Cefazolin

From WikEM
Jump to: navigation, search

General

  • Type: 1st gen Cephalosporin
  • Dosage Forms: powder for injection
  • Dosage Strengths: 500mg; 1, 2, 10, 20, 100, 300g
  • Routes of Administration: 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

Common

Pharmacology

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

Antibiotic Sensitivities[1]

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

References

  1. Sanford Guide to Antimicrobial Therapy 2014
  • Epocrates