Cefazolin

Cefazolin - Use | Dosage | Side Effects

Cefazolin (Ancef), powder for solution for injection 1 g, is a broad spectrum antimicrobial, bactericidal medicine against most Gram-positive and Gram-negative bacteria. Mechanism of bactericidal action of cefazolin is based on the prevention of cell wall peptidoglycan synthesis of bacteria. Cefazolin (Ancef) is active against the following microorganisms: Gram-positive microorganisms:

  • Staphylococcus aureus (including strains that produce beta-lactamase);
  • Staphylococcus epidermidis;
  • Streptococcus spp. (including the beta-hemolytic streptococci, and enterococci, many resistant strains)
  • Streptococcus pneumoniae
Gram-negative organisms:
  • Escherichia coli
  • Klebsiella spp.
  • Proteus mirabilis
  • Enterobacter aerogenes
  • Haemophilus influenza
 Notes:
  • Staphylococci resistant to methicillin, should be resistant to cefazolin.
  • Most strains of indole-positive Proteus (Proteus vulgaris), Enterobacter cloacae, Morganella morganii and Providencia rettgeri, Serratia spp., Pseudomonas spp., Mima-Herellea microorganisms are, in most cases resistant to cefazolin.

Indications

Cefazolin (Ancef) powder for solution for injection 1 g is used in the treatment of:

  • Respiratory infections caused by a S. pneumoniae, Klebsiella spp., H. influenzae, S.aureus (strains sensitive to penicillin, and penicillin-resistant strains), and the group a beta hemolytic streptococci;
  • Urinary tract infections caused by the E. coli, Proteus mirabilis, Klebsiella spp., and some strains of Enterococcus spp. and Enterobacter spp.
  • Infections of the skin and/or skin caused by the Staphylococcus aureus (strains sensitive to penicillin and penicillin-resistant strains), group a beta-hemolytic streptococci and other strains of streptococci;
  • Infection of the gallbladder and/or the bile ducts caused by E. coli, various strains of streptococci, with P. mirabilis, Klebsiella spp., and S. aureus;
  • Bone and joint infections caused by a S. aureus;
  • Genital infections (e.g., prostatitis, epididymitis) induced by E. coli, P. mirabilis, Klebsiella spp. and some strains of Enterococcus spp.
  • Septicemia caused by S. pneumoniae, S. aureus (strains sensitive to penicillin, and penicillin-resistant strains), P. mirabilis, E. coli and Klebsiella spp.
  • Endocarditis caused by S. aureus with (penicillin- susceptible strains and strains resistant to penicillin) and group a beta-hemolytic streptococci.

Cefazolin (Ancef) powder for solution for injection 1 g is also used for:

  • Prevention of postoperative infection in contaminated or execution potentially contaminated surgery (vaginal hysterectomy and cholecystectomy in high-risk patients such as those older than 70 years, acute cholecystitis, obstructive jaundice or biliary lithiasis or operations open heart surgery, prosthetic arthroplasty, etc.).

Warning and precautions

Cefazolin (Ancef) injection can not be used in hypersensitivity to cefazolin and/or other antimicrobials cephalosporins!

  • Prior to the application of cefazolin (ancef) should determine whether the patient has demonstrated response hypersensitivity to cefazolin, cephalosporins, penicillins, or other medicines. If the cefazolin administered to patients hypersensitive to penicillin antimicrobials, is required caution, since it is confirmed cross-hypersensitivity among beta-lactams antimicrobials (to approximately 10% of patients with a history of allergy to penicillin).
  • If there is a allergic reaction to cefazolin, use of the medicine should be discontinued. In the case of severe, acute hypersensitivity reaction of epinephrine can be administered, as well as other emergency measure (maintenance of patency of the airway, oxygen, iv. compensation fluid, iv. antihistamines, corticosteroids).
  • Diarrhea caused by Clostridium difficile can develop during or after treatment with virtually all antimicrobials, and with cefazolin. Treatment of antimicrobials alters the normal flora of the large intestine, and thus creating the possibility of excessive growth of C. difficile. Studies show that a toxin produced by C. difficile is the main cause of occurrence of colitis. Each diarrhea associated with the use of antimicrobials, especially persistent profuse diarrhea accompanied by the appearance of blood, with or without abdominal cramps, may indicate the presence of C. difficile as a causative agent. It is necessary to interrupt the application of cefazolin, if it is suspected development of diarrhea during therapy, and to apply the appropriate treatment (replacement of fluid, electrolytes, and proteins, the application of adequate antimicrobial etc).
  • Cephalosporins may be associated with a reduction in activity of prothrombin (coagulation factor), especially in patients with impaired renal or liver function, malnourished patients, patients receiving long-term antimicrobial therapy, and in patients previously stabilized on anticoagulant therapy. In high risk patients should be monitored prothrombin time, and if it is necessary to administer vitamin K. During prolonged application of cefazolin may result in overgrowth of nonsusceptible microorganisms. If necessary, the specific antimicrobial therapy can be applied in the course of application of cefazolin. Use of cefazolin requires special caution in patients with impaired renal function, in which the dose should be adjusted to the degree of damage.
  • Although cefazolin is effective in the eradication of streptococci in the nose and throat, there are no reliable clinical data on the effectiveness of the medicine in the prevention of rheumatic fever.

Use with other medicines (Interactions)

Please note that this information may also apply to medicines that no longer apply, and the medication that you plan to use in the future. Tell your doctor if you are applying, or have recently applied some medicine, including medicines obtained without a prescription.

  • Probenecid decreases secretion of cefazolin (ancef), and thus increasing its concentration in plasma
  • A false positive reaction for glucose in the urine may occur when you are testing with Benedikt solution, Feling solution or Clinitest ® tablets, but not with enzymatic assays as CLINISTIX ®.
  • In the course of therapy may occur positive direct and indirect antiglobulin test-Coombs test. The same can happen in the infant whose mothers received cephalosporins before childbirth.
  • Cefazolin (Ancef) can cause disulfiram similar reactions with alcohol.
  • Cefazolin can enhance the effects of warfarin which increases the risk of bleeding

Pregnanacy and lactation

Before you start to apply some medicine, consult your doctor or pharmacist. Cefazolin (Ancef) passes the placental barrier. Reproductive studies in animals have confirmed the existence of cefazolin adverse effects on fertility or fetus. Adequate and well-controlled studies on the application of cefazolin (ancef) in pregnant women have not been conducted. The medicine may be used during pregnancy only if the physician determines that the expected benefit to the mother outweighs the potential risk to the fetus. Cefazolin (ancef) is excreted into breast milk in very small quantities. Application of cefazolin (ancef) during breast-feeding is not contraindicated. During therapy, nursing mothers are recommended temporary interruption of breastfeeding and use of alternative modes of infant feeding.

Driving and using machines

The medicine does not exert a negative impact on the ability to drive and/or machines.

Cefazolin use

Cefazolin (ancef) injection may be administered only by qualified medical personnel in health institutions with the necessary precautions! The medicine is intended for intramuscular and intravenous administration. Dosage: Adults:

Type of infection Dose Frequency
Moderately severe to severe infections 500 mg to 1 g Every 6 to 8 hours
Mild infections caused by susceptible gram-positive bacteria 250 mg to 500 mg Every 8 hours
Acute, uncomplicated infections of urinary tract 1 g Every 12 hours
Pneumococcal pneumonia 500 mg Every 12 hours
Serious infections that threaten the patient's life (endocarditis, septicemia) 1 g to 1,5 g Every 6 hours

Preventing the occurrence of infection after surgery In order to prevent postoperative infection in contaminated or potentially contaminated surgery (vaginal hysterectomy, and cholecystectomy in high-risk patients such as those older than 70 years, with acute cholecystitis, obstructive jaundice or biliary lithiasis or open heart surgery, prosthetic arthroplasty, etc. .) recommends the following dosages: a) 1 g intravenous (iv.) or intramuscular (im.) for 30 minutes to 1 hour before the surgery; b) a long surgical procedures (2 hours or more), 500 mg to 1 g iv. or im. during operation (application adjust on the duration of the operation); c) 500 mg to 1 g iv. or im. every 6 to 8 hours over the first 24 hours after completion of the surgical procedure. It is important that the pre-operative dose of cefazolin (ancef) is given immediately before the start of the operation (1/2 to 1 hour) in order to achieve an appropriate effective serum and tissue levels of antimicrobial in the period commencing surgery. In addition, it is important that during the operation cefazolin (ancef) is administered at appropriate intervals in order to achieve a sufficient level of medicament at a time when it is expected the greatest exposure to infectious micro-organisms. In operations where the occurrence of infection may be particularly risky (open heart surgery, prosthetic arthroplasty, etc.), prophylactic use of cefazolin (ancef) may be continued for 3 to 5 days after surgery. Dosage in patients with impaired renal function

  • Patients with creatinine clearance >= 55 ml/min or serum creatinine of <= 1.5 mg% can receive the full dose at the usual intervals.
  • Patients with a creatinine clearance of 35 to 54 ml/min or a serum creatinine of 1.6 mg to 3.0% can receive a full dose every 8 hours (or at less frequent intervals).
  • Patients with a creatinine clearance of 11 to 34 ml/min or a serum creatinine of 3.1 mg to 4.5% can receive half of the usual dosage every 12 hours.
  • Patients with a creatinine clearance of <= 10 ml/min or a serum creatinine >= 4.6 mg% can receive half of the usual dosage every 18 to 24 hours.

All recommended, reduced doses are applied after the initial loading dose, which should be adapted to the severity of the infection. Dosage in patients with impaired hepatic function Impaired liver function does not require adjustment of the dose of cefazolin (ancef) unless there is a simultaneous kidney damage. Dosage in geriatric patients Cefazolin (ancef) is excreted from the body mainly by the kidneys. In elderly patients are more potential for decreased renal function, which should be taken into account when choosing a dose. Children The total daily dose is in children from 25 to 50 mg/kg body weight (divided into 3 to 4 individual doses) and is effective for the majority of mild to moderately severe infections. The total daily dose may be increased up to 100 mg/kg of body weight in the treatment of severe infections. As the safety of the medicine in premature births and infant is not determined, the use of cefazolin (ancef) in that population is not recommended.

In intravenous medicine administration in children under the age of 17 years minimum dilution of cefazolin (ancef) is 1 g/50 ml and should be administered for 30 to 60 minutes. The medicine can also be administered intravenously slowly during 3 to 5 minutes after the initial dilution of 75 to 125 mg/ml. The maximum recommended intravenous dose of cefazolin in children under 17 years of age is 100 mg / kg/day. Dosing in children with impaired renal function

  • Children with mild to moderate renal impairment (creatinine clearance of 70 to 40 ml/min), 60% of the usual daily dose, every 12 hours.
  • Children with moderate renal impairment (creatinine clearance of 40 to 20 ml/min), 25% of the usual daily dose, every 12 hours.
  • Children with severe renal impairment (creatinine clearance of 5 to 20 ml/min), 10% of the usual daily dose, every 24 hours.

All the recommended doses are applied after the initial loading dose of cefazolin!

Preparation of injection solution

Intramuscular administration of the medicine: 500 mg cefazolin should dissolve in 2 ml of sterile water for injection, to achieve a concentration of 225 mg/ml. Shake well until it came to a dissolution. The reconstituted solution should be clear. 1 g of cefazolin should dissolve in 2,5 ml of sterile water for injection, to achieve a concentration of 330 mg/ml. Shake well until it came to a dissolution. The reconstituted solution should be clear. Intravenouse administration of the medicine: Intravenous injections: After the preparation of injection solutions in the manner described in the intramuscular administration of the medicine, prepared injection solution is further diluted in a minimum of 10 ml of sterile water for injection. Mix well. Intravenous infusion: After the preparation of injection solutions in the manner described in the intramuscular administration of the medicine , prepared injection solution is further diluted with 50 or 100 ml of 5 % dextrose or 0.9 % strength NaCl solution. Mix well.

The manner of application of the prepared injection solution

Intramuscular administration of the medicine: Application solutions were prepared by an injection performed in the large muscle, deep intramuscularly. Prior to injection, it is necessary to perform aspiration in order to avoid the possibility of inadvertent application of a blood vessel. Intravenouse administration of the medicine: The prepared injection solution can be administered as an intravenous injection (intermittent application) for a period of 3 to 5 minutes. Duration of intermittent intravenous administration of the medicine should not be less than 3 minutes. Continuous intravenous infusion should be administered for 30 to 60 minutes. Cefazolin (ancef) powder for solution for injection 1 g can be dissolved in the following solution:

  • 0.9% NaCl solution;
  • 10% or 5% dextrose solution;
  • Ringer's solution;
  • 5% solution of sodium bicarbonate.

Overdose

The patients are most often dizziness, have paresthesia, headache, convulsions, increase in the values of urea, creatinine, liver enzymes and bilirubin in the blood, thrombocytosis, thrombocytopenia, eosinophilia, leukopenia, prolongation of prothrombin time and a positive Coombs' test. Medical assistance includes monitoring the patient with the use of symptomatic and supportive therapy, including ensuring a patent respiratory airway, oxygen, anticonvulsant therapy, and monitoring the status of gases and electrolytes and, if necessary, and the process of hemodialysis.

Side effects

Gastrointestinal side effects: diarrhea, oral candidiasis, nausea (rarely), vomiting (rare), abdominal cramps, loss of appetite, and pseudomembranous colitis. Allergic reactions: itching, skin rash, fever, eosinophilia, severe allergic reactions (anaphylaxis, Stevens-Johnson syndrome). Hematologic side effects: neutropenia, leukopenia, thrombocytopenia, thrombocythemia. Hepatic side effects: transient increase in liver enzymes (ASAT, ALAT, and alkaline phosphatase) hepatitis (rare). Renal side effects: an increase in the value of urea and creatinine levels, impaired kidney function. Local side effects: phlebitis at the injection place in intravenous injection (rare), pain at the place of intramuscular injection (rare). Other side effects: genital and anal pruritus (including vulvar pruritus, genital monilijazu and vaginitis).