Cefazolin (aka cephazolin)
[1 vial $1.60]
- Cefazolin, cephazolin
- prophylaxis around surgery
- treatment of infections caused by susceptible organisms
PRESENTATION AND ADMINISTRATION:
1gm vials of powder
Reconstitute with 2.5ml of water for injection ONLY to make a total of 3ml of final solution in a concentration of 330mg/ml then shake well until all powder is dissolved.
Store at room temperature
Normal saline, Glucose and sodium chloride, glucose 5%, glucose 10%, Hartmanns
1-2g IV 6-8 hourly
Note: for prophylaxis after cardiac surgery, patients should be given 1g 3 hours after ICU admission and 1g 8 hours later
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
- Dose in renal impairment [GFR (ml/min)]
<10: 1g daily
10-20: 1g 12 hourly
>20-50: 1g 8 hourly
- Dose in renal replacement therapy
CAPD: 1g daily
HD: 1g after dialysis
CVVHDF: 1g 12 hourly
DOSAGE IN PAEDIATRICS:
- 25-50mg/kg IV 6-8 hourly
- Cefazolin for injection is a 1st generation cephalosporin for parenteral administration. It has a bactericidal action resulting from inhibition of cell wall synthesis. When organisms are susceptible, Cefazolin sodium is active against the following organisms in vitro and in clinical infections:
Staphylococcus aureus (including penicillinase-producing strains).
Group A beta-hemolytic streptococci and other strains of streptococci (many strains of enterococci are resistant).
Most strains of indole positive Proteus (Proteus vulgaris), Enterobacter cloacae, Morganella morganii and Providencia rettgeri are resistant. Serratia, Pseudomonas, Mima, Herellea species are almost uniformly resistant to cefazolin.
- hypersensivity to cephalosporins
Cephalosporins are a common cause of anaphylactic reactions and cross reactivity with penicillins may occur
- Pseudomembranous colitis
Pseudomembranous colitis has been reported with nearly all antibacterial agents, including cefazolin, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents.
Prescribing cefazolin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Positive direct Coombs’ tests have been reported during treatment with the cephalosporin antibiotics. It should be recognized that a positive Coombs’ test may be due to the drug.
- Laboratory Tests:
No tests additional to usual ICU tests are required
- Drug/Laboratory Test Interactions:
A false positive reaction for glucose in the urine may occur with Benedict’s solution, Fehling’s solution or with Clinitest tablets, but not with enzyme-based tests such as Clinistix. Positive direct and indirect antiglobulin (Coombs) tests have occurred; these may also occur in neonates whose mothers received cephalosporins before delivery.
IMPORTANT DRUG INTERACTIONS FOR THE ICU
- None of note.
- Body as a whole:
Anaphylaxis, itching, drug fever, Stevens-Johnson syndrome.
- Hemopoietic System:
Neutropaenia, leukopaenia, thrombocytopaenia, thrombocythaemia, eosinophilia.
Diarrhoea, oral candidiasis (oral thrush), vomiting, nausea, stomach cramps, anorexia and pseudomembranous colitis. Transient rises in ALT, AST, and alkaline phosphatase levels has been observed. As with other cephalosporins, reports of hepatitis have been received.
Cephalosporin-Class Adverse Reactions
In addition to the adverse reactions listed above that have been observed in patients treated with cefaclor, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics: fever, abdominal pain, superinfection, renal dysfunction, toxic nephropathy, haemorrhage, false positive test for urinary glucose, elevated bilirubin, elevated LDH, and pancytopenia. Several cephalosporins have been implicated in triggering seizures, paticularly in patients with renal impairment when the dosage was not reduced. If seizures associated with drug therapy occur, the drug should be discontinued. Anticonvulsant therapy can be given if clinically indicated