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Pharmacologic class: First-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
Interferes with bacterial cell-wall synthesis, causing cell to rupture and die
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
• Renal impairment
• Elderly patients
• Hypersensitivity to cephalosporins or penicillins
Use cautiously in:
• renal impairment, phenylketonuria
• history of GI disease (especially colitis)
• emaciated patients
• elderly patients
• pregnant or breastfeeding patients
• 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.
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
Skin: urticaria, maculopapular or erythematous rash
Other: chills, fever, superinfection, anaphylaxis, serum sickness
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
☞ 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.
• 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.
ClassificationTherapeutic: anti infectives
Pharmacologic: first generation cephalosporins
- Skin and skin structure infections (including burn wounds),
- Urinary tract infections,
- Biliary tract infections,
- Genital infections,
- Bone and joint infections,
- Bacterial endocarditis prophylaxis for dental and upper respiratory procedures.
- Streptococcus pneumoniae,
- Group A beta-hemolytic streptococci,
- Penicillinase-producing staphylococci.
- Methicillin-resistant staphylococci,
- Bacteroides fragilis,
- Proteus mirabilis,
- Escherichia coli.
Time/action profile (blood levels)
|IM||rapid||0.5–2 hr||6–12 hr|
|IV||rapid||5 min||6–12 hr|
Adverse Reactions/Side Effects
Central nervous system
- seizures (high doses) (life-threatening)
- pseudomembranous colitis (life-threatening)
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- Stevens-Johnson syndrome (life-threatening)
- rash (most frequent)
- pain at IM site (most frequent)
- phlebitis at IV site (most frequent)
- allergic reactions including anaphylaxis and serum sickness
Drug-Drug interactionProbenecid ↓ excretion and ↑ blood levels of renally excreted cephalosporins.
Renal ImpairmentIntramuscular Intravenous (Adults) CCr 10–30 mL/min— Administer dose every 12 hr; CCr ≤10 mL/min—Administer every 24 hr.
Availability (generic available)
- 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 DiagnosesRisk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
- 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.
- 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.
- 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.
- 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.