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Authoritative Clinical Reference
Schedule H
Intravenous (IV), Intramuscular (IM)
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
Parameter Recommendation
Starting dose 1 g IV (standard risk); 2 g IV (high-risk: cardiothoracic, orthopaedic, obese patients)
Titration Not applicable
Usual maintenance dose Single preoperative dose; re-dose intraoperatively if surgery >4 hours or blood loss >1500 mL
Maximum dose 2 g per single dose
Timing Administer 30–60 minutes before incision
Post-operative dosing Not routinely required unless infection suspected
Parameter Recommendation
Starting dose 500 mg – 1 g IV/IM every 8 hours
Titration Not applicable
Usual maintenance dose 1 g IV every 8 hours
Maximum dose 6 g/day in divided doses
Duration 5–10 days depending on severity
Clinical note Preferred over antistaphylococcal penicillins for MSSA due to better tolerability
Parameter Recommendation
Starting dose 1–2 g IV every 8 hours
Titration Not applicable
Usual maintenance dose 2 g IV every 8 hours
Maximum dose 6 g/day
Duration Minimum 4–6 weeks (prolonged IV therapy under specialist guidance)
Parameter Recommendation
Starting dose 1 g IV every 12 hours
Titration Not applicable
Usual maintenance dose 1 g IV every 12 hours
Maximum dose 6 g/day
Duration 5–7 days based on organism sensitivity and clinical response
Clinical note Less preferred for uncomplicated UTIs due to pharmacokinetics
Parameter Recommendation
Starting dose 2 g IV every 8 hours
Titration Not applicable
Usual maintenance dose 2 g IV every 8 hours
Maximum dose 6 g/day
Duration 4–6 weeks with source control
Clinical note Requires Infectious Disease specialist supervision
Secondary Indications — Adults (Off-label)
Indication Dose Duration Notes
Community-acquired pneumonia (penicillin-allergic patients) — OFF-LABEL 1–2 g IV every 8 hours (combine with azithromycin) 5–7 days Specialist only; based on institutional protocols where penicillins cannot be used
PAEDIATRIC DOSING (Specialist Only)
Primary Indications (Approved / Standard in India)
Parameter Recommendation
Starting dose 30 mg/kg IV (max 2 g/dose)
Titration Not applicable
Usual maintenance dose Single dose; re-dose if surgery >4 hours
Timing Within 30 minutes prior to incision
Parameter Recommendation
Starting dose 25 mg/kg IV every 8 hours
Titration Increase based on severity
Usual maintenance dose 50–100 mg/kg/day IV in 3–4 divided doses
Maximum dose 150 mg/kg/day in severe infections; do not exceed 2 g per individual dose
Duration 7–14 days based on infection severity
Age Dose
<7 days old 20 mg/kg IV every 12 hours
7–28 days old 20 mg/kg IV every 8 hours
Monitoring: Renal function must be monitored closely
Secondary Indications — Paediatrics (Off-label)
None commonly used off-label in India
⚠️ Not recommended in children <1 month of age without specialist supervision
| eGFR (ml/min/1.73m²) | Recommendation |
|---|
50 No adjustment required
11–50 0.5–1 g IV every 12 hours
≤10 0.5 g IV every 24 hours
Haemodialysis Administer dose after dialysis (e.g., 1 g post-HD); adjust per clinical response
Peritoneal dialysis Limited data; use with close monitoring
| Severity | Recommendation |
|---|---|
| Mild impairment | No dose adjustment required |
| Moderate impairment | No dose adjustment required |
| Severe impairment | No dose adjustment required |
Cefazolin is primarily renally excreted with minimal hepatic metabolism.
Parameter Information
Risk category Generally safe (USFDA Category B equivalent)
Preferred alternatives May be first choice for indicated infections; preferred over fluoroquinolones or aminoglycosides
When to use When clearly indicated (e.g., surgical prophylaxis, serious MSSA infections)
Monitoring Signs of hypersensitivity; renal function in late pregnancy
Parameter Information
Compatibility Compatible with breastfeeding
Drug levels in milk Low
Preferred alternatives Not usually required; cefazolin is acceptable
Infant monitoring Observe for loose stools, rash, oral candidiasis (rare)
Interacting Drug Effect Recommendation
Probenecid Inhibits renal tubular secretion → increased cefazolin levels and prolonged half-life Avoid combination or monitor closely for toxicity
Loop diuretics (e.g., furosemide) Additive nephrotoxicity risk Monitor renal function; use cautiously
Warfarin Prolonged antibiotic use may disrupt gut flora → reduced vitamin K synthesis → elevated INR Monitor INR closely during and after therapy
Interacting Drug Effect Recommendation
Aminoglycosides Additive nephrotoxicity when used concurrently Monitor renal function regularly
Methotrexate Competition for renal excretion → potential decreased methotrexate clearance Monitor methotrexate levels if co-administered
Oral contraceptives Theoretical reduced efficacy due to GI flora disturbance Clinical significance low; advise backup contraception if concerned
Adverse Effect Action Required
Anaphylaxis Immediate discontinuation; emergency management
Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis Rare; discontinue immediately
Clostridioides difficile-associated colitis Suspect if ≥3 watery stools/day or prolonged use; discontinue and treat
Neutropenia / Eosinophilia May occur with extended use (>10 days); discontinue if severe
Seizures Especially in renal impairment with high doses; dose reduction required
Phase Parameters
Baseline Serum creatinine, eGFR; CBC if prolonged course planned
During treatment Creatinine every 2–3 days in renal impairment or elderly; CBC weekly if therapy >10 days
Ongoing Signs of GI upset, hypersensitivity reactions, and injection site reactions
(Mostly available as dry powder for injection)
| Formulation | Approximate Price (per tablet) |
|---|---|
| Injection 500 mg vial ₹15–₹35 | |
| Injection 1 g vial ₹25–₹60 | |
| Injection 2 g vial ₹50–₹100 |
Included in NLEM — NPPA price regulation applies
cefazolin; cephalosporin; first-generation cephalosporin; surgical prophylaxis; MSSA; skin infection; osteomyelitis; renal-adjustment; injectable antibiotic; NLEM India
RxIndia v1.1 — 04 May 2024
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