ANCEF IN PLASTIC CONTAINER
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANCEF IN PLASTIC CONTAINER (ANCEF IN PLASTIC CONTAINER).
Cefazolin, a first-generation cephalosporin, inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), thereby inhibiting peptidoglycan cross-linking and autolytic enzyme inhibition.
| Metabolism | Cefazolin undergoes minimal hepatic metabolism; primarily excreted unchanged by the kidneys via glomerular filtration and tubular secretion. |
| Excretion | Primarily renal (80-96% unchanged within 24 hours via glomerular filtration and tubular secretion); minimal biliary (<1%) and fecal (<1%). |
| Half-life | 1.5-2 hours in adults with normal renal function; prolonged to 10-30 hours in ESRD (CrCl <10 mL/min); anephric patients up to 40 hours. |
| Protein binding | 80-86% primarily to albumin. |
| Volume of Distribution | 0.12-0.14 L/kg (8-14 L in adults); indicates limited extravascular distribution (primarily extracellular fluid). |
| Bioavailability | IM: 100% (complete absorption); not administered orally. |
| Onset of Action | IV: immediate; IM: within 15-30 minutes. |
| Duration of Action | 6-8 hours for susceptible organisms; requires dose adjustment in renal impairment to maintain therapeutic levels. |
| Molecular Weight | 476.5 |
1-2 g IV/IM every 8 hours. Maximum 12 g/day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl >55 mL/min: 1-2 g q8h; CrCl 35-54: 1-2 g q8h (caution); CrCl 11-34: 1-2 g q12h; CrCl <10: 1-2 g q24h (or 500 mg q12h). |
| Liver impairment | No dose adjustment required for hepatic impairment. Child-Pugh classification does not alter dosing. |
| Pediatric use | Infants and children: 50-100 mg/kg/day IV/IM divided q8h. Severe infections: 100 mg/kg/day, max 6 g/day. |
| Geriatric use | Dose based on renal function. Use lower end of dosing range due to age-related creatinine clearance decline. Monitor renal function. |
| 1st trimester | Generally considered safe; cross-sectional studies show no increased risk of major malformations. |
| 2nd trimester | Safe for use; no known fetal risk. |
| 3rd trimester | Safe for use; prophylaxis for group B streptococcal infection is indicated. |
Clinical note
Comprehensive clinical and safety monograph for ANCEF IN PLASTIC CONTAINER (ANCEF IN PLASTIC CONTAINER).
| Placental transfer | Crosses placenta; achieves therapeutic concentrations in fetal serum and amniotic fluid. |
| Breastfeeding | Minimal excretion into breast milk; concentrations are low and unlikely to cause adverse effects in the infant. Compatible with breastfeeding. |
| Lactation Rating |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
Hypersensitivity to cefazolin or any cephalosporinHistory of immediate-type hypersensitivity reaction to penicillins or other beta-lactams
| Precautions | Hypersensitivity reactions including anaphylaxis, Pseudomembranous colitis due to Clostridium difficile, Bleeding risk due to hypoprothrombinemia (rare), Seizures with high doses in renal impairment, Superinfection with prolonged use, Drug interactions with nephrotoxic agents (e.g., aminoglycosides) |
| Food/Dietary | Alcohol may cause disulfiram-like reaction (flushing, headache, nausea, vomiting, tachycardia) due to interference with acetaldehyde metabolism; avoid alcohol during therapy and for 48 hours after last dose. No other significant food interactions. |
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| L1 - Safe |
| Teratogenic Risk | Cefazolin is Pregnancy Category B. Animal studies have not demonstrated fetal risk, but no adequate human studies in pregnant women. Avoid use during first trimester unless clearly needed; second and third trimester use considered safe when indicated. |
| Fetal Monitoring | No specific monitoring required; standard clinical observation for adverse effects. Renal function and coagulation parameters in prolonged therapy. |
| Fertility Effects | No known adverse effects on fertility in animal studies. No human data available; unlikely to impact fertility at therapeutic doses. |
| Clinical Pearls | First-generation cephalosporin; administer IV/IM; adjust dose in renal impairment (CrCl <55 mL/min); monitor for hypersensitivity (cross-reactivity in 10% of penicillin-allergic patients); use for surgical prophylaxis (administer within 60 minutes before incision); drug of choice for MSSA infections; tissue penetration good, but CNS penetration limited unless meninges inflamed. |
| Patient Advice | Take exactly as prescribed; complete full course even if feeling better. · Report any signs of allergic reaction (rash, itching, difficulty breathing, swelling) immediately. · Avoid alcohol during treatment and for at least 48 hours after last dose to prevent disulfiram-like reaction. · Inform healthcare provider if you have kidney disease, history of colitis, or are pregnant/breastfeeding. · Diarrhea may occur; report if severe, watery, or bloody (possible C. diff infection). |