ANCEF
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ANCEF (ANCEF).
First-generation cephalosporin that inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), disrupting peptidoglycan cross-linking.
| Metabolism | Not significantly metabolized; primarily excreted unchanged by renal tubular secretion. |
| Excretion | Primarily renal (80-90% unchanged by glomerular filtration and tubular secretion); small amounts biliary (<1%) and fecal. |
| Half-life | 1.5-2 hours in adults with normal renal function; prolongs significantly in renal impairment (up to 30 hours in anuria). |
| Protein binding | 80-85% bound to serum albumin. |
| Volume of Distribution | 0.14-0.17 L/kg; primarily extracellular fluid. |
| Bioavailability | IM: ~100% (well absorbed); IV: 100%. |
| Onset of Action | IM: 1-2 hours; IV: immediate. |
| Duration of Action | 6-8 hours; prolonged in renal failure. |
| Action Class | Cephalosporins: 3 generation |
| Brand Substitutes | Xone Hospital 1000mg Injection, Ritecef 1000mg Injection, Cefaxone 1gm Injection, Trixon 1000mg Injection, Ceftrax 1000mg Injection, Ceftrisone 500mg Injection, Cefaxone 0.5gm Injection, Keftra 500mg Injection, Retel 500mg Injection, Trixon 500mg Injection, Ceftril 250mg Injection, Troxone 250mg Injection, Nosocef 250mg Injection, Trixon 250mg Injection, Ramcef 250mg Injection, Retel 125mg Injection, Keftra 125mg Injection, Lyceft 125mg Injection, Xfit 125mg Injection, Becef 125mg Injection |
1-2 g IV/IM every 8 hours; maximum 6 g/day.
| Dosage form | INJECTABLE |
| Renal impairment | CrCl >55 mL/min: 1-2 g every 8 h. CrCl 35-54: 1-2 g every 8-12 h. CrCl 11-34: 1-2 g every 12 h. CrCl <10: 1-2 g every 24-48 h. Hemodialysis: 1-2 g after dialysis. |
| Liver impairment | No adjustment required for hepatic impairment. |
| Pediatric use | Infants and children 1 month and older: 25-50 mg/kg/day IV/IM divided every 8 h; severe infections: 100 mg/kg/day divided every 6-8 h. Maximum 6 g/day. |
| Geriatric use | No specific adjustment; use renal function-based dosing as per renal_adjustment. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ANCEF (ANCEF).
| Breastfeeding | Excreted in breast milk in low concentrations (M/P ratio unknown, likely low). Considered compatible with breastfeeding due to poor oral bioavailability in infants. |
| Teratogenic Risk | No evidence of teratogenicity in animal studies. Crosses placenta. Use only if clearly needed during pregnancy. First trimester: limited data, no known malformations. Second and third trimesters: no known fetal harm. |
| Fetal Monitoring |
■ FDA Black Box Warning
No FDA boxed warnings.
| Serious Effects |
["Hypersensitivity to cefazolin or other cephalosporins","History of severe immediate hypersensitivity reaction (e.g., anaphylaxis) to penicillins"]
| Precautions | ["Hypersensitivity reactions, including anaphylaxis, especially in patients with penicillin allergy","Clostridium difficile-associated diarrhea","Renal impairment: dose adjustment required","Prolonged use may result in superinfection","Seizures at high doses in renal impairment"] |
| Food/Dietary | No significant food interactions. Cefazolin may be administered with or without food. However, alcohol should be avoided due to potential disulfiram-like reaction (cephalosporin side chain effect). |
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| Monitor for maternal allergic reactions, superinfection. No specific fetal monitoring required, but fetal exposure minimal. |
| Fertility Effects | No adverse effects on fertility reported in animal studies. No known human data. |
| Clinical Pearls | Cefazolin (Ancef) is a first-generation cephalosporin with excellent gram-positive coverage, often used for surgical prophylaxis. It has poor CSF penetration, so it is not suitable for meningitis. Cross-allergenicity with penicillins occurs in approximately 10% of patients. Dose adjustment required in renal impairment (CrCl <30 mL/min). |
| Patient Advice | Take exactly as prescribed, even if you feel better. · Complete the full course to prevent resistance. · Report any signs of allergic reaction (rash, itching, difficulty breathing) immediately. · May cause diarrhea; contact your doctor if severe or persistent. · Avoid alcohol during treatment and for 48 hours after last dose (disulfiram-like reaction possible but rare). |