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Paul A. Pham Pharm.D. and John G. Bartlett M.D.
01-28-2010
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Available formulation in Zambia: Powder for injection: 1 g (as sodium salt) in vial.
- For surgical prophylaxis
Zambia Information Author: Paul A. Pham Pharm.D.
- Respiratory tract infectionsdue to S. pneumoniae, S. aureus(MSSA) and S. pyogenes.
- Urinary tract infectionsdue to E. coli, P mirabilis; prostatitis and epididymitis due to E. coli, P. mirabilis.
- Skin and skin-structure infectionsdue to S. aureus(MSSA), S. pyogenes, and other strains of streptococci.
- Biliary tract infectionsdue to E. coli, various strains of streptococci, P. mirabilis, and S. aureus (MSSA).
- Bone and joint infectionsdue to S. aureus(MSSA)
- Septicemiadue to S. pneumoniae, S. aureus(MSSA), P. mirabilis, E. coli.
- Endocarditisdue to S. aureus(MSSA) and S. pyogenes.
- Perioperative prophylaxis
- Parotitis (MSSA)
- Other Staphylococcus aureus (MSSA) infections
- Other Streptococcus pyogenes (Group A) infections
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
| Ancef | Cefazolin | GlaxoSmithKline and various generic manufacturers | IV or IM
vial
1g | $1.81 |
|
|
|
| IV or IM
vial
10g | $2.62 |
|
|
|
| IV or IM
vial
20g | $3.03 |
|
|
|
| IV
bag
0.5g/50mL | $12.6 per bag |
|
|
|
| IV
bag
1g/50mL | $12.6 per bag |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
- Usual adult dose: 0.5 -1 gm IV q6-8h
- UTI: 1 gm IV q12h
- Severe infections: 1-2gm IV q6 hrs
- For obese patients: consider 2 gm IV q6h
- Surgical prophylaxis: 2 gm IV push just before the procedure, repeat if needed for procedures lasting >4hrs. For obese patients: a minimum of 2gm IV should be given.
GFR >35 mL/min: 1-2 gm q8h.
GFR 11-34 mL/min: 0.5 gm-1.0 gm 12h.
0.5 gm-1 gm once daily.
0.5 gm-1 gm once daily plus 1.0 gm post dialysis (or on days of HD dose post-HD). Convenient outpatient treatment: 2gm (approx. 20 mg/kg) post-HD on Monday, Wednesday, and 3gm post-HD on Friday.
0.5 gm q12h.
CVVH: 1-2gm IV q12h; CVVHD: 2gm IV q12h (1 gm IV q12h for mild-moderate infections).
- Minimal phlebitis at infusion sites
- Allergic reactions (eosinophilia)
-
Diarrhea and C. difficile colitis
- Positive Coombs' test (without hemolytic anemia)
- CNS: convulsions (high dose with renal failure), confusion, disorientation and hallucinations
- Drug fever
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Neutropenia and thrombocytopenia
- Hepatitis
- Anaphylaxis reaction
- Hemolytic anemia (theoretical, case reports with ceftriaxone, cefotetan, cefoxitin, cefamandole, ceftazidime and cefalothin)
- Probenecid: increase in cephalosporin serum concentration. Monitor for ADR in ESRD.
- Warfarin anticoagulation effect may be enhanced. Monitor INR closely.
- MIC breakpoint for Enterobacteriaceae: <8 mcg/mL (sensitive); 16 mcg/mL (intermediate); > 32 mcg/mL (resistant).
- MIC breakpoint for S. aureus: < 8 mcg/mL (sensitive); 16 mcg/mL (intermediate); > 32 mcg/mL (resistant).
Parenteral 1st generation cephalosporin with relatively long half-life that can be given IV or IM. This is the preferred cephalosporin for methicillinsensitive S. aureus and for many forms of monotherapy surgical prophylaxis with the exception of colorectal procedures where cefotetan, cefoxitin or cefazolin + metronidazole is preferred.
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