Yes

Antibiotic, Cephalosporin (First Generation)

Dental: Alternative antibiotic for prevention of bacterial endocarditis when parenteral administration is needed. Individuals allergic to amoxicillin (penicillins) may receive cefazolin provided they have not had an immediate, local, or systemic IgE-mediated anaphylactic allergic reaction to penicillin. Alternate antibiotic for premedication in patients not allergic to penicillin who may be at potential increased risk of hematogenous total joint infection when parenteral administration is needed.

Medical: Treatment of gram-positive bacilli and cocci (except enterococcus); some gram-negative bacilli including E. coli, Proteus, and Klebsiella may be susceptible

B

Hypersensitivity to cefazolin sodium, any component, or cephalosporins

Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; use with caution in patients with a history of penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis, urticaria); may cause antibiotic-associated colitis or colitis secondary to C. difficile

1% to 10%:

Gastrointestinal: Diarrhea

Local: Pain at injection site

<1%: Anaphylaxis, rash, pruritus, Stevens-Johnson syndrome, oral candidiasis, nausea, vomiting, abdominal cramps, anorexia, pseudomembranous colitis, eosinophilia, neutropenia, leukopenia, thrombocytopenia, thrombocytosis, elevated transaminases, phlebitis, vaginitis, fever, seizures

Other reactions with cephalosporins include toxic epidermal necrolysis, abdominal pain, cholestasis, superinfection, renal dysfunction, toxic nephropathy, aplastic anemia, hemolytic anemia, hemorrhage, prolonged prothrombin time, pancytopenia

Symptoms of overdose include neuromuscular hypersensitivity, convulsions especially with renal insufficiency; many beta-lactam antibiotics have the potential to cause neuromuscular hyperirritability or seizures

Hemodialysis may be helpful to aid in the removal of the drug from the blood, otherwise most treatment is supportive or symptom directed

Increased effect: High-dose probenecid decreases clearance

Increased toxicity: Aminoglycosides increase nephrotoxic potential

Store intact vials at room temperature and protect from temperatures exceeding 40°C

Reconstituted solutions of cefazolin are light yellow to yellow

Protection from light is recommended for the powder and for the reconstituted solutions

Reconstituted solutions are stable for 24 hours at room temperature and 10 days under refrigeration

Stability of parenteral admixture at room temperature (25°C): 48 hours

Stability of parenteral admixture at refrigeration temperature (4°C): 14 days

Standard diluent: 1 g/50 mL D₅W; 2 g/50 mL D₅W

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Distribution: Widely distributed into most body tissues and fluids including gallbladder, liver, kidneys, bone, sputum, bile, pleural and synovial fluids; CSF penetration is poor; crosses the placenta and small amounts appear in breast milk

Protein binding: 74% to 86%

Metabolism: Hepatic is minimal

Half-life: 90-150 minutes (prolonged with renal impairment)

Time to peak serum concentration: I.M.: Within 0.5-2 hours

Elimination: 80% to 100% is excreted unchanged in urine

I.M., I.V.:

Adults: 250 mg to 2 g every 6-12 (usually 8) hours, depending on severity of infection; maximum dose: 12 g/day

Dosing adjustment in renal impairment:

Cl_cr 10-30 mL/minute: Administer every 12 hours

Cl_cr <10 mL/minute: Administer every 24 hours

Hemodialysis: Moderately dialyzable (20% to 50%); administer dose postdialysis or administer supplemental dose of 0.5-1 g after dialysis

Peritoneal dialysis: Administer 0.5 g every 12 hours

Continuous arteriovenous or venovenous hemofiltration (CAVH/CAVHD): Dose as for Cl_cr 10-30 mL/minute; removes 30 mg of cefazolin per liter of filtrate per day

Renal function periodically when used in combination with other nephrotoxic drugs, hepatic function tests, CBC; monitor for signs of anaphylaxis during first dose

Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction

May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins

May rarely cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

This drug is administered I.V. or I.M. Drink 2-3 L fluid/day. If diarrhea occurs, yogurt or buttermilk may help. May cause false-positive test with Clinitest®; use another form of testing. May interfere with oral contraceptives; additional contraceptive measures are necessary. Report severe, unresolved diarrhea; vaginal itching or drainage; sores in mouth; blood, pus, or mucus in stool or urine; easy bleeding or bruising; unusual fever or chills; rash; or respiratory difficulty. Breast-feeding precautions: Consult prescriber if breast-feeding.

Do not admix with aminoglycosides in same bottle/bag; observe for signs and symptoms of anaphylaxis during first dose

Infusion, premixed, as sodium, in D₅W (frozen) (Ancef®): 500 mg (50 mL); 1 g (50 mL)

Injection, as sodium (Kefzol®): 500 mg, 1 g

Powder for injection, as sodium (Ancef®, Zolicef®): 250 mg, 500 mg, 1 g, 5 g, 10 g, 20 g

"Advisory Statement. Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements. American Dental Association; American Academy of Orthopedic Surgeons," J Am Dent Assoc, 1997, 128(7):1004-8.

Dajani AS, Taubert KA, Wilson WW, et al, "Prevention of Bacterial Endocarditis. Recommendations by the American Heart Association," JAMA, 1997, 277(22):1794-801.

Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.

Gentry LO, Zeluff BJ, and Cooley DA, "Antibiotic Prophylaxis in Open-Heart Surgery: A Comparison of Cefamandole, Cefuroxime, and Cefazolin," Ann Thorac Surg, 1988, 46(2):167-71.

Gustaferro CA and Steckelberg JM, "Cephalosporin Antimicrobial Agents and Related Compounds," Mayo Clin Proc, 1991, 66(10):1064-73.

Marshall WF and Blair JE, "The Cephalosporins," Mayo Clin Proc, 1999, 74(2):187-95.

Peterson CD, Lake KD, Arom KV, et al, "Antibiotic Prophylaxis in Open-Heart Surgery Patients: Comparison of Cefamandole and Cefuroxime," Drug Intell Clin Pharm, 1987, 21(9):728-32.

Pickering LK, O'Connor DM, Anderson D, et al, "Clinical and Pharmacologic Evaluation of Cefazolin in Children," J Infect Dis, 1973, 128(Suppl):S407-1.

Robinson DC, Cookson TL, and Grisafe JA, "Concentration Guidelines for Parenteral Antibiotics in Fluid-Restricted Patients," Drug Intell Clin Pharm, 1987, 21(12):985-9.

Simon VC, Malerczyk V, Tenschert B, et al, "Die Geriatrische Pharmakologie von Cefazolin, Cefradin, und Sulfisomidin," Arzneim Forsch, 1976, 26(7):1377-82.