Ancef

Generic Name: Cefazolin Sodium
Class: First Generation Cephalosporins
CAS Number: 27164-46-1

Introduction

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

Uses for Ancef

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 endocarditis^{113 114} 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 administered to women identified as GBS carriers during routine prenatal GBS screening performed at 35–37 weeks during the current pregnancy and to women who have GBS bacteriuria during the current pregnancy, a previous infant with invasive GBS disease, unknown GBS status with delivery at <37 weeks gestation, amniotic membrane rupture for ≥18 hours, or intrapartum temperature of ≥38°C.^{111 112}

Perioperative Prophylaxis

Perioperative prophylaxis in patients undergoing surgical procedures classified as contaminated or potentially contaminated (e.g., vaginal hysterectomy, high-risk cesarean section, cholecystectomy in high-risk patients) and in those undergoing surgical procedures in which the development of infection at the surgical site would represent a serious risk (e.g., cardiac surgery, prosthetic arthroplasty).^{100 102 106 107 108 109 110 115 116 117 119}

Drug of choice for perioperative prophylaxis for a variety of procedures, including cardiac, noncardiac thoracic, esophageal, gastroduodenal, biliary tract, gynecologic and obstetric, head and neck, neurologic, orthopedic, and vascular surgery.^{102 106}

A drug or regimen with activity against anaerobic bacteria is recommended for procedures that might involve exposure to Bacteroides fragilis or other anaerobic bowel bacteria (e.g., colorectal surgery, appendectomy).^{102 106} Cefoxitin and cefotetan are more active than cefazolin against these bacteria; alternatively, metronidazole can be used in conjunction with cefazolin to provide anaerobic coverage.^{102 106}

Ancef Dosage and Administration

Administration

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

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 lyophilized 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}

Pediatric Patients

Mild to Moderately Severe Infections

IV or IM

Children >1 month of age: 25–50 mg/kg daily in 3 or 4 equally divided doses.^{100 105 115 116 119}

Severe Infections

IV

Children >1 month of age: 50–100 mg/kg daily in 3 or 4 equally divided doses.^{100 105 115 116 119}

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

Cardiac or Cardiothoracic Surgery

IV

20–30 mg/kg given at induction of anesthesia (within 0.5–1 hour prior to incision).¹⁰³ Some clinicians suggest additional doses of 20–30 mg/kg every 8 hours for up to 72 hours; most clinicians state postoperative doses usually unnecessary and may increase risk of bacterial resistance.^{102 106 110}

Neurosurgery

IV

20–30 mg/kg given at induction of anesthesia (within 0.5–1 hour prior to incision).¹⁰³

Head and Neck Surgery

IV

20–30 mg/kg given at induction of anesthesia (within 0.5–1 hour prior to incision) for clean head and neck surgery with placement of prosthesis.¹⁰³ For clean-contaminated head and neck surgery involving incision through oral or pharyngeal mucosa, 30–40 mg/kg at induction of anesthesia.¹⁰³

GI, Pancreatic, or Biliary Tract Surgery

IV

20–30 mg/kg given at induction of anesthesia (within 0.5–1 hour prior to incision).¹⁰³

Vascular or Orthopedic Surgery

IV

20–30 mg/kg given at induction of anesthesia (within 0.5–1 hour prior to incision).¹⁰³ Some clinicians suggest additional doses of 20–30 mg/kg every 8 hours for up to 24 hours; most clinicians state postoperative doses usually unnecessary and may increase risk of bacterial resistance.^{102 106 110}

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 time of labor or rupture of membranes) followed by 1 g every 8 hours until delivery.¹¹¹

Perioperative Prophylaxis

General Adult Dosage

IV or IM

Manufacturers recommend 1 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}

Most clinicians recommend 1–2 g given within 60 minutes of initial incision and, if surgery is >4 hours or major blood loss occurs, additional intraoperative doses given every 4–8 hours.¹⁰² Postoperative doses usually unnecessary and may increase risk of bacterial resistance.^{102 106}

Cardiac, Cardiothoracic, or Noncardiac Thoracic Surgery.

IV

1–2 g given at induction of anesthesia (within 0.5–1 hour prior to incision).^{102 103}

In patients undergoing open-heart surgery, some experts recommend an additional dose when the patient is removed from bypass.¹⁰²

For cardiothoracic surgery and heart and/or lung transplantation, some experts suggest additional 1-g doses every 8 hours for up to 48–72 hours; others state that prophylaxis for ≤24 hours is appropriate.¹⁰³ There is no evidence to support continuing prophylaxis until chest and mediastinal drainage tubes are removed.¹⁰³

Neurosurgery or Head and Neck Surgery

IV

1–2 g given at induction of anesthesia (within 0.5–1 hour prior to incision).^{102 103}

For clean, contaminated head and neck surgery, some experts suggest 2 g given at induction of anesthesia and every 8 hours for 24 hours.¹⁰³

GI, Gastroduodenal, Colorectal, Pancreatic, or Biliary Tract Surgery

IV

1–2 g given at induction of anesthesia (within 0.5–1 hour prior to incision).^{102 103}

For colorectal surgery, use in conjunction with IV metronidazole.¹⁰²

Vascular or Orthopedic Surgery

IV

1–2 g given at induction of anesthesia (within 0.5–1 hour prior to incision).^{102 103}

Some experts suggest additional 1-g doses every 8 hours for up to 24 hours.¹⁰³

Gynecologic and Obstetric Surgery

IV

1–2 g given at induction of anesthesia (within 0.5–1 hour prior to incision) for hysterectomy or as soon as umbilical cord is clamped for cesarean section.^{102 103}

Special Populations

Hepatic Impairment

No dosage recommendations.^{100 115 116 117 119}

Renal Impairment

Dosage adjustments recommended in patients with Cl_cr <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)	Dose	Frequency
35–54	Full dose	≥8-hour intervals
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 Impairment100115116119

Clcr (mL/minute)	Dose	Frequency
40–70	60% of usual dose	Every 12 hours
20–40	25% of usual dose	Every 12 hours
5–20	10% of usual dose	Every 24 hours

Cautions for Ancef

Contraindications

• 
  

  Known hypersensitivity to cefazolin or other cephalosporins.^{100 115 116 117 119}

  
  


• 
  

  Hypersensitivity to corn or corn products: Duplex delivery system containing lyophilized cefazolin and dextrose injection¹¹⁷ and premixed injection (frozen) containing cefazolin in dextrose injection.¹¹⁹

  
  

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Diarrhea and Colitis

Possible emergence and overgrowth of nonsusceptible organisms, especially Enterobacter, Pseudomonas, enterococci, or Candida.^a Careful observation of the patient is essential.^{100 115 116 117 119} Institute appropriate therapy if superinfection occurs.^{100 115 116 117 119}

Treatment with anti-infectives may permit overgrowth of Clostridium difficile.^{100 115 116 117 119} C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) has been reported with nearly all anti-infectives, including cefazolin, and may range in severity from mild diarrhea to fatal colitis.^{100 117 119}

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.^{100 117 119} Careful medical history is necessary since CDAD has been reported to occur as late as 2 months or longer after anti-infective therapy is discontinued.^{117 119}

If CDAD is suspected or confirmed, anti-infective therapy not directed against C. difficile may need to be discontinued.^{117 119} Some mild cases may respond to discontinuance alone.^{100 a} Manage moderate to severe cases with fluid, electrolyte, and protein supplementation, anti-infective therapy active against C. difficile (e.g., oral metronidazole or vancomycin), and surgical evaluation when clinically indicated.^{100 117 119}

Sensitivity Reactions

Hypersensitivity Reactions

Possible hypersensitivity reactions such as urticaria, pruritus, rash (maculopapular, erythematous, morbilliform), fever and chills, eosinophilia, joint pain or inflammation, edema, erythema, genital and anal pruritus, angioedema, shock, hypotension, vasodilatation, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis, and anaphylaxis.^a

If an allergic reaction occurs, discontinue cefazolin and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, and maintenance of an adequate airway and oxygen).^{100 a}

Cross-hypersensitivity

Partial cross-sensitivity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins.^{100 a}

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs.¹⁰⁰ Cautious use recommended in individuals hypersensitive to penicillins:¹⁰⁰ avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction and administer with caution in those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction.^a

General Precautions

History of GI Disease

Use with caution in those with a history of GI disease, particularly colitis.^{100 a} (See Superinfection/Clostridium difficile-associated Diarrhea and Colitis under Cautions.)

Prolonged PT

Prolonged PT reported with some cephalosporins.¹⁰⁰

Monitor PT in patients at risk, including those with renal or hepatic impairment, poor nutritional state, receiving prolonged therapy, or stabilized on anticoagulant therapy.¹⁰⁰ Administer vitamin K when indicated.¹⁰⁰

Selection and Use of Anti-infectives

To reduce development of drug-resistant bacteria and maintain effectiveness of cefazolin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.¹⁰⁰

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.¹⁰⁰ In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.¹⁰⁰

Patients with Diabetes

The commercially available Duplex delivery system containing 1 g of lyophilized cefazolin and 50 mL of dextrose 4% injection should be used with caution in patients with overt or known subclinical diabetes mellitus or in patients with carbohydrate intolerance for any reason.¹¹⁷

Sodium Content

Contains approximately 48 mg (2 mEq) of sodium per g of cefazolin.^{100 115 116 117}

Specific Populations

Pregnancy

Category B.^{100 115 116 117 119}

Lactation

Distributed into milk;^{100 115 116 117 119} use with caution.^{100 115 116 117 119}

Pediatric Use

Safety and efficacy not established in premature infants or neonates ≤1 month of age.^{100 115 116 119}

Geriatric Use

No overall differences in safety and efficacy in those ≥65 years of age compared with younger adults, but the possibility of increased sensitivity in some geriatric individuals cannot be ruled out.^{115 116 117 119}

Substantially eliminated by kidneys; risk of toxicity may be greater in those with impaired renal function.^{115 116 117 119} Select dosage with caution and consider monitoring renal function because of age-related decreases in renal function.^{115 116 117 119} (See Renal Impairment under Dosage and Administration.)

Renal Impairment

Possible increased serum concentrations and serum half-life.^a

Possibility of seizures if inappropriately high dosage used in patients with impaired renal function.^{100 115 116 117 119}

Use with caution and reduce dosage.^{100 115 116 117 119} (See Renal Impairment under Dosage and Administration.)

Common Adverse Effects

GI effects (diarrhea, nausea, vomiting, stomach cramps, oral candidiasis),^{115 116 117 119} hypersensitivity reactions.^{115 116 117 119}

Interactions for Ancef

Specific Drugs and Laboratory Tests

Drug	Interaction	Comments
Nephrotoxic Drugs	Potential for increased risk of nephrotoxicitya	Avoid concomitant use of nephrotoxic agents (e.g., aminoglycosides, colistin, polymyxin B, vancomycin) if possiblea
Probenecid	Decreased renal clearance and increased concentrations of cefazolin100
Tests for glucose	Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution100	Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix)100

Ancef Pharmacokinetics

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

Stability

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}

Store commercially available Duplex drug delivery system containing 1 or 2 g of lyophilized cefazolin and 50 mL of dextrose injection at 20–25°C (may be exposed to 15–30°C).¹¹⁷ Following reconstitution (activation), use within 24 hours if stored at room temperature or within 7 days if stored in a 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

Actions and SpectrumActions

• 
  

  Based on spectrum of activity, classified as a first generation cephalosporin.^a Has a limited spectrum of activity compared with second, third, and fourth generation cephalosporins.^a

  
  


• 
  

  Usually bactericidal.^a

  
  


• 
  

  Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.^{100 a}

  
  


• 
  

  Spectrum of activity includes many gram-positive aerobic bacteria and some gram-negative aerobic bacteria; inactive against fungi and viruses.^{100 a}

  
  


• 
  

  Gram-positive aerobes: active in vitro and in clinical infections against penicillinase-producing and nonpenicillinase-producing Staphylococcus aureus and S. epidermidis; Streptococcus pyogenes (group A β-hemolytic streptococci); S. agalactiae (group B streptococci); and S. pneumoniae.^{a 100} Enterococci and oxacillin-resistant (methicillin-resistant) staphylococci are resistant.¹⁰⁰

  
  


• 
  

  Gram-negative aerobes: active in vitro and in clinical infections against some strains of Haemophilus influenzae, Escherichia coli, Klebsiella, Proteus mirabilis, and Enterobacter aerogenes.^{100 a} Inactive against most other gram-negative bacteria, including Citrobacter, E. cloacae, Morganella, Providencia, Pseudomonas, and Serratia.^{100 a}

  
  

Advice to Patients

• 
  

  Advise patients that antibacterials (including cefazolin) should only be used to treat bacterial infections; they do not treat viral infections (e.g., the common cold).^{100 115 116 117 119}

  
  


• 
  

  Importance of completing full course of therapy, even if feeling better after a few days.^{100 115 116 117 119}

  
  


• 
  

  Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefazolin or other antibacterials in the