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Drug overview for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile):
Generic name: CEFAZOLIN SODIUM/WATER FOR INJECTION,STERILE (sef-A-zoe-lin)
Drug class: Beta-Lactams
Therapeutic class: Anti-Infective Agents
Cefazolin sodium is a semisynthetic, first generation cephalosporin antibiotic.
No enhanced Uses information available for this drug.
Generic name: CEFAZOLIN SODIUM/WATER FOR INJECTION,STERILE (sef-A-zoe-lin)
Drug class: Beta-Lactams
Therapeutic class: Anti-Infective Agents
Cefazolin sodium is a semisynthetic, first generation cephalosporin antibiotic.
No enhanced Uses information available for this drug.
DRUG IMAGES
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The following indications for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile) have been approved by the FDA:
Indications:
None.
Professional Synonyms:
None.
Indications:
None.
Professional Synonyms:
None.
The following dosing information is available for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile):
Dosage of cefazolin sodium is expressed in terms of cefazolin and is identical for IM or IV administration.
To avoid unintentional overdosage, the commercially available Duplex(R) drug delivery system containing cefazolin and dextrose injection and the commercially available frozen premixed cefazolin injection in dextrose should not be used in patients who require less than the entire 1- or 2-g dose in the container.
The usual adult dosage of cefazolin for the treatment of mild infections caused by susceptible gram-positive cocci is 250-500 mg every 8 hours.
The usual adult dosage of cefazolin for the treatment of moderate to severe infections is 0.5-1 g every 6-8 hours.
The usual adult dosage of cefazolin for the treatment of severe, life-threatening infections (e.g., endocarditis, septicemia) is 1-1.5 g every 6 hours. In rare instances, up to 12 g daily has been used.
The manufacturers state that safety and efficacy of cefazolin have not been established in premature infants or neonates 1 month of age or younger.
The American Academy of Pediatrics (AAP) recommends that neonates 7 days of age or younger+ receive IV or IM cefazolin in a dosage of 25 mg/kg every 12 hours, regardless of weight. For neonates 8-28 days of age+, the AAP recommends a dosage of 25 mg/kg every 12 hours for those weighing 2 kg or less and 25 mg/kg every 8 hours for those weighing more than 2 kg.
The usual dosage of cefazolin recommended by the manufacturers for the treatment of mild to moderately severe infections in pediatric patients older than 1 month of age is 25-50 mg/kg daily given in 3 or 4 equally divided doses. The manufacturers state that dosage may be increased to 100 mg/kg daily in divided doses for the treatment of severe infections.
The AAP recommends that pediatric patients beyond the neonatal period receive IV or IM cefazolin in a dosage of 25-50 mg/kg daily given in 3 equally divided doses for the treatment of mild to moderate infections or 100-150 mg/kg daily given in 3 equally divided doses for the treatment of severe infections.
In patients with impaired renal function, doses and/or frequency of administration of cefazolin must be modified in response to the degree of impairment, severity of the infection, susceptibility of the causative organism, and serum concentrations of the drug.
The manufacturers recommend an initial loading dose appropriate for the severity of the infection followed by dosage based on the degree of renal impairment. (See Table 1 and Table 2.)
Table 1. Dosage for Adults with Renal Impairment
Creatinine Clearance (mL/minute) Dosage After Initial Loading Dose 35-54 Full doses at intervals >=8 hours 11-34 50% of usual dose every 12 hours <=10 50% of usual dose every 18-24 hours
Table 2. Dosage for Children Older than 1 Month of Age with Renal Impairment
Creatinine Clearance (mL/minute) Dosage After Initial Loading Dose 40-70 60% of usual daily dosage in divided doses every 12 hours 20-40 25% of usual daily dosage in divided doses every 12 hours 5-20 10% of usual daily dosage once every 24 hours
To avoid unintentional overdosage, the commercially available Duplex(R) drug delivery system containing cefazolin and dextrose injection and the commercially available frozen premixed cefazolin injection in dextrose should not be used in patients who require less than the entire 1- or 2-g dose in the container.
The usual adult dosage of cefazolin for the treatment of mild infections caused by susceptible gram-positive cocci is 250-500 mg every 8 hours.
The usual adult dosage of cefazolin for the treatment of moderate to severe infections is 0.5-1 g every 6-8 hours.
The usual adult dosage of cefazolin for the treatment of severe, life-threatening infections (e.g., endocarditis, septicemia) is 1-1.5 g every 6 hours. In rare instances, up to 12 g daily has been used.
The manufacturers state that safety and efficacy of cefazolin have not been established in premature infants or neonates 1 month of age or younger.
The American Academy of Pediatrics (AAP) recommends that neonates 7 days of age or younger+ receive IV or IM cefazolin in a dosage of 25 mg/kg every 12 hours, regardless of weight. For neonates 8-28 days of age+, the AAP recommends a dosage of 25 mg/kg every 12 hours for those weighing 2 kg or less and 25 mg/kg every 8 hours for those weighing more than 2 kg.
The usual dosage of cefazolin recommended by the manufacturers for the treatment of mild to moderately severe infections in pediatric patients older than 1 month of age is 25-50 mg/kg daily given in 3 or 4 equally divided doses. The manufacturers state that dosage may be increased to 100 mg/kg daily in divided doses for the treatment of severe infections.
The AAP recommends that pediatric patients beyond the neonatal period receive IV or IM cefazolin in a dosage of 25-50 mg/kg daily given in 3 equally divided doses for the treatment of mild to moderate infections or 100-150 mg/kg daily given in 3 equally divided doses for the treatment of severe infections.
In patients with impaired renal function, doses and/or frequency of administration of cefazolin must be modified in response to the degree of impairment, severity of the infection, susceptibility of the causative organism, and serum concentrations of the drug.
The manufacturers recommend an initial loading dose appropriate for the severity of the infection followed by dosage based on the degree of renal impairment. (See Table 1 and Table 2.)
Table 1. Dosage for Adults with Renal Impairment
Creatinine Clearance (mL/minute) Dosage After Initial Loading Dose 35-54 Full doses at intervals >=8 hours 11-34 50% of usual dose every 12 hours <=10 50% of usual dose every 18-24 hours
Table 2. Dosage for Children Older than 1 Month of Age with Renal Impairment
Creatinine Clearance (mL/minute) Dosage After Initial Loading Dose 40-70 60% of usual daily dosage in divided doses every 12 hours 20-40 25% of usual daily dosage in divided doses every 12 hours 5-20 10% of usual daily dosage once every 24 hours
No enhanced Administration information available for this drug.
No dosing information available.
No generic dosing information available.
The following drug interaction information is available for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile):
There are 1 contraindications.
These drug combinations generally should not be dispensed or administered to the same patient. A manufacturer label warning that indicates the contraindication warrants inclusion of a drug combination in this category, regardless of clinical evidence or lack of clinical evidence to support the contraindication.
| Drug Interaction | Drug Names |
|---|---|
| Live Typhoid Vaccine/Antimicrobials SEVERITY LEVEL: 1-Contraindicated Drug Combination: This drug combination is contraindicated and generally should not be dispensed or administered to the same patient. MECHANISM OF ACTION: The antimicrobial may be active against the organism in the live-vaccine. Antimicrobial therapy may prevent the vaccine organism from replicating enough to trigger an immune response.(1) CLINICAL EFFECTS: Vaccination may be ineffective. PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Do not give oral typhoid vaccine until 72 hours after the last dose of antimicrobial. If possible, to optimize vaccine effectiveness, do not start antibacterial drugs for 72 hours after the last dose of oral typhoid vaccine. A longer interval should be considered for long-acting antimicrobials, such as azithromycin.(3) DISCUSSION: Because antimicrobial therapy may prevent sufficient vaccine-organism replication to generate an immune response, the manufacturer of live-attenuated typhoid vaccine and the Centers for Disease Control (CDC) state that the vaccine should not be administered to patients receiving antimicrobial therapy.(1-3) |
VIVOTIF |
There are 1 severe interactions.
These drug interactions can produce serious consequences in most patients. Actions required for severe interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration scheduling, and providing additional patient monitoring. Review the full interaction monograph for more information.
| Drug Interaction | Drug Names |
|---|---|
| Fecal Microbiota Spores/Antibiotics SEVERITY LEVEL: 2-Severe Interaction: Action is required to reduce the risk of severe adverse interaction. MECHANISM OF ACTION: Fecal microbiota spores is a suspension of live bacterial spores, which may be compromised by concurrent use of antibiotics.(1) CLINICAL EFFECTS: Antibiotics may decrease the effectiveness of fecal microbiota spores.(1) PREDISPOSING FACTORS: None determined. PATIENT MANAGEMENT: Antibiotics should not be used concurrently with fecal microbiota spores. Antibacterial treatment should be completed for 2 to 4 days before initiating treatment with fecal microbiota spores.(1) DISCUSSION: Antibiotics may compromise the effectiveness of fecal microbiota spores. |
VOWST |
There are 2 moderate interactions.
The clinician should assess the patient’s characteristics and take action as needed. Actions required for moderate interactions include, but are not limited to, discontinuing one or both agents, adjusting dosage, altering administration.
| Drug Interaction | Drug Names |
|---|---|
| Selected Cephalosporins & Penicillins/Probenecid SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: Probenecid impairs the clearance of some cephalosporins and penicillins via inhibition of renal anion transporters in the proximal tubule.(49) It has also been hypothesized that probenecid may affect tissue distribution of cephalosporins.(1-5) CLINICAL EFFECTS: The concurrent administration of probenecid may result in increased maximum concentration (Cmax), area-under-curve (AUC), and half-life of the cephalosporin or penicillin.(49) While this may improve antibiotic efficacy,(46-48) increased levels may also increase the risk for antibiotic-associated nephrotoxicity.(4) PREDISPOSING FACTORS: Underlying renal dysfunction may increase the risk for nephrotoxicity. PATIENT MANAGEMENT: In patients receiving the combination to improve antibiotic efficacy, monitor for antibiotic adverse effects and consider monitoring renal function. In patients receiving probenecid therapy to prevent or treat hyperuricemia, exposure to the antibiotic will be increased. A decrease in antibiotic dose or frequency may be required. The US manufacturer of piperacillin-tazobactam states probenecid should not be coadministered with piperacillin-tazobactam unless the benefit outweighs the risk.(50) DISCUSSION: Concurrent use of probenecid with a cephalosporin or penicillin may cause an increase in the Cmax, AUC, and an increased elimination half life of the antibiotic.(6-8,49) This may be beneficial or necessary in difficult to treat infections,(46-48) but an increased risk for adverse effects should be expected. Antibiotics not dose adjusted for concurrent use with probenecid may be associated with an increased risk for adverse effects, such as nephrotoxicity. Probenecid administered concurrently with piperacillin-tazobactam prolongs the half-life of piperacillin by 21% and tazobactam by 71%. In a study in 8 healthy males, concurrent administration of probenecid (1 g) with piperacillin (1 g IM) increased piperacillin's Cmax and AUC by 30% and 60%. Renal clearance was reduced by 40%.(51) The cephalosporins affected by probenecid include cefazolin,(9-11) cephacetrile,(12,13) cephaloglycin,(14,15) cephalexin,(16-21) cephradine, (22-23) cefoxitin,(24-28) cefadroxil(29), cefaclor,(23) cefamandole,(30) ceftizoxime,(31,32) cefuroxime,(33,34) cefprozil,(35) cefonicid,(36) cefmetazole,(37) cefmenoxime,(38) and cefditoren.(39) Probenecid has been shown not to affect moxalactam,(4,40,41) ceforanide, (4,42), cefoperazone, ceftazidime(4,34,43) or ceftriaxone.(4) |
PROBENECID, PROBENECID-COLCHICINE |
| Slt Anticoagulants (Vit K antagonists)/Slt Cephalosporins SEVERITY LEVEL: 3-Moderate Interaction: Assess the risk to the patient and take action as needed. MECHANISM OF ACTION: The exact mechanism is unknown, but may involve a combination of cephalosporin induced platelet inhibition and alteration of gut flora. CLINICAL EFFECTS: Concurrent use of some cephalosporins may increase the hypoprothrombinemic effect of the anticoagulant with possible bleeding. PREDISPOSING FACTORS: High doses, hepatic and/or renal impairment, and poor nutrition may increase the risk of bleeding. The risk for bleeding episodes may be greater in patients with disease-associated factors (e.g. thrombocytopenia). Drug associated risk factors include concurrent use of multiple drugs which inhibit anticoagulant/antiplatelet metabolism and/or have an inherent risk for bleeding (e.g. NSAIDs). PATIENT MANAGEMENT: Monitor prothrombin activity and adjust the anticoagulant dosage accordingly. Consider using an alternative antibiotic. If concurrent therapy is warranted, monitor patients receiving concurrent therapy for signs of blood loss, including decreased hemoglobin, hematocrit, fecal occult blood, and/or decreased blood pressure and promptly evaluate patients with any symptoms. When applicable, perform agent-specific laboratory test (e.g. INR, aPTT) to monitor efficacy and safety of anticoagulation. Discontinue anticoagulation in patients with active pathologic bleeding. Instruct patients to report any signs and symptoms of bleeding, such as unusual bleeding from the gums or nose; unusual bruising; red or black, tarry stools; red, pink or dark brown urine; acute abdominal or joint pain and/or swelling. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. Contact the prescriber before initiating, altering the dose or discontinuing either drug. DISCUSSION: Although the majority of cephalosporins that have been documented to interact with anticoagulants have a NMTT side chain, there are reports of interactions with cefazolin, cefoxitin, ceftaroline, and ceftriaxone as well. The time of highest risk for a coumarin-type drug interaction is when the precipitant drug is initiated or discontinued. A large systematic review was performed on 72 warfarin drug-drug interactions studies that reported on bleeding, thromboembolic events, or death. Most studies were retrospective cohorts. A meta-analysis of 11 of those studies found a higher rate of clinically significant bleeding in patients on warfarin and antimicrobials (OR=1.63; 95% CI 1.45-1.83). Increased bleeding risk was also seen in subgroup analyses with cephalosporins (OR=1.50; 95% CI 1.21-1.86). |
ANISINDIONE, DICUMAROL, JANTOVEN, PHENINDIONE, WARFARIN SODIUM |
The following contraindication information is available for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile):
Drug contraindication overview.
No enhanced Contraindications information available for this drug.
No enhanced Contraindications information available for this drug.
There are 0 contraindications.
There are 6 severe contraindications.
Adequate patient monitoring is recommended for safer drug use.
| Severe List |
|---|
| Chronic kidney disease stage 2 (mild) GFR 60-89 ml/min |
| Chronic kidney disease stage 3A (moderate) GFR 45-59 ml/min |
| Chronic kidney disease stage 3B (moderate) GFR 30-44 ml/min |
| Chronic kidney disease stage 4 (severe) GFR 15-29 ml/min |
| Chronic kidney disease stage 5 (failure) GFr<15 ml/min |
| Clostridioides difficile infection |
There are 1 moderate contraindications.
Clinically significant contraindication, where the condition can be managed or treated before the drug may be given safely.
| Moderate List |
|---|
| Hypoprothrombinemia |
The following adverse reaction information is available for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile):
Adverse reaction overview.
No enhanced Common Adverse Effects information available for this drug.
No enhanced Common Adverse Effects information available for this drug.
There are 35 severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
| None. | None. |
| Rare/Very Rare |
|---|
|
Abnormal hepatic function tests Acute generalized exanthematous pustulosis Agranulocytosis Anaphylaxis Angioedema Aplastic anemia Candidiasis Cholestasis Clostridioides difficile infection Colitis DRESS syndrome Eosinophilia Erythema multiforme Hallucinations Hemolytic anemia Hemorrhage Hepatitis Hyperbilirubinemia Hypersensitivity drug reaction Hypoprothrombinemia Interstitial nephritis Jaundice Kidney disease with reduction in glomerular filtration rate (GFr) Myoclonus Obstructive hyperbilirubinemia Pancytopenia Pemphigus Pruritus of skin Renal failure Seizure disorder Serum sickness Stevens-johnson syndrome Thrombocytopenic disorder Toxic epidermal necrolysis Urticaria |
There are 20 less severe adverse reactions.
| More Frequent | Less Frequent |
|---|---|
|
Acute abdominal pain Diarrhea Dyspepsia Nausea Vomiting |
Gastritis Vulvovaginal candidiasis |
| Rare/Very Rare |
|---|
|
Acute cognitive impairment Agitation Arthralgia Dizziness Drug fever Fatigue Genital organ pruritus Headache disorder Paresthesia Phlebitis after infusion Pruritus ani Skin rash Vaginitis |
The following precautions are available for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile):
No enhanced Pediatric Use information available for this drug.
Contraindicated
Severe Precaution
Management or Monitoring Precaution
Contraindicated
| None |
Severe Precaution
| None |
Management or Monitoring Precaution
| None |
No enhanced Pregnancy information available for this drug.
No enhanced Lactation information available for this drug.
No enhanced Geriatric Use information available for this drug.
The following prioritized warning is available for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile):
No warning message for this drug.
No warning message for this drug.
The following icd codes are available for CEFAZOLIN SODIUM-STERILE WATER (cefazolin sodium/water for injection,sterile)'s list of indications:
No ICD codes found for this drug.
No ICD codes found for this drug.
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