Cefazolin Sodium

Antibacterial; β-lactam antibiotic; first generation cephalosporin.100 115 116 117 119 a

Biliary Tract Infections

Treatment of biliary tract infections caused by susceptible Escherichia coli,100 115 116 117 119 Klebsiella,115 116 Proteus mirabilis,100 115 116 117 119 Staphylococcus aureus,100 115 116 117 119 or various streptococci.100 115 116 117 119

Bone and Joint Infections

Treatment of bone and joint infections caused by susceptible S. aureus.100 115 116 117 119

Endocarditis

Treatment of endocarditis caused by susceptible Streptococcus pyogenes.100 113 114 115 116 117 119 AHA recommends cefazolin as an alternative for treatment of staphylococcal endocarditis113 114 or endocarditis caused by viridans streptococci†, S. bovis†, S. pneumoniae†, S. pyogenes, or groups B, C, and G streptococci† in penicillin-allergic individuals; should not be used in those with immediate-type penicillin hypersensitivity (see Cross-hypersensitivity under Cautions).113

Alternative for prevention of α-hemolytic (viridans group) streptococcal endocarditis† in individuals undergoing certain dental or upper respiratory tract procedures who have cardiac conditions that put them at highest risk.104 Oral amoxicillin is usual drug of choice for such prophylaxis;104 cefazolin (or ceftriaxone) is an alternative in penicillin-allergic individuals or when an oral anti-infective cannot be used.104 Should not be used in those with immediate-type penicillin hypersensitivity (see Cross-hypersensitivity under Cautions).104 Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with highest risk of endocarditis and which procedures require prophylaxis.104

Respiratory Tract Infections

Treatment of respiratory infections caused by susceptible S. pneumoniae,100 115 116 117 119 S. pyogenes (group A β-hemolytic streptococci),100 115 116 117 119 S. aureus (including penicillin-resistant strains),100 115 116 117 119 Klebsiella,115 116 or Haemophilus influenzae.115 116

Septicemia

Treatment of septicemia caused by susceptible S. pneumoniae,100 115 116 117 119 S. aureus (including penicillinase-producing strains),100 115 116 117 119 E. coli,100 115 116 117 119 Klebsiella,115 116 or P. mirabilis.100 115 116 117 119

Skin and Skin Structure Infections

Treatment of skin and skin structure infections caused by susceptible S. aureus (including penicillinase-producing strains),100 115 116 117 119 S. pyogenes,100 115 116 117 119 or other streptococci.100 115 116 117 119

Urinary Tract Infections (UTIs) and Urogenital Infections

Treatment of UTIs caused by susceptible E. coli,100 115 116 117 119 P. mirabilis,115 116 117 119 Klebsiella,115 116 some strains of Enterobacter,115 116 or some strains of enterococci.115 116

Treatment of prostatitis or epididymitis caused by susceptible E. coli,100 115 116 117 119 Klebsiella,115 116 P. mirabilis,100 115 116 117 115 116 119 or some strains of enterococci.115 116

Prevention of Perinatal Group B Streptococcal Disease

Alternative to penicillin G or ampicillin for prevention of perinatal group B streptococcal (GBS) disease† (early-onset neonatal GBS disease) in penicillin-allergic pregnant women who do not have immediate-type penicillin hypersensitivity (see Cross-hypersensitivity under Cautions).111

Intrapartum anti-infective prophylaxis to prevent early-onset neonatal GBS disease is indicated in women identified as GBS carriers during routine prenatal GBS screening (vaginal and rectal cultures) performed at 35–37 weeks during the current pregnancy, women who have GBS bacteriuria identified at any time during the current pregnancy, and women with a previous infant diagnosed with invasive GBS disease.111

Prophylaxis also indicated in women with unknown GBS status at onset of labor (i.e., culture not done, incomplete, or results unknown) if delivery is at <37 weeks of gestation, duration of amniotic membrane rupture is ≥18 hours, intrapartum temperature is ≥38°C, or woman has a positive intrapartum GBS nucleic acid amplification test (NAAT).111

Perioperative Prophylaxis

Perioperative prophylaxis to reduce incidence of infection in patients undergoing certain cardiac surgery, noncardiac thoracic surgery, vascular surgery, head and neck surgery, neurosurgery, orthopedic surgery, GI surgery, GU surgery, and gynecologic and obstetric surgery.100 102 106 107 108 109 110 115 116 117 119

Drug of choice for perioperative prophylaxis for a wide variety of contaminated or potentially contaminated surgical procedures.102 103 Also recommended as drug of choice for perioperative prophylaxis for heart, lung, heart-lung, pancreas, and pancreas-kidney transplantation.103

For perioperative prophylaxis in patients undergoing certain GI procedures (e.g., colorectal surgery, appendectomy) that might involve exposure to Bacteroides fragilis or other anaerobic bowel bacteria or in patients undergoing head and neck surgery involving incisions through oral or pharyngeal mucosa; used in conjunction with metronidazole to provide anaerobic coverage.102 103

Consult published guidelines and protocols for perioperative prophylaxis for recommendations regarding specific procedures.102 103

Administration

Administer by IV injection or infusion or by deep IM injection.100 115 116 117 119

Duplex drug delivery system containing cefazolin and dextrose injection in separate chambers117 and the commercially available premixed cefazolin injection (frozen) should be used only for IV infusion.119

For solution and drug compatibility information, see Compatibility under Stability

IV Injection

Reconstitution and Dilution

Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL, respectively, of sterile water for injection to provide solutions containing approximately 225 or 330 mg/mL, respectively.100 115 Then further dilute reconstituted solution in approximately 5 mL of sterile water for injection.100 115

Rate of Administration

Inject directly into a vein over a period of 3–5 minutes or slowly into the tubing of a freely flowing compatible IV solution.100 115

IV Infusion

Reconstitution and Dilution

Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL, respectively, of sterile water for injection to provide solutions containing approximately 225 or 330 mg/mL, respectively.100 115 Then further dilute reconstituted solution in 50–100 mL of a compatible IV solution.100 115

Reconstitute 10- or 20-g pharmacy bulk packages according to the manufacturers' directions and then further dilute in a compatible IV solution prior to IV infusion.100 116

Reconstitute (activate) commercially available Duplex drug delivery system containing 1 or 2 g of cefazolin and 50 mL of dextrose injection in separate chambers according to the manufacturer's directions.117

Thaw the commercially available premixed injection (frozen) at room temperature (25°C) or under refrigeration (5°C); do not thaw by immersion in a water bath or by exposure to microwave radiation.119 A precipitate may have formed in the frozen injection, but should dissolve with little or no agitation after reaching room temperature.119 Discard thawed injection if solution is cloudy or contains an insoluble precipitate or if container seals or outlet ports are not intact or leaks are found.119 Do not use in series connections with other plastic containers, since such use could result in air embolism from residual air being drawn from the primary container before administration of fluid from the secondary container is complete.119

IM Injection

Inject IM deeply into a large muscle mass.100 115

Reconstitution

Reconstitute vials containing 500 mg or 1 g of cefazolin with 2 or 2.5 mL, respectively, of sterile water for injection to provide solutions containing approximately 225 or 330 mg/mL, respectively.100 115 Shake well until dissolved.100 115

Dosage

Available as cefazolin sodium; dosage expressed in terms of cefazolin.100 115 116 117 119

Do not use cefazolin available in Duplex drug delivery system or the premixed injection (frozen) in patients who require less than entire 1- or 2-g dose in the container.117 119

Pediatric Patients

General Dosage for Neonates† IM or IV

Neonates ≤7 days of age†: AAP recommends 25 mg/kg every 12 hours, regardless of weight.105

Neonates 8–28 days of age†: AAP recommends 25 mg/kg every 12 hours in those weighing ≤2 kg and 25 mg/kg every 8 hours in those weighing >2 kg.105

Manufacturers state safety and efficacy not established in premature infants or neonates ≤1 month of age.100 115 116

General Dosage for Infants and Children IV or IM

Children >1 month of age: 25–50 mg/kg daily in 3 or 4 equally divided doses for mild to moderate infections.100 115 116 Dosage may be increased to 100 mg/kg daily in divided doses for severe infections.100 115 116

Children beyond neonatal period: AAP recommends 25–50 mg/kg daily given in 3 equally divided doses for treatment of mild to moderate infections and 100–150 mg/kg daily given in 3 equally divided doses for treatment of severe infections.105

Endocarditis Treatment of Staphylococcal Endocarditis IV

100 mg/kg daily (up to 6 g daily) in 3 or 4 equally divided doses.114

For native valve endocarditis, duration of treatment is 6 weeks (with or without gentamicin given during the first 3–5 days).113 114

For endocarditis involving prosthetic valves or other prosthetic materials, duration of treatment is ≥6 weeks (with or without rifampin given for ≥6 weeks).114

Prevention of Endocarditis in Patients Undergoing Certain Dental or Respiratory Tract Procedures† IV or IM

A single dose of 50 mg/kg given 0.5–1 hour prior to the procedure.104

Perioperative Prophylaxis Various Surgical Procedures IV

30 mg/kg103 within 60 minutes before surgical incision.102 103

If procedure is prolonged (>4 hours) or if major blood loss occurs, additional intraoperative doses may be given every 4 hours.102 103 Duration of prophylaxis should be <24 hours for most procedures;102 no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.102 103

If used in patients undergoing certain GI procedures (e.g., colorectal surgery, appendectomy) that might involve exposure to B. fragilis or other bowel anaerobes or in patients undergoing head and neck surgery involving incisions through oral or pharyngeal mucosa, give usual cefazolin dose in conjunction with IV metronidazole (15 mg/kg)103 within 60 minutes before surgical incision.102 103

Adults

Mild Infections Caused by Gram-positive Bacteria IV or IM

250–500 mg every 8 hours.100 115 116 117 119

Moderate to Severe Infections IV or IM

500 mg–1 g every 6–8 hours.100 115 116 117 119

Severe, Life-threatening Infections IV or IM

1–1.5 g every 6 hours.100 115 116 117 119 Dosage up to 12 g daily has been used.100 115 116 117 119

Endocarditis Treatment of Endocarditis IV or IM

1–1.5 g every 6 hours.100 115 116 117 119 Dosage up to 12 g daily has been used.100 115 116 117 119

AHA recommends 2 g IV every 8 hours for 4–6 weeks for native valve staphylococcal endocarditis (with or without gentamicin during the first 3–5 days).113

Prevention of Endocarditis in Patients Undergoing Certain Dental or Upper Respiratory Tract Procedures† IV or IM

A single 1-g dose given 0.5–1 hour prior to the procedure.104

Respiratory Tract Infections Pneumococcal Pneumonia IV or IM

500 mg every 12 hours.100 115 116 117 119

Septicemia IV or IM

1–1.5 g every 6 hours.100 115 116 117 119 Doses up to 12 g daily have been used.100 115 116 117 119

Urinary Tract Infections (UTIs) Acute Uncomplicated Infections IV or IM

1 g every 12 hours.100 115 116 117 119

Prevention of Perinatal Group B Streptococcal (GBS) Disease† IV

An initial 2-g dose (at onset of labor or rupture of membranes) followed by 1 g every 8 hours until delivery.111

Perioperative Prophylaxis Various Surgical Procedures IV or IM

Manufacturers recommend 1 or 2 g given 0.5–1 hour prior to surgery, 0.5–1 g during surgery for lengthy procedures (e.g., ≥2 hours), and 0.5–1 g every 6–8 hours for 24 hours postoperatively.100 115 116 117 119 Manufacturers also recommend that prophylaxis be continued for 3–5 days following surgery where the occurrence of infection may be particularly devastating (e.g., open-heart surgery, prosthetic arthroplasty).100 115 116 117 119

Some experts recommend 1 g in adults weighing <80 kg and 2 g in those weighing ≥80 kg given within 60 minutes of surgical incision and suggest that morbidly obese patients may need higher dosage.102 Other experts suggest 2 g for most adults and 3 g for those weighing ≥120 kg.103

If procedure is prolonged (>4 hours) or if major blood loss occurs, additional intraoperative doses may be given every 4 hours.102 103 Duration of prophylaxis should be <24 hours for most procedures;102 no evidence to support continuing prophylaxis after wound closure or until all indwelling drains and intravascular catheters are removed.102 103

If used in patients undergoing certain GI procedures (e.g., colorectal surgery, appendectomy) that might involve exposure to B. fragilis or other bowel anaerobes or in patients undergoing head and neck surgery involving incisions through oral or pharyngeal mucosa, give usual cefazolin dose in conjunction with IV metronidazole (0.5 g) within 60 minutes before surgical incision.102 103

Special Populations

Hepatic Impairment

No dosage recommendations.100 115 116 117 119

Renal Impairment

Dosage adjustments recommended in patients with Clcr <55 mL/minute.100 115 116 117 119

Administer an initial loading dose appropriate for the severity of the infection, followed by dosage based on the degree of renal impairment.100 115 116 117 119

Dosage for Adults with Renal Impairment100115116117119

Clcr (mL/minute)	Dosage After Initial Loading Dose
35–54	Full doses at intervals ≥8 hours
11–34	50% of usual dose every 12 hours
≤10	50% of usual dose every 18–24 hours

Dosage for Children >1 Month of Age with Renal Impairment100116

Clcr (mL/minute)	Dosage After Initial Loading Dose
40–70	60% of usual daily dosage in divided doses every 12 hours
20–40	25% of usual daily dosage in divided doses every 12 hours
5–20	10% of usual daily dosage once every 24 hours

Absorption

Bioavailability

Not appreciably absorbed from GI tract; must be administered parenterally.100

After IM injection, peak serum concentrations attained within 1–2 hours.a

Distribution

Extent

Widely distributed into tissues and fluids,a including synovial fluid.100

Only low concentrations distribute into CSF.a

Crosses the placenta100 and is distributed into milk.100

Plasma Protein Binding

74–86%.a

Elimination

Metabolism

Not appreciably metabolized.a

Elimination Route

Excreted unchanged in urine.100 Approximately 60% of a dose excreted within 6 hours and 70–80% excreted within 24 hours in those with normal renal impairment.100

Half-life

Serum half-life approximately 1.8 hours after IV administration and 2 hours after IM administration.100

Special Populations

Half-life increased in renal impairment.100

Storage

Parenteral

Powder for Injection or IV Infusion

20–25°C;100 115 116 protect from light.100 115 116

Powder and reconstituted solutions may darken; does not indicate loss of potency.100 115 117

Reconstituted solutions containing 225 or 330 mg of cefazolin per mL prepared using sterile or bacteriostatic water for injection or sodium chloride injection are stable for 24 hours at room temperature or 10 days at 5°C.100 115

For Injection, for IV Infusion

Duplex drug delivery system containing cefazolin and dextrose injection: 20–25°C (may be exposed to 15–30°C).117 After reconstitution (activation), use within 24 hours if stored at room temperature or within 7 days if stored in refrigerator; do not freeze.117

Injection (Frozen) for IV Infusion

-20°C or lower.119 Thawed solutions stable for 48 hours when stored at room temperature (25°C) or 30 days under refrigeration (5°C).119

Do not refreeze after thawing.119

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution Compatibility

Compatible
Amino acids 4.25%, dextrose 25%b
Dextrose 5 or 10%100 b
Dextrose 5% in Ringer’s injection, lactated100 b
Dextrose 5% in sodium chloride 0.2, 0.45, or 0.9%100
Ionosol B in dextrose 5% in waterb
Normosol M in dextrose 5% in waterb
Plasma-Lyte in dextrose 5% in waterb
Ringer’s injection, lactated100 b
Sodium bicarbonate 5%100
Sodium chloride 0.9%100 b

Drug Compatibility Admixture Compatibilityb

Compatible
Aztreonam
Clindamycin phosphate
Famotidine
Fluconazole
Linezolid
Meperidine HCl
Metronidazole
Metronidazole HCl with sodium bicarbonate
Verapamil HCl
Incompatible
Amikacin sulfate
Atracurium besylate
Bleomycin sulfate
Clindamycin phosphate with gentamicin sulfate
Ranitidine HCl
Variable
Cimetidine HCl

Y-Site Compatibilityb

Compatible
Acyclovir sodium
Allopurinol sodium
Amifostine
Atracurium besylate
Aztreonam
Bivalirudin
Calcium gluconate
Cefpirome sulfate
Cyclophosphamide
Dexmedetomidine HCl
Diltiazem HCl
Docetaxel
Doxapram HCl
Doxorubicin HCl liposome injection
Enalaprilat
Esmolol HCl
Etoposide phosphate
Famotidine
Fenoldopam mesylate
Filgrastim
Fluconazole
Fludarabine phosphate
Foscarnet sodium
Gatifloxacin
Gemcitabine HCl
Granisetron HCl
Heparin sodium
Hetastarch in lactated electrolyte injection (Hextend)
Insulin, regular
Labetalol HCl
Lidocaine HCl
Linezolid
Magnesium sulfate
Melphalan HCl
Meperidine HCl
Midazolam HCl
Milrinone lactate
Morphine sulfate
Multivitamins
Nicardipine HCl
Ondansetron HCl
Pancuronium bromide
Perphenazine
Propofol
Ranitidine HCl
Remifentanil HCl
Sargramostim
Tacrolimus
Teniposide
Theophylline
Thiotepa
Vecuronium bromide
Vitamin B complex with C (Berocca-C and Berocca-C 500)
Warfarin sodium
Incompatible
Amphotericin B cholesteryl sulfate complex
Idarubicin HCl
Pentamidine isethionate
Vinorelbine tartrate
Variable
Amiodarone HCl
Hetastarch in sodium chloride 0.9%
Hydromorphone HCl
Promethazine HCl
Vancomycin HCl