KEY PONTS
- Cefazolin (Ancef) is an injectable first-generation cephalosporin and beta-lactam antibiotic that interferes with bacterial cell wall synthesis in sensitive organisms
- Has activity versus some Gram positive organisms (e.g., Strep. species, methicillin-sensitive Staphylococcus aureus [MSSA])
- VERY commonly used for it’s MSSA coverage
- Since MSSA lives on the skin, cefazolin a common drug to use for surgical prophylaxis – this drug “flows like water” in operating rooms
- Use higher doses in larger size patients (see guideline)
- Since MSSA lives on the skin, cefazolin a common drug to use for surgical prophylaxis – this drug “flows like water” in operating rooms
- VERY commonly used for it’s MSSA coverage
- Has activity versus Gram negative organisms: “PEcK” –> Proteus, E. coli, Klebsiella
- Used as a surrogate for many oral cephalosporins for susceptibility versus Enterobacterales
- This includes cefuroxime, cefdinir, and cefpodoxime, but not cefadroxil
- CLSI M100 table 2A says for cefazolin: “surrogate test for oral cephalosporins and uncomplicated UTIs”
- “(36) Breakpoints are for cefazolin when used as a surrogate test to predict results for the oral agents cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime, cephalexin, and loracarbef when used for therapy of uncomplicated UTIs due to E. coli, K. pneumonias, and P. mirabilis. Cefazolin tested as a surrogate may overcall resistance to cefdinir, cefpodoxime, and cefuroxime. If cefazolin tests resistant, test these drugs individually if needed for therapy.”
- Used as a surrogate for many oral cephalosporins for susceptibility versus Enterobacterales
- Generally, not considered to have any anaerobic or Enterococcal coverage
- Has activity versus some Gram positive organisms (e.g., Strep. species, methicillin-sensitive Staphylococcus aureus [MSSA])
- Can be infused over various durations, including IV push (over 5 minutes), continuous infusion (over 24 hours) or other
- Requires dosage adjustment for renal function
- One strategy used in HD is to do 2/2/3 –> 2gm post-HD Monday, 2gm post-HD Wednesday, then 3gm post-HD on Friday to last the weekend and repeat
- Oral counterparts are cephalexin and cefadroxil
RESOURCES
- Cefazolin Package Insert
- Surgical Prophylaxis Guidelines – ASHP
- IDSA Practice Guidelines
- CLSI M100 Free
- Antibiotic Dosing for Critically Ill Adult Patients Receiving Intermittent Hemodialysis, Prolonged Intermittent Renal Replacement Therapy, and Continuous Renal Replacement Therapy: An Update (2019)
- Antimicrobial Dosing Concepts and Recommendations for Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy or Intermittent Hemodialysis (2012)
