Cefazolin
ANCEF
What it isPBP-inhibiting first-generation cephalosporin; surgical prophylaxis and MSSA infection.
Why this oneThe standard surgical prophylaxis agent, and it outperforms vancomycin for susceptible staphylococcal bacteremia.
What limits itNo MRSA cover. Renally adjusted; poor CNS penetration.
FDA-approved for
- surgical prophylaxis (1973)
- bacterial infections (1973)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Moderate–severe infections | Adults (CrCl ≥55) | 500 mg–1 g q6–8h | 500 mg–1 g q6–8h | 12 g/day (rare) |
| Mild infections (gram-positive cocci) | Adults | 250–500 mg q8h | 250–500 mg q8h | |
| Acute uncomplicated UTI | Adults | 1 g q12h | 1 g q12h | |
| Pneumococcal pneumonia | Adults | 500 mg q12h | 500 mg q12h | |
| Severe life-threatening (endocarditis, septicemia) | Adults | 1–1.5 g q6h | 1–1.5 g q6h | 12 g/day (rare) |
| Perioperative prophylaxis | Adults | 1–2 g 0.5–1 h pre-op; 0.5–1 g intraop; 0.5–1 g q6–8h ×24 h post-op | ||
| Mild–moderate infections | Children ≥1 mo (CrCl ≥70) | 25–50 mg/kg/day divided into 3–4 doses | 25–50 mg/kg/day divided 3–4× | |
| Severe infections | Children ≥1 mo | up to 100 mg/kg/day divided into 3–4 doses | up to 100 mg/kg/day divided 3–4× |
Renal Adults CrCl <55: full dose q8h+ (35–54), half dose q12h (11–34), half dose q18–24h (≤10) after loading dose. Peds CrCl <70: 60% daily dose q12h (40–70), 25% q12h (20–40), 10% q24h (5–20)
Hepatic Undefined
Instructions
- IV infusion or IV bolus (2 g/vial not for IM); bolus: 1 g over 3–5 min, 2 g over 7–11 min
- Perioperative prophylaxis usually stopped within 24 h (up to 3–5 days for open-heart/prosthetic arthroplasty)
Cautions
- Hypersensitivity; cross-reactivity up to 10% in penicillin-allergic patients
- Seizures in renal impairment if dose not reduced
- CDAD, mild to fatal colitis
- Fall in prothrombin activity; monitor PT and give vitamin K in at-risk patients
- False-positive urine glucose (non-enzymatic); positive Coombs
Adverse reactions
- GI: nausea, vomiting, diarrhea, oral candidiasis, C. difficile colitis
- Allergic: anaphylaxis, eosinophilia, rash, drug fever, Stevens-Johnson syndrome
- Hematologic: neutropenia, leukopenia, thrombocytopenia
- Hepatic transaminase/ALP elevation; increased BUN/creatinine, renal failure
- Injection-site phlebitis/induration
Pregnancy No established drug-associated risk of birth defects/miscarriage; crosses placenta; animal studies without adverse developmental effects
Lactation Present in human milk but not expected to accumulate in the breastfed infant
NO BOXED WARNINGS
Principal riskNo MRSA cover
Cost, est. cash$20–$1,500/dose or month
Generic entry1985
Classes and tags
Clinical profile
Legacy pregnancy categoryB
Defining liabilityAllergy, gastrointestinal effects and agent-specific renal, hepatic, hematologic or interaction risks.
Mechanism of action: Cefazolin ballicule
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Memory aids: mascots and interaction avatars
