Cefazolin

How it works

Cefazolin binds penicillin-binding proteins to inhibit bacterial cell-wall peptidoglycan synthesis, giving bactericidal activity against common skin staphylococci and streptococci responsible for surgical-site infection.

Prescribing in practice

• Give within the recommended window before skin incision to achieve adequate tissue concentrations at the time of surgery, with redosing for prolonged procedures or major blood loss per protocol.
• Avoid in patients with a history of severe immediate hypersensitivity to penicillins or cephalosporins, and consider an alternative where MRSA cover is required.
• Adjust dosing in significant renal impairment, as cefazolin is renally cleared.

Monitoring

Monitor for hypersensitivity reactions around administration and review renal function where repeated or prolonged dosing is needed.

Counselling the patient

• This antibiotic is given at the time of your operation to lower the risk of wound infection.
• Tell the team about any previous reaction to penicillins or cephalosporins before it is given.

Evidence & guidelines

First-generation cephalosporins such as cefazolin are recommended as standard surgical antibiotic prophylaxis in orthopaedic surgery by SIGN and other guidance.