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Cefazolin: Drug information

Cefazolin: Drug information
(For additional information see "Cefazolin: Patient drug information" and see "Cefazolin: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Pharmacologic Category
  • Antibiotic, Cephalosporin (First Generation)
Dosing: Adult
Bloodstream infection

Bloodstream infection:

Pathogen-directed therapy for methicillin-susceptible staphylococci:

IV: 2 g every 8 hours (Ref); treat uncomplicated Staphylococcus aureus bacteremia for ≥14 days starting from day of first negative blood culture, with longer courses warranted for endocarditis or metastatic sites of infection (Ref).

Pathogen-directed therapy for susceptible Enterobacteriaceae:

IV: 2 g every 8 hours (Ref). Usual duration is 7 to 14 days; individualize depending on source and extent of infection as well as clinical response. A 7-day duration is recommended for patients with uncomplicated Enterobacteriaceae infection who respond appropriately to antibiotic therapy (Ref).

Antibiotic lock technique (catheter-salvage strategy): Note: For infections caused by susceptible organisms when the catheter cannot be removed; use in addition to systemic antibiotics. Catheter salvage is not recommended for S. aureus.

Intracatheter: Prepare lock solution to final concentration of cefazolin 5 to 10 mg/mL (may be combined with heparin). Instill into each lumen of the catheter access port using a volume sufficient to fill the catheter (2 to 5 mL), with a dwell time of up to 72 hours depending on frequency of catheter use and solution stability. Withdraw lock solution prior to catheter use; replace with fresh cefazolin lock solution after catheter use. Antibiotic lock therapy is given for the same duration as systemic antibiotics (Ref).

Endocarditis, prophylaxis

Endocarditis, prophylaxis (dental or invasive respiratory tract procedures) (alternative agent for patients with nonsevere, non-IgE-mediated penicillin allergy who cannot take oral therapy) (off-label use):

IM, IV: 1 g as a single dose 30 to 60 minutes before procedure; if inadvertently not given prior to the procedure, may be administered up to 2 hours after the procedure. Note: Reserve for select situations (cardiac condition with the highest risk of adverse endocarditis outcomes and procedure likely to result in bacteremia with an organism that can cause endocarditis) (Ref).

Endocarditis, treatment

Endocarditis, treatment:

Pathogen-directed therapy for methicillin-susceptible staphylococci (alternative agent for patients with nonsevere, non-IgE-mediated penicillin allergy):

Native valve: IV: 2 g every 8 hours for 6 weeks. Note: Duration intended for complicated right-sided infective endocarditis (IE) or left-sided IE. For uncomplicated right-sided IE, 2 weeks of therapy may be adequate (Ref).

Prosthetic valve: IV: 2 g every 8 hours for ≥6 weeks (combine with rifampin for entire duration of therapy and gentamicin for the first 2 weeks) (Ref).

Intra-abdominal infection, mild to moderate, community-acquired in patients without risk factors for resistance or treatment failure

Intra-abdominal infection, mild to moderate, community-acquired in patients without risk factors for resistance or treatment failure:

Note: Reserve for patients with low risk for resistant pathogens (eg, local Enterobacteriaceae resistance rate to cefazolin <10% and no recent antibiotic exposure) (Ref).

Cholecystitis, acute: IV: 1 to 2 g every 8 hours; continue for 1 day after gallbladder removal or until clinical resolution in patients managed nonoperatively (Ref). Note: The addition of anaerobic therapy (eg, metronidazole) is recommended if biliary-enteric anastomosis is present (Ref).

Other intra-abdominal infections (eg, perforated appendix, appendiceal abscess, diverticulitis) (off-label use): IV: 1 to 2 g every 8 hours in combination with metronidazole. Total duration of therapy (which may include transition to oral antibiotics) is 4 to 5 days following adequate source control (Ref). For diverticulitis or uncomplicated appendicitis managed without intervention, duration is 10 to 14 days (Ref); for perforated appendicitis managed with laparoscopic appendectomy, 2 to 4 days may be sufficient (Ref).

Osteomyelitis and/or discitis

Osteomyelitis and/or discitis:

Treatment, pathogen-directed therapy for methicillin-susceptible S. aureus:

IV: 2 g every 8 hours for ≥6 weeks depending on extent of infection, debridement, and clinical response (Ref).

Prevention, following open fractures:

IV: 2 g for patients <120 kg or 3 g for patients ≥120 kg every 8 hours; ideally administer within 6 hours of injury. For type I or II fractures (no more than moderate comminution or contamination, no or minimal periosteal stripping, adequate soft tissue coverage), discontinue 24 hours following wound closure. For type III fractures (severe contamination or comminution), use as part of an appropriate combination regimen and continue for 72 hours after injury or up to 24 hours after wound closure (Ref). Note: For patients with risk for methicillin-resistant S. aureus (MRSA), potential water exposure, or fecal or clostridial contamination, alternative or additional antibiotics are recommended (Ref).

Peritonitis, treatment

Peritonitis, treatment (peritoneal dialysis patients) (off-label use):

Note: As a component of empiric therapy in patients at low risk for MRSA or as pathogen-directed therapy. Intraperitoneal administration is preferred to IV administration. Duration of therapy is ≥2 to 3 weeks, depending on organism, for patients with adequate clinical response (Ref). Consider a 25% dose increase in patients with significant residual renal function (urine output >100 mL/day) (Ref).

Intermittent: Intraperitoneal: 15 to 20 mg/kg added to one exchange of dialysis solution once daily (allow to dwell for ≥6 hours). For patients on continuous ambulatory peritoneal dialysis, add cefazolin to the overnight dwell. Note: Some experts recommend adding cefazolin to each exchange in patients on automated peritoneal dialysis as nighttime intraperitoneal levels of cefazolin may fall below the minimum inhibitory concentration of most organisms (Ref).

Continuous (with every exchange) (dose is per liter of dialysate): Intraperitoneal: Loading dose: 500 mg/L of dialysate added to first exchange of dialysate; maintenance dose: 125 mg/L of dialysate with each subsequent exchange of dialysate (Ref).

Pneumonia

Pneumonia: Pathogen-directed therapy for methicillin-susceptible S. aureus: IV: 2 g every 8 hours (Ref). Minimum duration is generally 5 days for community-acquired pneumonia and 7 days for hospital-acquired or ventilator-associated pneumonia; patients should be clinically stable with normal vital signs before therapy is discontinued (Ref).

Prostatitis, acute bacterial

Prostatitis, acute bacterial: Pathogen-directed therapy for susceptible organisms: IV: 1 g every 8 hours; may switch to oral therapy 24 to 48 hours after improvement in fever and clinical symptoms. Total duration of therapy is 4 to 6 weeks (Ref).

Prosthetic joint infection

Prosthetic joint infection: Pathogen-directed therapy for methicillin-susceptible S. aureus: IV: 2 g every 8 hours. Duration ranges from 2 to 6 weeks depending on prosthesis management, use of rifampin, and other patient-specific factors. Note: In select cases (eg, debridement and retention of prosthesis or one-stage arthroplasty), combine with oral rifampin and give oral suppressive antibiotic therapy following completion of IV treatment (Ref).

Septic arthritis, without prosthetic material

Septic arthritis, without prosthetic material: Pathogen-directed therapy for methicillin-susceptible S. aureus: IV: 2 g every 8 hours. Duration is 3 to 4 weeks (in the absence of osteomyelitis), including oral step-down therapy (Ref). Some experts recommend 4 weeks of parenteral therapy for patients with concomitant bacteremia (Ref).

Skin and soft tissue infection

Skin and soft tissue infection:

Erysipelas or nonpurulent cellulitis in patients without risk for methicillin-resistant S. aureus: IV: 1 to 2 g every 8 hours. Total duration of therapy ≥5 days (including oral step-down therapy); may extend to 14 days depending on severity and clinical response (Ref).

Pathogen-directed therapy for methicillin-susceptible S. aureus: IV: 1 to 2 g every 8 hours. Total duration of therapy is 5 to 14 days (including oral step-down therapy) depending on severity of infection, need for debridement, and clinical response (Ref). Note: For necrotizing infections, antibiotic therapy must be used in conjunction with early and aggressive surgical exploration and debridement of necrotic tissue; continue until further debridement is not necessary and the patient has clinically improved and is afebrile for 48 to 72 hours (Ref).

Surgical site incisional infection (trunk or extremity surgery, not involving axilla or perineum): IV: 1 g every 8 hours; duration is dependent upon severity, need for debridement, and clinical response (Ref).

Streptococcus, maternal prophylaxis for prevention of neonatal disease

Streptococcus (group B), maternal prophylaxis for prevention of neonatal disease (alternative agent) (off-label use):

IV: 2 g as a single dose at onset of labor or prelabor rupture of membranes, then 1 g every 8 hours until delivery. Reserve for patients with penicillin allergy who are at low risk for anaphylaxis (eg, rash without urticaria and no systemic symptoms) (Ref).

Surgical prophylaxis

Surgical prophylaxis: IV: 2 g for patients <120 kg or 3 g for patients ≥120 kg; administer within 60 minutes of surgical incision. Use in combination with metronidazole for procedures requiring anaerobic coverage (eg, colorectal and clean-contaminated head and neck procedures). May repeat dose intraoperatively in 4 hours if procedure is lengthy or if there is excessive blood loss (Ref); maximum dose: 12 g/day (manufacturer's labeling). In cases where an extension of prophylaxis is warranted postoperatively, total duration should be ≤24 hours (Ref). Postoperative prophylaxis is not recommended in clean and clean-contaminated surgeries (Ref).

Toxic shock syndrome

Toxic shock syndrome (off-label use): Pathogen-directed therapy for group A streptococcus (alternative agent for patients with nonsevere, non–IgE-mediated penicillin allergy) or methicillin-susceptible S. aureus (off-label use): IV: 2 g every 8 hours in combination with clindamycin. In the absence of bacteremia, treat for a total of ≥10 days, including oral step-down therapy (Ref).

Urinary tract infection, complicated

Urinary tract infection, complicated (pyelonephritis or urinary tract infection with systemic signs/symptoms): Pathogen-directed therapy for susceptible organisms: IV: 1 g every 8 hours (Ref). Switch to an appropriate oral regimen once symptoms improve, if culture and susceptibility results allow. Total duration of therapy ranges from 5 to 14 days and depends on clinical response and the antimicrobial chosen to complete the regimen (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Note: The following dose adjustments are for the usual recommended dosing of 1 to 2 g IV every 8 hours.

Altered kidney function (Ref): IV:

Note: Consider an initial unadjusted dose appropriate to the severity of the infection before reducing the dose.

CrCl ≥50 mL/minute: 1 to 2 g every 8 hours.

CrCl 30 to <50 mL/minute: 1 to 2 g every 8 to 12 hours.

CrCl >10 to <30 mL/minute: 500 mg to 1 g every 12 hours (some experts give 2 g every 12 hours for severe infections in patients with CrCl 10 to <30 mL/minute (Ref)).

CrCl ≤10 mL/minute: 500 mg to 1 g every 24 hours.

Augmented renal clearance (measured urinary CrCl ≥130 mL/minute/1.73 m2): Augmented renal clearance (ARC) is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations. Young patients (<55 years of age) admitted post trauma or major surgery are at highest risk for ARC, as well as those with sepsis, burns, or hematologic malignancies. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients (Ref).

IV: 2 g every 6 hours (Ref).

Hemodialysis, intermittent (thrice weekly): Dialyzable (45% to 60% (Ref)):

IV:

Daily dosing: 500 mg to 1 g every 24 hours (when scheduled dose falls on a dialysis day, administer after dialysis).

or

Thrice weekly (post dialysis) dosing: 2 g after dialysis 3 times weekly (Ref) or 20 mg/kg (maximum dose: 2 g) after dialysis 3 times weekly (Ref) or 2 g after dialysis if next dialysis is expected in 48 hours or 3 g after dialysis if next dialysis is expected in 72 hours (Ref).

Peritoneal dialysis: IV: 500 mg every 12 hours or 1 g every 24 hours (Ref).

CRRT: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of 20 to 25 mL/kg/hour (or ~1,500 to 3,000 mL/hour) unless otherwise noted. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection), organism MIC, residual kidney function, and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity (Ref)) due to drug accumulation is important.

CVVH/CVVHD/CVVHDF: IV: 2 g loading dose followed by either 1 g every 8 hours or 2 g every 12 hours (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Appropriate dosing requires consideration of adequate drug concentrations (eg, site of infection), organism MIC, residual kidney function, and consideration of initial loading doses. Close monitoring of response and adverse reactions (eg, neurotoxicity (Ref)) due to drug accumulation is important.

IV: 2 g loading dose followed by either 1 g every 8 hours or 2 g every 12 hours (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Obesity: Adult

Refer to indication-specific dosing for obesity-related information (may not be available for all indications).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Cefazolin: Pediatric drug information")

General dosing, susceptible infection (Ref): Infants, Children, and Adolescents: IM, IV:

Mild to moderate infections: 25 to 100 mg/kg/day divided every 8 hours; maximum daily dose: 6 g/day

Severe infections (eg, bone/joint infections): 100 to 150 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 12 g/day

Endocarditis, prophylaxis before invasive dental procedures

Endocarditis, prophylaxis before invasive dental procedures (alternative agent): Limited data available:

Note: Alternative agent for use in patients who are unable to take oral medication and who have penicillin or ampicillin allergy (excluding those with a history of anaphylaxis, angioedema, or urticaria) (Ref). Recommended only in patients who are at highest risk for infective endocarditis (IE) or adverse outcomes (eg, history of IE, cardiac valve repair using prosthetic valves or material, unrepaired cyanotic congenital heart disease [CHD], left ventricular assist device or implantable heart, repaired CHD with prosthetic material or device during first 6 months after procedure, pulmonary artery valve or conduit placement [eg, Melody valve, Contegra conduit], repaired CHD with residual defects at the site or adjacent to site of prosthetic patch or device, heart transplant recipients with cardiac valvulopathy) (Ref).

Infants, Children, and Adolescents: IM, IV: 50 mg/kg as a single dose administered 30 to 60 minutes prior to dental procedure; maximum dose: 1,000 mg/dose (Ref).

Endocarditis, treatment

Endocarditis, treatment: Children and Adolescents: IV: 100 mg/kg/day in divided doses every 8 hours; usual adult dose: 2,000 mg/dose; maximum daily dose: 12 g/day; treat for at least 4 weeks; longer durations may be necessary; may use with or without gentamicin (Ref).

Peritonitis

Peritonitis (peritoneal dialysis) (Ref): Limited data available: Infants, Children, and Adolescents:

Prophylaxis:

Touch contamination of PD line: Intraperitoneal: 125 mg per liter

Invasive dental procedures: IV: 25 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 1,000 mg/dose

Gastrointestinal or genitourinary procedures: IV: 25 mg/kg administered 60 minutes before procedure; maximum dose: 2,000 mg/dose

Treatment: Intraperitoneal:

Intermittent: 20 mg/kg every 24 hours in the long dwell

Continuous: Loading dose: 500 mg per liter of dialysate; maintenance: 125 mg per liter of dialysate

Pneumonia, community-acquired pneumonia, S. aureus, methicillin susceptible

Pneumonia, community-acquired pneumonia (CAP), S. aureus , methicillin susceptible: Infants >3 months, Children, and Adolescents: IV: 50 mg/kg/dose every 8 hours (Ref); usual maximum dose for severe infections: 12 g/day (Ref)

Skin and soft tissue infection, S. aureus, methicillin susceptible

Skin and soft tissue infection, S. aureus, methicillin susceptible (mild to moderate): (Ref): Infants, Children, and Adolescents:

S. aureus, methicillin susceptible skin and soft tissue infections including pyomyositis: IV: 50 mg/kg/day divided every 8 hours; maximum dose: 1,000 mg/dose; higher doses may be required in severe cases; duration of therapy at least 5 days, but longer may be necessary in some cases, eg, febrile and neutropenic patients: 7 to 14 days; pyomyositis: 14 to 21 days

S. aureus, methicillin susceptible necrotizing infection of skin, fascia, or muscle: IV: 100 mg/kg/day divided every 8 hours; maximum dose: 1,000 mg/dose; continue therapy until surgical debridement no longer necessary, clinical improvement and afebrile for 48 to 72 hours

Streptococcal, nonpurulent skin infection (cellulitis): IV: 100 mg/kg/day divided every 8 hours; maximum dose: 1,000 mg/dose; duration of therapy at least 5 days, but longer may be necessary in some cases

Surgical prophylaxis

Surgical prophylaxis: Infants, Children, and Adolescents: IV: 30 mg/kg within 60 minutes prior to procedure, may repeat in 4 hours for prolonged procedure or excessive blood loss (eg, >1,500 mL in adults); maximum dose dependent upon patient weight: Weight <120 kg: 2,000 mg/dose; weight ≥120 kg: 3,000 mg/dose (Ref)

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Note: Dosing is based on pharmacokinetic parameters, limited pediatric studies, adult studies, and expert opinion (Ref).

The following dose adjustments assume a usual recommended dose of 25 to 50 mg/kg/dose every 8 hours.

Altered kidney function:

Infants, Children, and Adolescents: IV, IM:

GFR ≥50 mL/minute/1.73 m2: No dosage adjustment necessary.

GFR 30 to <50 mL/minute/1.73 m2: 25 to 30 mg/kg/dose every 12 hours; doses up to 50 mg/kg/dose may be needed for severe infections; maximum dose: 2,000 mg/dose.

GFR 10 to 30 mL/minute/1.73 m2: 25 to 30 mg/kg/dose every 24 hours; doses up to 50 mg/kg/dose may be needed for severe infections; maximum dose: 2,000 mg/dose.

GFR ≤10 mL/minute/1.73 m2: 25 to 30 mg/kg/dose every 48 hours; doses up to 50 mg/kg/dose may be needed for severe infections; maximum dose: 2,000 mg/dose.

Hemodialysis, intermittent: Dialyzable: 35% to 65%.

Note: Appropriate dosing requires consideration of drug penetration to site of infection, minimum inhibitory concentration (MIC) of bacteria, severity of illness, residual kidney function, and interval between dialysis sessions.

Infants, Children, and Adolescents:

Intermittent dosing (eg, 3 times weekly): IV: 25 to 50 mg/kg/dose after dialysis; maximum dose: 2,000 mg/dose. Note: Children with residual kidney function may require higher or more frequent dosing.

Peritoneal dialysis:

Infants, Children, Adolescents: IV, IM: 25 to 30 mg/kg/dose every 24 to 48 hours; maximum dose: 1,000 mg/dose.

CRRT:

Note: Drug clearance is dependent on the effluent flow rate, filter type, and method of renal replacement. Recommendations are based on high-flux dialyzers and effluent flow rates of ≥1,500 mL/m2/hour) unless otherwise noted; flow rates vary widely in pediatric patients. Appropriate dosing requires consideration of drug penetration to site of infection, MIC of bacteria, and severity of illness. Close monitoring of response and adverse reactions due to drug accumulation (eg, neurotoxicity) is important. Due to minimal data in pediatric patients receiving CRRT, consider monitoring serum concentrations (eg, trough concentration) if available. Dosing based on limited adult information and expert opinion.

CVVH/CVVHD/CVVHDF: Infants, Children, and Adolescents: IV: 25 to 50 mg/kg/dose IV every 8 to 12 hours. Maximum dose: 2,000 mg/dose.

Augmented renal clearance (ARC):

Note: ARC is a condition that occurs in certain critically ill patients without organ dysfunction and with normal serum creatinine concentrations that results in increased drug elimination. An 8- to 24-hour measured urinary CrCl is necessary to identify these patients.

Infants, Children, and Adolescents:

GFR ≥200 mL/minute/1.73 m2:

Continuous infusion: 150 mg/kg/day as a continuous infusion; maximum daily dose: 12 g/day. May give an initial loading dose of 30 mg/kg (maximum dose: 2,000 mg/dose) before starting the continuous infusion if rapid attainment of therapeutic drug concentrations is desired (eg, sepsis). Dosing is based on a pharmacokinetic modeling study; additional dosages (eg, lower daily doses, every-6-hour dosing) may be appropriate depending on the clinical situation.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions (Significant): Considerations
Clostridioides difficile infection

Clostridioides difficile infection has occurred, including Clostridioides difficile-associated diarrhea and Clostridioides difficile colitis (Ref).

Mechanism: Dose- and time-related; potentially related to recent or cumulative antibiotic exposure. Cefazolin may cause disruption of the intestinal microbiota resulting in the overgrowth of pathogens, such as C. difficile (Ref).

Onset: Varied; may start on the first day of antibiotic therapy or up to 3 months postantibiotic (Ref).

Risk factors:

• Exposure to cefazolin during the 4-week period prior to positive C. difficile test (Ref)

• Antibiotic exposure (highest risk factor) (Ref)

• Type of antibiotic (third-/fourth-generation cephalosporins among the highest risk (Ref)

• Long durations in a hospitalization or other healthcare setting (recent or current) (Ref)

• Older adults (Ref)

• Immunocompromised conditions (Ref)

• A serious underlying condition (Ref)

• GI surgery/manipulation (Ref)

• Antiulcer medications (eg, proton pump inhibitors, H2 blockers) (Ref)

• Chemotherapy (Ref)

Hemolytic anemia

Hemolytic anemia has occurred in patients receiving cephalosporins, including cefazolin (Ref). While extremely rare, hemolytic anemia associated with cefazolin has been fatal (Ref).

Mechanism: Not clearly established; no clear consensus about the mechanism of cefazolin-induced hemolytic anemia among limited case reports (Ref).

Onset: Varied; occurs within the first few hours to 7 days after the first dose (Ref).

Hypersensitivity reactions (immediate and delayed)

Hypersensitivity reactions (immediate and delayed) range from morbilliform skin rash to rare cases of anaphylaxis and anaphylactic shock (Ref). Urticaria and angioedema have also occurred (Ref). Delayed hypersensitivity reactions, including severe cutaneous adverse reactions (SCARs) (acute generalized exanthematous pustulosis [AGEP], Stevens-Johnson syndrome [SJS], and toxic epidermal necrolysis [TEN]) and serum sickness-like reaction, have been reported (Ref). The incidence of cefazolin hypersensitivity in perioperative settings is low (<1%) (Ref). Due to the unique R1-side chain, the incidence of cefazolin hypersensitivity is lower than other beta-lactam antibiotics. For this reason, beta-lactam cross-reactivity is rare, and patients may experience “selective hypersensitivity” to cefazolin (Ref).

Mechanism: Non–dose-related; immunologic. Immediate hypersensitivity reactions (eg, anaphylaxis, urticaria) are IgE-mediated. Delayed hypersensitivity reactions, including maculopapular rash and SCARs, are T-cell-mediated (Ref).

Onset: Immediate hypersensitivity reactions: Rapid; occur within 1 hour of administration but may occur up to 6 hours after exposure (Ref). Delayed hypersensitivity reactions: Maculopapular reactions: Intermediate; occur 7 to 10 days after initiation. Other reactions (including SCARs): Varied; occur after 7 to 14 days up to 3 months (Ref).

Risk factors:

• Cross-reactivity between penicillins and cephalosporins and among cephalosporins is mostly related to side chain similarity (Ref). Studies and a practice parameter have shown negligible cross-reactivity between penicillins and cefazolin (Ref)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Cardiovascular: Hypotension, syncope

Dermatologic: Pruritus (including genital pruritus), skin rash

Gastrointestinal: Abdominal cramps, anorexia, diarrhea, epigastric pain, flatulence, heartburn, nausea, oral candidiasis, oral mucosal ulcer, pruritus ani, vomiting

Genitourinary: Vaginitis, vulvovaginal candidiasis, vulvovaginal pruritus

Hematologic & oncologic: Eosinophilia, leukopenia, neutropenia, thrombocytopenia, thrombocytosis

Hepatic: Hepatitis, increased serum alanine aminotransferase, increased serum alkaline phosphatase, increased serum aspartate aminotransferase

Local: Induration at injection site, injection-site phlebitis, pain at injection site

Nervous system: Asthenia, confusion, dizziness, drowsiness, drug fever, fatigue, headache

Renal: Increased blood urea nitrogen, increased serum creatinine, renal failure syndrome

Postmarketing:

Dermatologic: Acute generalized exanthematous pustulosis (Cleminson 2020), Stevens-Johnson syndrome (Saavedra 2012), toxic epidermal necrolysis (Sriganesh 2018), urticaria (Pipet 2011)

Gastrointestinal: Clostridioides difficile-associated diarrhea (Hansen 2013), Clostridioides difficile colitis (Hansen 2013)

Hematologic & oncologic: Hemolytic anemia (Mause 2021)

Hypersensitivity: Anaphylactic shock (Bogas 2021), anaphylaxis (Bogas 2021), angioedema (Pipet 2011), serum sickness-like reaction (Nguyen 2017)

Renal: Acute interstitial nephritis

Contraindications

Immediate hypersensitivity (eg, anaphylaxis, serious skin reactions) to cefazolin, other cephalosporin antibiotics, penicillins, other beta-lactams, or any component of the formulation.

Warnings/Precautions

Concerns related to adverse effects:

• Elevated INR: May be associated with increased INR, especially in nutritionally deficient patients, prolonged treatment, hepatic or renal disease.

• Superinfection: Prolonged use may result in fungal or bacterial superinfection.

Disease-related concerns:

• Gastrointestinal disease: Use with caution in patients with a history of gastrointestinal disease, particularly colitis.

• Renal impairment: Use with caution in patients with renal impairment; dosage adjustment required.

• Seizure disorders: Use with caution in patients with a history of seizure disorder; high levels, particularly in the presence of renal impairment, may increase risk of seizures.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous [preservative free]:

Generic: 1 g/50 mL in Dextrose 4% (50 mL); 2 g/100 mL in Dextrose 4% (100 mL)

Solution Reconstituted, Injection:

Generic: 1 g (1 ea); 10 g (1 ea)

Solution Reconstituted, Injection [preservative free]:

Generic: 500 mg (1 ea); 1 g (1 ea); 10 g (1 ea); 100 g (1 ea); 300 g (1 ea)

Solution Reconstituted, Intravenous [preservative free]:

Generic: 1 g (1 ea); 1 g and Dextrose 4% (1 ea); 2 g and Dextrose 3% (1 ea)

Solution Reconstituted, Injection, as sodium [preservative free]:

Generic: 2 g (1 ea)

Solution Reconstituted, Intravenous, as sodium:

Generic: 3 g (1 ea)

Generic Equivalent Available: US

Yes

Pricing: US

Solution (ceFAZolin Sodium-Dextrose Intravenous)

1GM/50ML 4% (per mL): $0.13

2GM/100ML 4% (per mL): $0.11

Solution (reconstituted) (ceFAZolin Sodium Injection)

1 g (per each): $1.10 - $7.50

2 g (per each): $7.31

10 g (per each): $7.20 - $60.00

100 g (per each): $144.00

300 g (per each): $420.00

500 mg (per each): $1.31 - $9.74

Solution (reconstituted) (ceFAZolin Sodium Intravenous)

1 g (per each): $3.28

3 g (per each): $10.53

Solution (reconstituted) (ceFAZolin Sodium-Dextrose Intravenous)

1GM 4%(50ML) (per each): $15.74

2GM 3%(50ML) (per each): $17.71

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Reconstituted, Injection:

Generic: 500 mg (1 ea); 1 g (1 ea); 10 g (1 ea); 100 g (1 ea)

Solution Reconstituted, Intravenous:

Generic: 10 g (1 ea)

Solution Reconstituted, Injection, as sodium:

Generic: 2 g (1 ea)

Administration: Adult

IM: Inject deep IM into large muscle mass.

IV: Inject direct IV over 3 to 5 minutes or may infuse as an intermittent infusion over 30 to 60 minutes.

Some penicillins (eg, carbenicillin, ticarcillin and piperacillin) have been shown to inactivate aminoglycosides in vitro. This has been observed to a greater extent with tobramycin and gentamicin, while amikacin has shown greater stability against inactivation. Concurrent use of these agents may pose a risk of reduced antibacterial efficacy in vivo, particularly in the setting of profound renal impairment. However, definitive clinical evidence is lacking. If combination penicillin/aminoglycoside therapy is desired in a patient with renal dysfunction, separation of doses (if feasible), and routine monitoring of aminoglycoside levels, CBC, and clinical response should be considered.

Administration: Pediatric

Parenteral:

IM: Deep IM injection into a large muscle mass.

IV: Infuse over 10 to 60 minutes; may be administered IVP over 3 to 5 minutes.

Use: Labeled Indications

Biliary tract infection: Treatment of biliary tract infections due to Escherichia coli, various strains of streptococci, Proteus mirabilis, Klebsiella species, and Staphylococcus aureus.

Bloodstream infection: Treatment of bloodstream infection due to methicillin-susceptible staphylococci, E. coli , P. mirabilis, and Klebsiella species.

Bone and joint infection: Treatment of bone and joint infections due to S. aureus.

Endocarditis, treatment: Treatment of endocarditis due to methicillin-susceptible staphylococci and group A beta-hemolytic streptococci (Streptococcus pyogenes).

Genital infection: Treatment of genital infections (ie, prostatitis, epididymitis) due to E. coli, P. mirabilis, and Klebsiella species.

Respiratory tract infection: Treatment of respiratory tract infections due to Streptococcus pneumoniae, Klebsiella species, methicillin-susceptible S. aureus, and group A beta-hemolytic streptococci.

Skin and soft tissue infection: Treatment of skin and soft tissue infections due to methicillin-susceptible S. aureus, group A beta-hemolytic streptococci, and other strains of streptococci.

Surgical prophylaxis: To reduce the incidence of certain postoperative infections in adults and pediatric patients 10 to 17 years of age undergoing surgical procedures.

Urinary tract infection: Treatment of urinary tract infections due to E. coli, P. mirabilis, and Klebsiella species.

Use: Off-Label: Adult

Endocarditis, prophylaxis; Peritonitis, treatment (peritoneal dialysis patients); Streptococcus (group B), maternal prophylaxis for prevention of neonatal disease; Toxic shock syndrome

Medication Safety Issues
Sound-alike/look-alike issues:

CeFAZolin may be confused with cefoTEtan, cefOXitin, cefprozil, cefTAZidime, cefTRIAXone, cephalexin.

Metabolism/Transport Effects

Substrate of OAT1/3

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Fosphenytoin: CeFAZolin may increase the serum concentration of Fosphenytoin. Specifically, the ratio of free phenytoin to total phenytoin may be increased. Risk C: Monitor therapy

Furosemide: May enhance the nephrotoxic effect of Cephalosporins. Risk C: Monitor therapy

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Phenytoin: CeFAZolin may increase the serum concentration of Phenytoin. Specifically, the ratio of free phenytoin to total phenytoin may be increased. Risk C: Monitor therapy

Probenecid: May increase the serum concentration of Cephalosporins. Risk C: Monitor therapy

RifAMPin: CeFAZolin may enhance the adverse/toxic effect of RifAMPin. Specifically, the risk for bleeding may be increased. Management: Avoid concomitant use of rifampin with cefazolin when possible. If combined, closely monitor prothrombin time or other coagulation tests and administer vitamin K as needed. Risk D: Consider therapy modification

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy

Pregnancy Considerations

Cefazolin crosses the placenta.

Based on available data, cephalosporin antibiotics are generally considered compatible for use during pregnancy (Ailes 2016; Bookstaver 2015; Crider 2009; Czeizel 2001; Lamont 2014; Muanda 2017a; Muanda 2017b). Adverse events have not been reported in the fetus following administration of cefazolin prior to cesarean delivery.

Due to pregnancy-induced physiologic changes, some pharmacokinetic parameters of cefazolin may be altered (Allegaert 2009; Elkomy 2014; Philipson 1987). In addition to pregnancy, obesity has been found to influence the pharmacokinetics of cefazolin (Ahmadzia 2015; Duff 2019; Eley 2020; Groff 2017; Kram 2017; Pevzner 2011; Stitely 2013; Young 2015). Higher doses are recommended in obese patients; however, additional studies are needed to determine the ideal dose, especially in pregnant patients with extreme obesity (ACOG 2018; Dallmann 2019; La Rosa 2020).

A targeted antibiotic such as cefazolin is recommended prior to all cesarean deliveries unless the patient is already receiving an appropriate antibiotic. A single dose administered within 60 minutes prior to the delivery is recommended unless drug allergies are present. Dose adjustments of cefazolin may be considered based on maternal weight (ACOG 2018).

Cefazolin is recommended as an alternative antibiotic for group B streptococcus (GBS) prophylaxis in pregnant patients who are penicillin allergic and at low risk for anaphylaxis. Treatment is intended to prevent early-onset disease in newborns. Prophylaxis is reserved for pregnant patients with a positive GBS vaginal or rectal screening in late gestation; GBS bacteriuria during the current pregnancy; history of birth of an infant with early-onset GBS disease; and unknown GBS culture status with any of the following: birth <37 0/7 weeks gestation, intrapartum fever, prolonged rupture of membranes, known GBS positive in a previous pregnancy, or intrapartum nucleic acid amplification testing positive for GBS (ACOG 2020).

Cefazolin is one of the recommended antibiotics that may be used prior to vaginal delivery in patients at high risk for endocarditis. This includes patients with congenital heart disease, prosthetic valves, previous infective endocarditis, or cardiac transplant. Cefazolin is given 30 to 60 minutes prior to a vaginal delivery; the endocarditis prophylactic dose is the same as nonpregnant patients (ACOG 2018).

Breastfeeding Considerations

Cefazolin is present in breast milk.

Based on limited information, the relative infant dose (RID) of cefazolin is <1% following a single maternal dose of 2 g (Yoshioka 1979).

In general, breastfeeding is considered acceptable when the RID of a medication is <10% (Anderson 2016; Ito 2000).

The RID of cefazolin was calculated using a milk concentration of 1.51 mcg/mL, providing an estimated daily infant dose via breast milk of 0.2265 mcg/kg/day. This milk concentration was obtained 3 hours following maternal administration cefazolin 2 g IV to 20 postpartum women (Yoshioka 1979).

In general, antibiotics that are present in breast milk may cause non-dose-related modification of bowel flora (WHO 2002). The manufacturer recommends that caution be exercised when administering cefazolin to breastfeeding women.

Dietary Considerations

Some products may contain sodium.

Monitoring Parameters

Renal function, hepatic function, CBC, signs of anaphylaxis during first dose.

Mechanism of Action

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Pharmacokinetics (Adult Data Unless Noted)

Distribution: Widely into most body tissues and fluids including gallbladder, liver, kidneys, bone, sputum, bile, pleural, and synovial; CSF penetration is low.

Vd:

Preterm neonates (GA: 25 to <32 weeks; PNA: Median: 16 days [range: 3 to 91 days]): 0.39 L/kg (range: 0.31 to 0.52 L/kg) (Balevic 2019).

Preterm and term neonates (GA: 30 to 40 weeks; PNA: 2 to 28 days): 0.212 to 0.373 L/kg (Deguchi 1988).

Children 3 to 12 years of age: 0.133 ± 0.015 L/kg (Koshida 1987).

Adults: 0.193 ± 0.064 L/kg (Scheld 1981).

Bone:serum concentration ratio: Median: 0.25 (range: 0.06 to 0.41) (Zeller 2009).

Protein binding:

Neonates (GA: 30 to 40 weeks; PNA: 2 to 28 days): 49% (range: 17% to 78%) (Deguchi 1988); protein binding is decreased (with a resulting higher free fraction) with lower albumin concentrations, higher bilirubin concentration, higher total cefazolin concentration, and lower PMA (Smits 2012).

Children 3 to 12 years: 78% ± 2.5% (range: 75% to 82.3%) (Koshida 1987).

Adults: 80% (Marshall 1999).

Half-life elimination:

Preterm neonates (PNA: 2 to 12 days): IV: 4.05 ± 0.72 hours (range: 2.8 to 4.74 hours) (Sakata 1980).

Infants ≥9 months of age and children ≤10 years of age: IV: 1.7 ± 0.6 hours (Nahata 1991).

Children 10 to 12 years of age: IV: 1.95 hours (range 1.44 to 2.88 hours) (Schmitz 2015).

Adults: IV: 1.8 hours; IM: ~2 hours (prolonged with renal impairment).

Time to peak, serum: IM: 0.5 to 2 hours; IV: Within 5 minutes.

Excretion: Urine (70% to 80% as unchanged drug).

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Anti-infective considerations:

Parameters associated with efficacy: Time dependent, associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC).

Organism specific:

S. aureus (methicillin-susceptible [MSSA]): Goal: ≥ ~24% to 55% fT > MIC (bacteriostatic) (Turnidge 1998; Zelenitsky 2018); ≥ ~55% to 100% fT > MIC (bacteriocidal) (Vogelman 1988; Zelenitsky 2018).

E. coli: Goal: ≥60% fT > MIC (bacteriostatic); ≥100% fT > MIC (2-log kill) (Vogelman 1988).

Population specific:

Critically ill patients in the ICU: Minimum goal: ≥50% fT > MIC; preferred goal: ≥100% fT > MIC (Roberts 2015); some experts favor ≥100% fT ≥4 times the MIC (Guilhaumou 2019).

Expected drug concentrations in patients with normal renal function:

Infants ≥9 months of age and children ≤10 years of age: Cmax (peak), single dose: Mean dose: 22.7 mg/kg ± 4 mg/kg: 137 ± 87.9 mg/L (Nahata 1991).

Adults: Cmax (peak), steady state: 1 g every 8 hours: 94 ± 30.33 mg/L (Bhalodi 2013).

Postantibiotic effect: Generally little to no postantibiotic effect (<1 hour) for streptococci and gram-negative bacilli; for S. aureus: ~4 hours (Craig 1993; Craig 1998).

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Cefamezin | Kefzol | Totacef;
  • (AR) Argentina: Cefazolina | Cefazolina argentia | Cefazolina Drawer | Cefazolina Max Vision | Cefazolina northia | Zolcef;
  • (AT) Austria: Cefazolin mip | Cefazolin sandoz | Kefzol | Zolicef;
  • (AU) Australia: Cefazolin | Cefazolin aft | Cephazolin alphapharm | Cephazolin sodium | Kefzol;
  • (BD) Bangladesh: Cefazol | Zolibac;
  • (BE) Belgium: Cefacidal | Cefazoline Mylan | Cefazoline Sandoz | Kefzol;
  • (BG) Bulgaria: Cefamezin | Cefazolin | Cefazolin abr | Zepilen;
  • (BR) Brazil: Cefazolina sodica | Ceftrat | Cellozina | Cezolin | Fazolon | Kefalin | Kefazol | Zolidina;
  • (CH) Switzerland: Cefazolin labatec | Kefzol;
  • (CL) Chile: Cefamezin | Cefazolina;
  • (CN) China: Cefamezin | Cefamezin sodium | Cefazolin | Cefrazolin sodium | Na lin | Sai fu ning | Xin tai lin;
  • (CO) Colombia: Cefacidal | Cefazolina | Cefazolina sodica | Fazopira | Kefzol;
  • (CZ) Czech Republic: Azepo | Cefazolin | Cefazoline | Kefzol | Orizolin | Vulmizolin;
  • (DE) Germany: Baktozil | Basocef | Cefazolin | Cefazolin Eberth | Cefazolin normon | Cefazolin qilu | Cefazolin saar | Cefodinin | Cephazolin | Saarzolin;
  • (DO) Dominican Republic: Alcovera | Cefazolina | Intrazolina | Kefzol | Prisolin;
  • (EC) Ecuador: Cefacidal | Cefazolina | Kefzol | Zolidina;
  • (EE) Estonia: Cefamezin | Cefazolin | Cefazolin nycomed | Cezolin | Kefzol | Totacef | Zepilen;
  • (EG) Egypt: Cefazolin | Kefzol | Totacef | Zinol;
  • (ES) Spain: Areuzolin | Brizolina | Cefamezin | Cefaresan | Cefazolina cepa | Cefazolina G.E.S. | Cefazolina llorente | Cefazolina normon | Cefazolina Reig Jofre | Fazoplex | Intrazolina | Kefol | Tasep | Tecfazolina | Zepilen | Zolival;
  • (ET) Ethiopia: Cefazolin sandoz;
  • (FI) Finland: Cefazolin | Kefzol;
  • (FR) France: Cefacidal | Cefazoline Flavelab | Cefazoline merck | Cefazoline panpharma | Kefzol;
  • (GB) United Kingdom: Kefzol | Trav cephazolin;
  • (GR) Greece: Kefzol | Vifazolin;
  • (HK) Hong Kong: Cefamezin | Cefazolin | Stazolin;
  • (HR) Croatia: Cefazolin BCPP | Zepilen;
  • (HU) Hungary: Cefazolin human | Cefazolin mip | Cefazolin panpharma | Kefzol | Totacef;
  • (ID) Indonesia: Biozolin | Cefamezin | Cefazol | Cefazolin | Evalin | Venozol;
  • (IE) Ireland: Cefazolin;
  • (IL) Israel: Cefamezin | Kefazin | Totacef;
  • (IN) India: Alcizon | Azolin | Cefazolin | Cezolin | Orizolin | Prezolin | Prilex | Reflin;
  • (IT) Italy: Cefabiozim | Cefamezin | Cefazil | Cefazina | Cefazolina | Cefazolina acs | Cefazolina drm | Cefazolina k24 | Cefazolina union health | Cromezin | Nefazol | Recef | Silzolin | Totacef;
  • (JO) Jordan: Cefamezin | Cefazolin sandoz | Hikma cefazolin | Zolecef;
  • (JP) Japan: Cefamezin | Cefamezin alpha | Cefamezol | Cefazopen | Cenazine | Efunikol | Rasenazolin hexal | Rasenazolin maruko | Sefmazon | Synclomedin | Taicezolin sanken | Taicezolin taiyo | Taicezolin towa | Tokio;
  • (KE) Kenya: Cefzole | Cezol | Fazlin | Fezolin;
  • (KR) Korea, Republic of: Cefamezin | Cefanzol | Cefarizon | Cefazolin | Cefazoline yungjin | Cefozol | Ckd cefazolin | Hanlim cefazoline sodium | Kepodon | Kukje cefazoline | Union cefazoline | Yoo young cefazolin sodium | Yuhan cefazoline;
  • (KW) Kuwait: Cefazolin sandoz | Zolecin;
  • (LB) Lebanon: Cefazoline;
  • (LT) Lithuania: Cefamezin | Cefazolin | Cefazolin mip | Cezolin | Intrazoline | Kefzol | Lysolin | Orizolin | Pan-cefazolin | Reflin | Rezol | Totacef | Vulmizolin | Zepilen;
  • (LU) Luxembourg: Cefacidal | Cephazolin | Kefzol;
  • (LV) Latvia: Cefamezin | Cefazolin | Cefazolin BCPP | Cefazolin mip | Cezolin | Kefzol | Lysolin | Orizolin | Pan-cefazolin | Reflin | Totacef | Vulmizolin;
  • (MA) Morocco: Kefzol;
  • (MX) Mexico: Cefacidal;
  • (MY) Malaysia: Cefazolin | Cefazolin aft;
  • (NL) Netherlands: Cefacidal | Cefazoline Aurobindo | Cefazoline Hospira | Cefazoline Mylan | Cefazoline Sandoz | Kefzol | Servazolin;
  • (NO) Norway: Cefazolin | Cefazolin hexal | Cefazolin Reig Jofre;
  • (NZ) New Zealand: Cefazolin | Cephazolin | Cephazolin sodium | Kefzol | M cefazolin;
  • (PE) Peru: Cecan | Cefacidal | Cefazaliph | Cefazolina | Cephlin | Kefzol | Primacef | Proxicaf | Reflin;
  • (PH) Philippines: 2 World Cefazolin | Cefalin | Cefavex | Cefazol | Cefazole | Cefazovit | Cifoxim | Cizo | Cloviz | Faxilen | Fazol | Fazolin | Fazonil | Fonvicol | Hazolin | Ilozef | Lozan | May cefazolin | Megacef | Novazef | Phizolin | Samarial | Sanzol | Solosprin | Stancef | Zofacef | Zolival;
  • (PK) Pakistan: Afazole | Amrozolin injection | Avezol | Biozolin | C-zol | Cefamezin | Cefasol | Cefazol | Cefazolin | Cefzo | Celex | Cezolin | Curolin | Kavelin | Kefone | Kefzol | Kefzomed | Medizol | Nelzim | Parmazolin | Pefzol | Sazolene | Zolocef;
  • (PL) Poland: Biofazolin | Cefamezin | Cefazolin | Cefazolin mip | Cefazolin tzf | Kefzol | Tarfazolin | Vulmizolin;
  • (PR) Puerto Rico: Ancef | Cefazolin | Kefzol;
  • (PT) Portugal: Cefazolina hikma | Cefazolina normon | Cefazolina pharmis | Cefazolina sandoz;
  • (PY) Paraguay: Cefazoland | Cefazolina genfar | Cefazolina hospicenter | Cefazolina interlabo | Cefazolina millet | Cefazolina northia | Cefazolina richet | Lexibac evim | Mediforina | Novo cefacilin | Novo talexin | Novo thidoxol | Zolidina;
  • (RO) Romania: Kefzol | Zolinef;
  • (RU) Russian Federation: Ancef | Cefamezin | Cefaxon | Cefazolin | Cefazolin akos | Cefazolin Elfa | Cefazolin sandoz | Cefazolin vatchem | Cefezol | Cefoprid | Cezolin | Intrazoline | Kefotex | Kefzol | Lizolin | Lysolin | Lyzolin | Nacef | Orizolin | Orpin | Prozolin | Reflin | Totacef | Zolfin | Zolin;
  • (SA) Saudi Arabia: Cefamezin | Cefazolin | Kefzol | Tazoline | Totacef | Zepilen | Zolecin;
  • (SE) Sweden: Cefazolin mip | Celmetin | Kefzol;
  • (SG) Singapore: Cefazolin | Cefazoline | Cezolin | Zepilen;
  • (SI) Slovenia: Altazolin | Cefamezin | Cefazolin actavis | Cefazolin Apta | Kefzol | Zepilen;
  • (SK) Slovakia: Cefamezin | Cefazolin | Kefzol | Vulmizolin | Zepilen;
  • (TH) Thailand: Anbizolin | Cefaben | Cefacidal im/iv | Cefalin | Cefamezin | Cefazillin | Cefazol | Cefazolin | Cefazolin meiji | Cefolin | Cefono | Cefzolin | Fazolin | Pharlin | Zefa m h | Zepilen | Zofalin | Zolicef | Zolimed;
  • (TN) Tunisia: Cefamezin | Cefazol | Zepilen;
  • (TR) Turkey: Befazol | Cefamezin | Cefozin | Cezol | Eqizolin | Iespor | Maksiporin | Maxicilin | Sefamax | Sefazol | Vansef;
  • (TW) Taiwan: Cefa | Cefacin | Cefamezin | Cefazin | Cefazo | Cefazolin | Cepha | Cephazolin | Cezolin | Kefzol | Kelin | Kofatol | Leadercef | Lofalin | Lyo Sefa | Meisin | Oricef | Sezolin | Stazolin | Uzolin | Veterin | Winzolin;
  • (UA) Ukraine: Cefazex | Cefazolin | Cefazolinum | Cezolin | Ifizol | Kefzol | Nacef | Reflin | Totacef | Zolfin;
  • (UG) Uganda: Zepilen;
  • (UY) Uruguay: Cefazolina | Cefazolina northia | Zolidina;
  • (VE) Venezuela, Bolivarian Republic of: Cefacidal | Cefazolina | Cellozina | Efaztas | Kefzol;
  • (VN) Viet Nam: Shinzolin | Yuhan Cefazolin;
  • (ZA) South Africa: Cefacidal | Cefazolin oethmaan | Cefazolin-fresenius | Kefzol | Mylan Cefazolin | Pharmacare cefazolin | Ranzol | Sabax cefazolin | Zefkol;
  • (ZM) Zambia: Kefzol
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