Cefazolin dosing

For penicillin-allergic (nonanaphylactoid type) patients Cefazolin doses 6 gf24 hours IV in three equally divided doses 6 weeks 1 B Consider skin testing for oxacillin-susceptible staphylococci and questionable history of immediate-type hypersensitivity to penicillin Cephalosporins should be avoided in patients with anaphylactoid-... 

To evaluate cost impact of two DUE activities performed by undergraduate pharmacy students OD Historical control None DCA Cefazolin dosing modification (q6h to q8h) resulted in savings of 18,000 substitution of metronidazole for clindamycin saved S21,000 Input costs not considered clinical outcomes not considered... 

Guidelines suggest that if an operation exceeds two half-lives of the selected antimicrobial, then another dose should be administered.1 Repeat dosing has been shown to lower rates of SSI. For example, cefazolin has a half-life of about 2 hours, thus... 

Oxacillin-resistant strains Vancomycin6 doses Pediatic dose cefazolin 100 mg/kg per 24 hours IV in three equally divided doses gentamicin 3 mg/kg per 24 hours IV/ IM in three equally divided doses 30 mg/kg per 24 hours IV in two equally divided doses 6 weeks IB Adjust vancomycin dosage to achieve 1 -hour serum concentration of... 

Penicillin G 24 million units/24 h IV in four to six equally divided doses may be used in place of nafcillin or oxacillin if strain is penicillin susceptible (minimum inhibitory concentration 0,1 mcg/mL) and does not produce /5-lactamase vancomycin should be used in patients with immediate-type hypersensitivity reactions to beta-lactam antibiotics (see Table 37-3 for dosing guidelines) cefazolin may be substituted for nafcillin or oxacillin in patients with non-immediate-type hypersensitivity reactions to penicillins... 

As streptococcal cellulitis is indistinguishable clinically from staphylococcal cellulitis, administration of a semisynthetic penicillin (nafrillin or oxacillin) or first-generation cephalosporin (cefazolin) is recommended until a definitive diagnosis, by skin or blood cultures, can be made (Table 47-4). If documented to be a mild cellulitis secondary to streptococci, oral penicillin VK, or intramuscular procaine penicillin may be administered. More severe streptococcal infections should be treated with IV antibiotics (such as ceftriaxone 50 to 100 mg/kg as a single dose). 

A single dose of IV cefazolin will provide adequate prophylaxis for most cases. Oral ciprofloxacin may be used for patients with /Tlactam hypersensitivity. 

Most frequently encountered organisms include E. colt, Klebsiella, and Enterococci. Single-dose prophylaxis with cefazolin is currently recommended. Ciprofloxacin and levofloxacin are alternatives for patients with /1-lactam hypersensitivity. 

Maxillofacial surgery Staphylococcus aureus, streptococci oral anaerobes Cefazolin 2 g or clindamycin 600 mg Repeat intraoperative dose for operations longer than 4 hours IA... 

Abdominal aorta and lower eternity vascular surgeiy 5. aureus, S. epidermidis, enteric gramnegative bacilli Cefazolin 1 g at induction and every 8 hours x 2 more doses Although complications from infections may be infrequent, graft infections are associated with significant morbidity IB... 

Joint replacement S. aureus, S. epidermidis Cefazolin 1 gx 1 preoperatively, then every 8 hours x 2 more doses Vancomycin reserved for penicillin-allergic patients or where institutional prevalence of methicillin-resistant Staphylococcus aureus warrants use IA... 

Cerebrospinal fluid shunt procedures 5. aureus, S. epidermidis Cefazolin 1 g every 8 hours x 3 doses or ceftriaxone 2 gx 1 No agents have been shown to be better than cefazolin in randomized comparative trials. IA... 

A single preoperative dose of cefazolin or cefoxitin is recommended for vaginal hysterectomy. For patients with /3-lactam hypersensitivity, a single preoperative dose of metronidazole or doxycycline is effective. 

Both cefazolin and antianaerobic cephalosporins (e.g., cefoxitin, cefote-tan) have been studied extensively for abdominal hysterectomy. Singledose cefotetan is superior to single-dose cefazolin. The antibiotic course should not exceed 24 hours in duration. 

While typical doses of cefazolin are ineffective for anaerobic infections, the recommended 2-g dose produces concentrations high enough to be inhibitory to these organisms. A 24-hour duration has been used in most studies, but single-dose therapy may also be effective. 

Cefazolin has been extensively studied and is currently considered the drug of choice. Patients weighing 80 kg should receive 2 g cefazolin rather than 1 g. Doses should be administered no earlier than 60 minutes before the first incision and no later than the beginning of induction of anesthesia. 

Single doses of cefazolin or, where required, vancomycin appear to lower SSI risk after craniotomy. 

A pharmacist reported that 1- and 10-g vials of Marsam cefazolin sodimn appear to be identical in shape and have the same color flip-top closures. The pharmacy ordered the 1-g product from the wholesaler. However, the wholesaler sent 10-g bulk vials of cefazolin sodium along with stickers for the 1-g vial. The pharmacy, which does not normally stock the 10-g vials, interspersed the 10-g vials with the 1-g vials in their stock. Several vials were reconstituted in error. Fortunately no patient received the wrong dose. 

In another reported incident, a pharmacist ordered the 10-g vials of cefazolin sodium but received the 1-g vials in error. Intending to reconstitute and divide the 10-g vials into 1-g doses, a technician inadvertently reconstituted the 1-g vials and proceeded to divide the total solution of each vial into ten 100-mg doses. Some of the prepared 100-mg doses of cefazolin sodium were administered to patients instead of their scheduled 1-g doses, but no adverse effects were reported. The pharmacist thought that the error occurred partly because the vials are identical in size and have similar labels. 

Cefazolin is the only first-generation parenteral cephalosporin still in general use. After an intravenous infusion of 1 g, the peak level of cefazolin is 90-120 mcg/mL. The usual intravenous dosage of cefazolin for adults is 0.5-2 g intravenously every 8 hours. Cefazolin can also be administered intramuscularly. Excretion is via the kidney, and dose adjustments must be made for impaired renal function. 

Absorption of cefazolin is poor low concentrations were found in plasma and tissues after intramammary administration. It is bound to plasma proteins in the circulation and crosses tlie placenta. Metabolism of cefazolin is very limited and no major metabolites seem to occur. After parenteral administration to horse, nearly 100% of the dose was excreted unchanged in the urine within 24 h. 

In ophthalmology, both trans-scleral and transcomeal dmg delivery has been studied. Drags investigated include fluorescein, tobramycin, gentamicin, ticarcillin, cefazolin, dexamethasone and ketoconazole. Iontophoresis has been found to be both safe and effective in delivering the required doses locally, at the intended site of action. Excepting for lidocaine, which has been tested in human volunteers, all the other drags have been tested in rabbits. 

Cefazolin I g at induction and every 8 hours x 2 more doses... 

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