Ancef


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cefazolin sodium

Ancef

Pharmacologic class: First-generation cephalosporin

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Interferes with bacterial cell-wall synthesis, causing cell to rupture and die

Availability

Powder for injection: 500 mg, 1 g, 10 g, 20 g

Premixed containers: 500 mg/50 ml in dextrose 5% in water (D5W), 1 g/50 ml in D5W

Indications and dosages

Respiratory tract infections caused by group A beta-hemolytic streptococci, Klebsiella species, Haemophilus influenzae, and Staphylococcus aureus; skin infections caused by S. aureus and beta-hemolytic streptococci; biliary tract infections caused by Escherichia coli, Klebsiella species, Proteus mirabilis, and S. aureus; bone and joint infections caused by S. aureus; genital infections caused by E. coli, Klebsiella species, P. mirabilis, and strains of enterococci; septicemia caused by E. coli, Klebsiella species, P. mirabilis, S. aureus, and S. pneumoniae; endocarditis caused by S. aureus or beta-hemolytic streptococci

Adults: For mild infections, 250 to 500 mg q 8 hours I.V. or I.M. For moderate to severe infections, 500 to 1,000 mg I.V. or I.M. q 6 to 8 hours. For life-threatening infections, 1,000 to 1,500 mg I.M. or I.V. q 6 hours, to a maximum dosage of 6 g/day.

Children: For mild to moderate infections, 25 to 50 mg/kg/day I.V. or I.M. in divided doses t.i.d. or q.i.d. For severe infections, 100 mg/kg/day I.V. or I.M. in divided doses t.i.d. or q.i.d.

Acute uncomplicated urinary tract infections (UTIs) caused by E. coli, Klebsiella species, P. mirabilis, and strains of Enterococcus and Enterobacter species

Adults: 1 g I.V. or I.M. q 12 hours

Surgical prophylaxis

Adults: 1g I.V. or I.M. 30 to 60 minutes before surgery, then 0.5 to 1 g I.V. or I.M. q 6 to 8 hours for 24 hours. If surgery exceeds 2 hours, another 0.5- to 1-g dose I.M. or I.V. may be given intraoperatively.

Pneumococcal pneumonia

Adults: 500 mg I.M. or I.V. infusion q 12 hours

Dosage adjustment

• Renal impairment
• Elderly patients

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:
• renal impairment, phenylketonuria
• history of GI disease (especially colitis)
• emaciated patients
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Obtain specimens for culture and sensitivity testing as needed before starting therapy.
• For intermittent I.V. infusion, administer in volume-control set or in separate, secondary I.V. container over 30 to 60 minutes.
• For direct I.V. injection, dilute reconstituted dose in 5 ml of sterile water for injection and administer slowly over 3 to 5 minutes.
• Don't mix premixed solution with other drugs.

Don't use flexible container in series connections because of risk of air embolism.
• For I.M. use, reconstitute with sterile water for injection, bacteriostatic water, or normal saline solution for injection. Shake well until dissolved.
• Inject I.M. into large muscle mass.

Adverse reactions

CNS: headache, lethargy, confusion, hemiparesis, paresthesia, syncope, seizures

CV: hypotension, palpitations, chest pain, vasodilation

EENT: hearing loss

GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis

GU: vaginal candidiasis, nephrotoxicity

Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression

Hepatic: hepatic failure, hepatomegaly

Musculoskeletal: arthralgia

Respiratory: dyspnea

Skin: urticaria, maculopapular or erythematous rash

Other: chills, fever, superinfection, anaphylaxis, serum sickness

Interactions

Drug-drug.Aminoglycosides, loop diuretics: increased risk of nephrotoxicity

Anticoagulants: increased anticoagulant effect

Chloramphenicol: antagonistic effect

Probenecid: decreased excretion and increased blood level of cefazolin

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results

Hemoglobin, platelets, white blood cells: decreased values

Drug-behaviors.Alcohol use: acute alcohol intolerance (disulfiram-like reaction) if alcohol is consumed within 72 hours of drug administration

Patient monitoring

If patient is receiving high doses, monitor for extreme confusion, tonic-clonic seizures, and mild hemiparesis.
• Monitor CBC, prothrombin time, and kidney and liver function test results.
• Watch for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins may occur.

Patient teaching

• Tell patient to report reduced urinary output, persistent diarrhea, bruising, or bleeding.
• Instruct patient to take drug exactly as prescribed and to complete full course of therapy even when he feels better.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

ceFAZolin

(sef-a-zoe-lin) ,

Ancef

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: first generation cephalosporins
Pregnancy Category: B

Indications

Treatment of the following infections due to susceptible organisms:
  • Skin and skin structure infections (including burn wounds),
  • Pneumonia,
  • Urinary tract infections,
  • Biliary tract infections,
  • Genital infections,
  • Bone and joint infections,
  • Septicemia,
  • Bacterial endocarditis prophylaxis for dental and upper respiratory procedures.
Perioperative prophylaxis.Not suitable for the treatment of meningitis.

Action

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria.
Active against many gram-positive cocci including:
  • Streptococcus pneumoniae,
  • Group A beta-hemolytic streptococci,
  • Penicillinase-producing staphylococci.
Not active against:
  • Methicillin-resistant staphylococci,
  • Bacteroides fragilis,
  • Enterococcus.
Active against some gram-negative rods including:
  • Proteus mirabilis,
  • Escherichia coli.

Pharmacokinetics

Absorption: Well absorbed after IM administration.
Distribution: Widely distributed. Penetrates bone and synovial fluid well. Crosses the placenta and enters breast milk in low concentrations. Minimal CSF penetration.
Protein Binding: 74—86%.
Metabolism and Excretion: Excreted almost entirely unchanged by the kidneys.
Half-life: Neonates: 3–5 hrs; Adults: 90–150 min (↑ in renal impairment).

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
IMrapid0.5–2 hr6–12 hr
IVrapid5 min6–12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins.
Use Cautiously in: Renal impairment (dose ↓ and/or ↑ dosing interval recommended if CCr <30 mL/min); Hepatic impairment; History of GI disease, especially colitis; Obstetric / Half-life is shorter and blood levels lower during pregnancy; has been used safely. Lactation: Low concentrations of drug appear in breast milk; Geriatric: Dose adjustment due to age-related ↓ in renal function may be necessary.

Adverse Reactions/Side Effects

Central nervous system

  • seizures (high doses) (life-threatening)

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • cramps

Dermatologic

  • Stevens-Johnson syndrome (life-threatening)
  • rash (most frequent)
  • pruritis
  • urticaria

Hematologic

  • leukopenia
  • neutropenia
  • thrombocytopenia

Local

  • pain at IM site (most frequent)
  • phlebitis at IV site (most frequent)

Miscellaneous

  • allergic reactions including anaphylaxis and serum sickness
  • superinfection

Interactions

Drug-Drug interaction

Probenecid ↓ excretion and ↑ blood levels of renally excreted cephalosporins.

Route/Dosage

Intramuscular Intravenous (Adults) Moderate-to-severe infections—500 mg-2 g every 6–8 hr; maximum 12 g/day. Mild infections with Gram-positive cocci—250–500 mg every 8 hr.Uncomplicated urinary tract infection—1 g every 12 hr.Pneumococcal pneumonia—500 mg every 12 hr.Infective endocarditis or septicemia—1–1.5 g every 6 hr.Perioperative prophylaxis—1 g within 30–60 min prior to incision (an additional 500 mg–1 g should be given for surgeries ≥ 2 hr). 500 mg-1 g should then be given for all surgeries every 6–8 hr for 24 hr following the surgery.
Intramuscular Intravenous (Children and Infants >1 mo) 50–100 mg/kg/day divided every 8 hr; maximum: 6 g/dayBacterial endocarditis prophylaxis in penicillin-allergic patients—25 mg/kg 30 minutes prior to procedure; maximum dose: 1 g.
Intramuscular Intravenous (Neonates ≤ 7 days) 40 mg/kg/day divided q 12 hr.
Intramuscular Intravenous (Neonates > 7 days and ≤ 2 kg) 40 mg/kg/day divided q 12 hr.
Intramuscular Intravenous (Neonates > 7 days and > 2 kg) 60 mg/kg/day divided q 8 hr.

Renal Impairment

Intramuscular Intravenous (Adults) CCr 10–30 mL/min— Administer dose every 12 hr; CCr ≤10 mL/min—Administer every 24 hr.

Availability (generic available)

Powder for injection: 500 mg/vial, 1 g/vial, 10 g/vial, 20 g/vial
Premixed containers: 1 g/50 mL D5W, 2 g/50 mL D5W

Nursing implications

Nursing assessment

  • Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
  • Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Assess patient for skin rash frequently during therapy. Discontinue at first sign of rash; may be life-threatening. Stevens-Johnson syndrome may develop. Treat symptomatically; may recur once treatment is stopped.
  • Lab Test Considerations: May cause positive results for Coombs' test in patients receiving high doses or in neonates whose mothers were given cephalosporins before delivery.
    • May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
    • May rarely cause leukopenia, neutropenia, thrombocytopenia, and eosinophilia.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)
Diarrhea (Adverse Reactions)

Implementation

  • Do not confuse cefazolin with cefotetan, cefoxitin, ceftazidime, or ceftriaxone.
  • Intramuscular: Reconstitute IM doses with 2 mL or 2.5 mL of with sterile water for injection to a achieve a final concentration of 225–330 mg/mL.
    • Inject deep into a well-developed muscle mass; massage well.
  • Intravenous Administration
  • pH: 4.5–7.0.
  • Intravenous: Monitor site frequently for thrombophlebitis (pain, redness, swelling). Change sites every 48–72 hr to prevent phlebitis.
    • Do not use solutions that are cloudy or contain a precipitate.
    • If aminoglycosides are administered concurrently, administer in separate sites, if possible, at least 1 hr apart. If second site is unavailable, flush line between medications.
  • Diluent: Dilute with sterile water for injection. Do not use preparations containing benzyl alcohol for neonates. Concentration: ≤100 mg/mL.
  • Rate: Administer slowly over 3–5 min.
  • Intermittent Infusion: Diluent: Reconstituted solution may be further diluted with 0.9% NaCl, D5W, D10W, D5/0.25% NaCl, D5/0.45% NaCl, D5/09% NaCl, D5/LR, or LR solution. Solution is stable for 24 hr at room temperature and 10 days if refrigerated.
  • Concentration: ≤20 mg/mL.
  • Rate: Administer over 30–60 min.
  • Y-Site Compatibility: acyclovir, alfentanil, allopurinol, alprostadil, amifostine, aminocaproic acid, aminophylline, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, carmustine, cefoperazone, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chlorampheniocol, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, docetaxel, doxacurium, doxapram, doxorubicin liposome, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, esmolol, etoposide, etoposide phosphate, fenoldopam, fentanyl, filgrastim, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, gemcitabine, glycopyrrolate, granisetron, heparin, hydrocortisone, ifosfamide, imipenem/cilastatin, indomethacin, insulin, irinotecan, isoproterenol, ketamine, ketorolac, leucovorin, lidocaine, linezolid, lorazepam, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate,.methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium,.penicillin G, perphenazine, phenobarbital, phenylephrine, phytonadione, potassium acetate, potassium chloride, procainamide, propofol, propranolol, ranitidine, remifentanil, rituximab, sargramostim, sodium acetate, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tolazoline, trastuzumab,.vasopressin, vecuronium, verapamil, vinblastine, vincristine, vitamin B complex with C, voriconazole, warfarin, zoledronic acid
  • Y-Site Incompatibility: alemtuzumab, amphotericin B cholesteryl, azathioprine, calcium chloride, caspofungin, cefotaxime, chlorpromazine, dantrolene, diazepam, diazoxide, diphenhydramine, dobutamine, dolasetron, dopamine, doxorubicin hydrochloride, doxycycline, erythromycin, ganciclovir, haloperidol, hydralazine, hydroxyzine, idarubicin, levofloxacin, mitoxantrone, mycophenolate, papaverine, pemetrexed, pentamidine, pentazocine, pentobarbital, phentolamine, phenytoin, prochlorperazine, promethazine, protamine, pyridoxime, quinupristin/dalfopristin, sodium citrate, tobramycin, trimethoprim/sulfamethoxazole, vinorelbine.

Patient/Family Teaching

  • Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
  • Instruct patient to notify health care professional if rash, or fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.

Evaluation/Desired Outcomes

  • Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
  • Decreased incidence of infection when used for prophylaxis.

Ancef

a trademark for a semisynthetic cephalosporin antibiotic (cefazolin sodium).
References in periodicals archive ?
Yes, an EMR with CPOE would have caught my allergy to Ancef and an appropriately implemented medication administration system would have blocked administration.
Under the agreement, beginning in January 1994, Abbott will market the injectable vial formulations of Ancef (cefazolin sodium), Tazicef (ceftazidime), Bactocill (oxacillin), Nallpen (nafcillin), Ticar (ticarcillin disodium) and Totacillin (ampicillin).