Cefazolin (cephazolin)

Cefazolin (aka cephazolin)

[1 vial $1.60]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Cefazolin, cephazolin

ICU INDICATIONS:

  1. prophylaxis around surgery
  2. treatment of infections caused by susceptible organisms

PRESENTATION AND ADMINISTRATION:

  • IV:
    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
    Compatible with:
    Normal saline, Glucose and sodium chloride, glucose 5%, glucose 10%, Hartmanns

DOSAGE:

  • IV:
    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

CLINICAL PHARMACOLOGY:

  • 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).
    Staphylococcus epidermidis

    Group A beta-hemolytic streptococci and other strains of streptococci (many strains of enterococci are resistant).
    Streptococcus pneumoniae.
    Escherichia coli.
    Proteus mirabilis.
    Klebsiella species.
    Enterobacter aerogenes.
    Haemophilus influenzae.

    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.

CONTRAINDICATIONS:

  1. hypersensivity to cephalosporins

WARNINGS

  • Anaphylaxis
    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.

PRECAUTIONS

  • General:
    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.

ADVERSE REACTIONS

  • Body as a whole:
    Anaphylaxis, itching, drug fever, Stevens-Johnson syndrome.
  • Hemopoietic System:
    Neutropaenia, leukopaenia, thrombocytopaenia, thrombocythaemia, eosinophilia.
  • Skin:
    Skin rash
    Gastrointestinal System:

    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

Critical Care Drug Manual

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