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 |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANCEF IN DEXTROSE 5% IN PLASTIC CONTAINER (ANCEF IN DEXTROSE 5% IN PLASTIC CONTAINER).
| Breastfeeding | Cefazolin is excreted into breast milk in low concentrations (M/P ratio approximately 0.2-0.5). Considered compatible with breastfeeding; monitor for potential gastrointestinal effects in the infant. |
| 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. |
■ FDA Black Box Warning
None
| Serious Effects |
["Hypersensitivity to cefazolin or any cephalosporin","Severe immediate hypersensitivity (e.g., anaphylaxis) to penicillins or other beta-lactams"]
| 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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| 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). |