| Reference | [1]. Ann Intern Med. 1978 Nov;89(5 Pt 1):650-6. doi: 10.7326/0003-4819-89-5-650.<br />
Cefazolin.<br />
Quintiliani R, Nightingale CH.<br />
After 5 years of use, cefazolin can be considered similar to cephalothin as a therapeutic agent and in its potential for adverse reactions. When cefazolin and cephalothin are compared by appropriately designed clinical trials, neither cefazolin's slightly greater in-vitro susceptibility to staphylococcal beta-lactamase inactivation, nor its slightly greater microbiologic activity for some enterobacteraciae has been shown to result in any readily apparent therapeutic differences. The important differences between cefazolin and cephalothin–and this is also probably true with respect to cephapirin and cephradine–are not in therapeutic effectiveness, microbiologic activity, or toxicity but rather in pharmacokinetics and cost-effectiveness.<br />
DOI: 10.7326/0003-4819-89-5-650 PMID: 362999 [Indexed for MEDLINE]<br />
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[2]. Clin Infect Dis. 2020 Oct 23;71(7):1783-1789. doi: 10.1093/cid/ciaa216.<br />
Critical National Shortage of Cefazolin in Japan: Management Strategies.<br />
Honda H(1), Murakami S(1), Tokuda Y(2), Tagashira Y(1), Takamatsu A(1).<br />
Author information: (1)Division of Infectious Diseases and Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan. (2)Muribushi Project for Teaching Hospitals, Iso, Urasoe, Okinawa, Japan.<br />
Comment in Clin Infect Dis. 2021 Apr 8;72(7):1293-1295. Clin Infect Dis. 2021 Apr 8;72(7):1295-1296.<br />
The shortage of antimicrobials poses a global health threat. In Japan, for instance, the current, critical shortage of cefazolin, a first-line agent for the treatment of common infectious diseases and surgical antimicrobial prophylaxis, has had a substantial impact on inpatient care. A shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, with the unintended consequence of militating against antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. Although there is global awareness of the shortage of crucial antimicrobials, action to resolve this problem, especially with a view to preventing antimicrobial resistance and promoting antimicrobial stewardship, has been slow, possibly due to the failure to appreciate the urgency of the dilemma. A comprehensive plan for stabilizing antimicrobial access and international collaboration to secure a continuous supply of essential antimicrobials are urgently needed.<br />
DOI: 10.1093/cid/ciaa216 PMID: 32133482 [Indexed for MEDLINE]<br />
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[3]. Am J Health Syst Pharm. 2008 May 1;65(9):823-6. doi: 10.2146/ajhp070243.<br />
Cefazolin-induced hypoprothrombinemia.<br />
Chung AH(1), Watson K.<br />
Author information: (1)Veterans Affairs Maryland Health Care System-Baltimore Division, Baltimore, MD, USA.<br />
PURPOSE: A case of cefazolin-induced hypoprothrombinemia in a patient with renal failure is reported. SUMMARY: A 50-year-old African-American woman was transferred from the orthopedics service to the internal medicine service for management of acute renal failure. Before her transfer, she had spinal surgery and subsequently developed a wound infection complicated by Escherichia coli bacteremia. After trials of multiple antibiotics, she developed acute interstitial nephritis and renal failure. On the day of her transfer to the internal medicine service, i.v. cefazolin sodium 1 g was administered every 24 hours to eradicate the E. coli detected in blood cultures. Her baseline International Normalized Ratio (INR) was 1.3. On day 7 of cefazolin therapy, her INR increased to 4.0. Because of her recent history of bleeding and hypotension, vitamin K 10 mg i.v. was administered, followed by 5 mg orally for the next two days. Her INR decreased and normalized at 1.1. The patient had no changes to other drug therapies and had no medical conditions known to independently affect prothrombin time during this episode. The score on the Naranjo et al. adverse-event probability scale revealed a probable relationship between cefazolin and hypoprothrombinemia in this patient. CONCLUSION: A patient with a postsurgery wound infection and acute renal failure developed hypoprothrombinemia after receiving cefazolin for seven days.<br />
DOI: 10.2146/ajhp070243 PMID: 18436729 [Indexed for MEDLINE]<br />
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[4]. Clin Infect Dis. 1992 Feb;14(2):624. doi: 10.1093/clinids/14.2.624.<br />
Cefazolin-induced neurotoxicity.<br />
Ortiz A.<br />
Comment on Rev Infect Dis. 1991 Jul-Aug;13(4):772-3.<br />
DOI: 10.1093/clinids/14.2.624 PMID: 1554860 [Indexed for MEDLINE]<br />
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[5]. J Antimicrob Chemother. 2019 May 1;74(5):1342-1347. doi: 10.1093/jac/dky574.<br />
Pharmacokinetics of cefazolin delivery via the cardiopulmonary bypass circuit priming solution in infants and children.<br />
Cies JJ(1)(2)(3), Moore WS(1), Parker J(2)(3), Stevens R(2)(3), Al-Qaqaa Y(4)(5), Enache A(6), Chopra A(1)(4)(5).<br />
Author information: (1)The Center for Pediatric Pharmacotherapy LLC, Pottstown, PA, USA. (2)St Christopher's Hospital for Children, Philadelphia, PA, USA. (3)Drexel University College of Medicine, Philadelphia, PA, USA. (4)NYU Langone Medical Center, New York, NY, USA. (5)NYU School of Medicine, New York, NY, USA. (6)Atlantic Diagnostic Laboratories, Bensalem, PA, USA.<br />
OBJECTIVES: Our aim was to describe the pharmacokinetics of cefazolin in paediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) who received cefazolin for peri-operative surgical prophylaxis in addition to having cefazolin added to the CPB circuit priming solution. Secondary aims were to determine the pharmacodynamic exposure associated with the addition of cefazolin to the CPB priming solution and to assess whether a target cefazolin concentration range for the CPB priming solution could be identified. METHODS: A multicentre, prospective, open-label pharmacokinetic study was carried out in children from birth to 16 years of age undergoing cardiac surgery. RESULTS: Forty-one patients met the inclusion criteria and accounted for 492 samples for analysis. Cefazolin concentrations were best described by a one-compartment model with weight as a covariate on the volume of distribution (Vd) with allometric scaling. The mean ± standard deviation (SD) total body CL for the birth-6 month cohort was 0.009 ± 0.006 mL/min/kg with a mean ± SD Vd of 0.59 ± 0.26 L/kg, the mean ± SD total body CL for the 7 month-3 year cohort was 0.01 ± 0.005 mL/min/kg with a mean ± SD Vd of 0.79 ± 0.15 L/kg, and the mean ± SD total body CL for the 4-16 year cohort was 0.007 ± 0.004 mL/min/kg with a mean ± SD Vd of 3.4 ± 0.94 L/kg. The median cefazolin loss in the CPB circuit ranged from 78% to 95% and the median patient cefazolin concentration after CPB circuit detachment ranged from 92 to 197 mg/L. CONCLUSIONS: These data demonstrate that mixing cefazolin in the CPB circuit priming solution was effective in maintaining cefazolin serum concentrations during surgery. If this practice is utilized, re-dosing of cefazolin during the CPB run and upon CPB circuit detachment is most probably not needed. Larger pharmacokinetic studies are warranted.<br />
DOI: 10.1093/jac/dky574 PMID: 30689931 [Indexed for MEDLINE]
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