ANCEF IN DEXTROSE 5% IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANCEF IN DEXTROSE 5% IN PLASTIC CONTAINER (ANCEF IN DEXTROSE 5% IN PLASTIC CONTAINER).
Cefazolin is a first-generation cephalosporin antibiotic that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), inhibiting transpeptidation and disrupting peptidoglycan cross-linking. This leads to cell lysis and death, primarily in actively dividing bacteria.
| Metabolism | Cefazolin is minimally metabolized; primarily undergoes renal tubular secretion and glomerular filtration. Not significantly metabolized by cytochrome P450 enzymes. |
| Excretion | Renal: >80% unchanged via glomerular filtration and tubular secretion; biliary/fecal: <1% |
| Half-life | 1.8 hours (normal renal function); prolonged to 10-30 hours in severe renal impairment (CrCl <10 mL/min) |
| Protein binding | 80-86% bound to serum albumin |
| Volume of Distribution | 0.12-0.16 L/kg; primarily in extracellular fluid |
| Bioavailability | IM: ~85% (peak levels in 0.5-2 hours); IV: 100% |
| Onset of Action | IV: Immediate; IM: 1-2 hours (therapeutic levels achieved) |
| Duration of Action | 6-8 hours (dose-dependent); requires dosing adjustment in renal impairment |
| Molecular Weight | 454.5 |
For uncomplicated infections: 1-2 g IV every 8 hours. For severe infections: up to 2 g IV every 4 hours. Administered as an IV infusion over 30-60 minutes.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl 35-54 mL/min: 1-2 g every 8 hours. CrCl 11-34 mL/min: 1-2 g every 12 hours. CrCl <10 mL/min: 1-2 g every 24-48 hours. For patients on hemodialysis, administer 1-2 g after each dialysis session. |
| Liver impairment | No dosage adjustment required for hepatic impairment. Cefazolin is primarily renally eliminated. |
| Pediatric use | For children >1 month: 25-100 mg/kg/day IV divided every 6-8 hours. For severe infections: up to 100 mg/kg/day IV divided every 6-8 hours. Maximum dose: 6 g/day. |
| Geriatric use | Adjust dose based on renal function. Calculate CrCl and follow renal adjustment guidelines. No additional geriatric-specific modifications beyond renal consideration. |
| 1st trimester | Cefazolin crosses the placenta; considered safe based on large studies; no evidence of teratogenicity. |
| 2nd trimester | Safe for use; no known fetal harm. |
| 3rd trimester | Safe; used for prophylaxis during cesarean section. |
Clinical note
Comprehensive clinical and safety monograph for ANCEF IN DEXTROSE 5% IN PLASTIC CONTAINER (ANCEF IN DEXTROSE 5% IN PLASTIC CONTAINER).
| Placental transfer | Cefazolin crosses the placenta; therapeutic levels achieved in fetal serum. |
| Breastfeeding | Cefazolin is excreted into breast milk in low amounts; considered compatible with breastfeeding. Monitor infant for possible diarrhea or allergic reaction. |
| Lactation Rating |
■ FDA Black Box Warning
None
| Serious Effects |
Hypersensitivity to cefazolin or other cephalosporinsHypersensitivity to penicillins (cross-sensitivity)
| Precautions | Hypersensitivity reactions: Cross-allergenicity with other beta-lactams; caution in penicillin-allergic patients, Acute generalized exanthematous pustulosis (AGEP), Clostridioides difficile-associated diarrhea (CDAD), Seizures at high doses or in renal impairment, Nephrotoxicity (especially with aminoglycosides or loop diuretics), Hemolytic anemia (rare), Interference with glucose and protein tests, Use in renal impairment: dose adjustment required, Pregnancy category B: use only if clearly needed, Geriatric use: increased risk of adverse effects |
| Food/Dietary | No specific food interactions. Avoid alcohol during therapy and for 72 hours post-treatment due to risk of disulfiram-like reaction (cefazolin has a methylthiotetrazole side chain). Patients with diabetes should account for dextrose content (5 g/100 mL) in their carbohydrate intake. |
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| L1 - Safe |
| Teratogenic Risk | Pregnancy Category B. No evidence of risk in humans based on animal studies and human data; however, adequate studies in pregnant women are lacking. No known teratogenic effects in first trimester; use only if clearly needed. |
| Fetal Monitoring | Monitor renal function, complete blood count, and signs of hypersensitivity or superinfection. In prolonged use, monitor for Clostridioides difficile-associated diarrhea. |
| Fertility Effects | No evidence of impaired fertility in animal studies. No human data on fertility effects. |
| Clinical Pearls | For surgical prophylaxis, administer within 60 minutes before incision. Use extended infusion (over 1-2 hours) for critically ill patients to optimize pharmacokinetic/pharmacodynamic target attainment. Monitor renal function given cefazolin excretion; adjust dose for CrCl <55 mL/min. Avoid in patients with immediate-type hypersensitivity to penicillins (10% cross-reactivity risk). In obese patients (BMI ≥40 kg/m²), consider doubling the standard dose (2 g IV) for adequate tissue penetration. |
| Patient Advice | Complete the full course of antibiotics as prescribed, even if you feel better. · Report any signs of allergic reaction (rash, itching, difficulty breathing, swelling of face or throat) to your healthcare provider immediately. · If you are diabetic, note that each 1% dextrose solution provides 3.4 kcal/g; monitor blood glucose levels closely. · The medication is given intravenously; ensure the IV site is clean and free from redness, swelling, or pain. · Avoid alcohol during treatment and for at least 72 hours after the last dose to prevent disulfiram-like reactions (flushing, nausea, vomiting). |