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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANCEF IN PLASTIC CONTAINER (ANCEF IN PLASTIC CONTAINER).
| Breastfeeding | Cefazolin is excreted into human breast milk in low concentrations (M/P ratio approximately 0.02-0.16). Considered compatible with breastfeeding; however, monitor infant for potential gastrointestinal disturbances and sensitization. |
| 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. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Known hypersensitivity to cefazolin or other cephalosporins","Severe allergic reaction to penicillins (cross-sensitivity)"]
| 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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| 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). |