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Ancef, Kefzol
Pharmacologic classification: first-generation cephalosporin Therapeutic classification: antibiotic Pregnancy risk category B
Available forms
Available by prescription only Infusion: 500-mg or 1-g Redi Vials, Faspaks, or ADD-Vantage vials Injection (parenteral): 250 mg, 500 mg, 1 g
35-54 11-35 10
Full dose q 8 hr or less frequently 1/2 usual dose q 12 hr 1/2 usual dose q 18 to 24 hr
Pediatric dosage
60% of normal daily dose q 12 hr 25% of normal daily dose q 12 hr 10% of normal daily dose q 24 hr
Pharmacodynamics
Antibacterial action: Cefazolin is primarily bactericidal; it also may be bacteriostatic. Activity depends on the organism, tissue penetration, dosage, and rate of organism multiplication. It acts by adhering to bacterial penicillin-binding proteins, thereby inhibiting cell wall synthesis. Cefazolin is active against Escherichia coli, Enterobacteriaceae, Haemophilus influenzae, Klebsiella,Proteus mirabilis, Staphylococcus aureus, Streptococcus pneumoniae, and group A beta-hemolytic streptococci.
Pharmacokinetics
Absorption: Not well absorbed from the GI tract; must be given parenterally. Distribution: Distributed widely into most body tissues and fluids, including the gallbladder, liver, kidneys, bone, sputum, bile, and pleural and synovial fluids; CSF penetration is poor. It crosses the placental barrier and is 74% to 86% protein-bound. Metabolism: Not metabolized. Excretion: Excreted primarily unchanged in urine by renal tubular secretion and glomerular filtration; small amounts of drug appear in breast milk. Elimination half-life is about 1 to 2 hours in patients with normal renal function; end-stage renal disease prolongs half-life to 12 to 50 hours. Hemodialysis or peritoneal dialysis removes cefazolin. Route I.V. I.M. Onset Unknown Peak 1-2 hr Duration Unknown
cephalosporins. Use cautiously in breast-feeding women and patients with impaired renal function or penicillin allergy.
Interactions
Drug-drug. Bacteriostatic drugs (chloramphenicol, erythromycin, tetracyclines): May interfere with bactericidal activity. Avoid use together. Loop diuretics, nephrotoxic drugs (aminoglycosides, colistin, polymyxin B, vancomycin): May increase risk of nephrotoxicity. Monitor patient closely. Probenecid: Competitively inhibits renal tubular secretion of cephalosporins, resulting in higher, prolonged serum levels of these drugs. Monitor patient closely.
Adverse reactions
CV: phlebitis, thrombophlebitis (with I.V. injection). GI: pseudomembranous colitis, nausea, anorexia, vomiting, diarrhea, glossitis, dyspepsia, abdominal cramps, anal pruritus, oral candidiasis. GU: genital pruritus, candidiasis, vaginitis. Hematologic: neutropenia, leukopenia, eosinophilia, thrombocytopenia. Skin: maculopapular and erythematous rashes, urticaria, pruritus, Stevens-Johnson syndrome; pain, induration, sterile abscesses, tissue sloughing (at injection site). Other: hypersensitivity reactions (serum sickness, anaphylaxis).
Special considerations
For I.M. use, reconstitute with sterile water, bacteriostatic water, or normal saline solution: 2 ml to a 500-mg vial and 2.5 ml to a 1-g vial produces 225 mg/ml, and 330 mg/ml, respectively. I.M. cefazolin injection is less painful than that of other cephalosporins. Reconstituted solution is stable for 24 hours at room temperature and for 10 days if refrigerated. Cephalosporins cause false-positive results in urine glucose tests using cupric sulfate (Benedicts reagent or Clinitest); use glucose oxidase tests (Chemstrip uG, Diastix, or glucose
enzymatic test strip) instead. Cefazolin causes false elevations in serum or urine creatinine levels in tests using Jaffe reaction. Cefazolin also causes positive Coombs test results. For patients on sodium restriction, note that cefazolin injection contains 2 mEq of sodium per gram of drug. Obtain electrolyte studies. If patient has renal impairment, monitor renal function tests. Breast-feeding patients Safety hasnt been established. Use drug cautiously in breastfeeding women. Pediatric patients Drug has been used in children. However, safety in infants younger than age 1 month hasnt been established.
Patient education
Inform patient of potential adverse reactions.