Adults: Moderate to Severe Infections: 500mg-1g IV/IM q6-8h. Mild Gram-Positive Cocci Infections: 250-500mg IV/IM q8h. Acute, Uncomplicated Urinary Tract Infection: 1g IV/IM q12h. Pneumococcal Pneumonia: 500mg IV/IM q12h. Severe Life-Threatening Infections (eg, Endocarditis, Septicemia): 1-1.5g IV/IM q6h. Max: 12g/day (rare). Perioperative Prophylaxis: 1g IV/IM or 2g IV 0.5-1 hr before surgery. For Lengthy Procedures (eg, ≥2 Hrs): 500mg-1g IV/IM during surgery. Postoperative: 500mg-1g IV/IM q6-8h for 24 hrs. Continue for 3-5 days following the completion of surgery where occurrence of infection may be particularly devastating (eg, open-heart surgery, prosthetic arthroplasty). Renal Impairment: CrCl 35-54mL/min: Full dose q8h or longer. CrCl 11-34mL/min: 1/2 usual dose q12h. CrCl ≤10mL/min: 1/2 usual dose q18-24h. Apply reduced dosage recommendations after initial LD is given.

    PEDIATRIC DOSAGE

    Pediatrics: >1 Month: Mild to Moderately Severe Infections: 25-50mg/kg/day IV/IM, given tid or qid. Titrate: May increase to 100mg/kg/day IV/IM for severe infections. Refer to PI for proper dosing guidelines. Renal Impairment: CrCl 41-70mL/min: 60% of usual dose given in equally divided doses q12h. CrCl 21-40mL/min: 25% of usual dose given in equally divided doses q12h. CrCl 5-20mL/min or less: 10% of usual dose given in equally divided doses q24h. Apply reduced dosage recommendations after an initial LD is given.

    HOW SUPPLIED

    Inj: 500mg, 1g

    WARNINGS/PRECAUTIONS

    Caution with penicillin (PCN)-sensitive patients; cross-hypersensitivity among β-lactam antibiotics may occur. D/C if an allergic reaction occurs. Clostridium difficile-associated diarrhea (CDAD) reported; d/c if CDAD suspected or confirmed. Institute appropriate fluid and electrolyte management, protein supplementation, antibacterial drug treatment of C. difficile, and surgical evaluation as clinically indicated. Use in the absence of a proven or strongly suspected bacterial infection or prophylactic indication is unlikely to provide benefit and increases the risk of the development of drug-resistant bacteria. May result in overgrowth of nonsusceptible microorganisms with prolonged use; take appropriate measures if superinfection develops. Lab test interactions may occur. Caution with renal impairment, overt/known subclinical diabetes mellitus (DM) or carbohydrate intolerance for any reason, and in elderly. Not recommended for premature infants and neonates.

    ADVERSE REACTIONS

    Diarrhea, oral candidiasis, N/V, stomach cramps, anorexia, anaphylaxis, leukopenia, thrombocytopenia, renal failure, hepatitis, pruritus, dizziness, fainting, confusion, weakness.

    DRUG INTERACTIONS

    Probenecid may decrease renal tubular secretion.

    PREGNANCY

    Category B, caution in nursing.

    MECHANISM OF ACTION

    Cephalosporin (1st generation); bactericidal agent that acts by inhibition of bacterial cell wall synthesis.

    PHARMACOKINETICS

    Absorption: (IV) Cmax=185mcg/mL. Distribution: Crosses placenta; found in breast milk. Elimination: Urine (unchanged); T1/2=2 hrs (IM), 1.8 hrs (IV).

    ASSESSMENT

    Assess for hypersensitivity to cephalosporin class of antibacterial drugs/PCN/other β-lactams, DM, carbohydrate intolerance, renal impairment, pregnancy/nursing status, and possible drug interactions. Perform appropriate culture and susceptibility tests to determine susceptible causative organisms.

    MONITORING

    Monitor for hypersensitivity reactions, CDAD, development of superinfection, drug resistance, and other adverse reactions. Monitor renal function in elderly. Monitor for seizures in patients with renal dysfunction.

    PATIENT COUNSELING

    Advise that allergic reactions, including serious allergic reactions may occur and require immediate treatment and discontinuation of therapy. Instruct to notify physician of any previous allergic reactions to the drug, cephalosporins, PCNs, or other similar antibacterials. Advise that diarrhea is a common problem that usually ends when therapy is discontinued; however, if watery and bloody stools (with/without stomach cramps and fever) occur, even as late as 2 or more months after last dose, instruct to contact physician as soon as possible. Inform that therapy only treats bacterial, not viral (eg, common cold), infections. Instruct to take exactly as directed even if the patient feels better early in the course of therapy; skipping doses or not completing the full course of therapy may decrease effectiveness and increase risk of bacterial resistance.

    ADMINISTRATION/STORAGE

    Administration: IV/IM route. Shake well before use. Refer to PI for preparation of parenteral solution and administration instruction. Storage: Before Reconstitution: 20-25°C (68-77°F). Protect from light. After Reconstitution: Stable for 24 hrs at room temperature or for 10 days if stored under refrigeration (5°C [41°F]).