First-Generation Cephalosporin Pregnancy: B

Cefazolin (Perioperative Burns)

Brand names: Kefzol

Adult dose

Dose: 1–2 g IV within 60 min before incision; 1 g IV every 8 hours for 24–48h post-burn (prophylaxis)

Route: intravenous injection or infusion

Frequency: every 8 hours

Max: 6 g/day

Surgical prophylaxis: 2 g if >120 kg; re-dose every 2–4 hours intraoperatively; use within 60 min of incision for maximum efficacy

Paediatric dose

Dose: 25 mg/kg

Route: IV

Frequency: every 6–8 hours

Max: 6 g/day

Concentration: 1 g/vial (reconstitute with 10 mL); dilute to 5–10 mg/mL mg/ml

Surgical prophylaxis: 30 mg/kg IV within 60 min before incision; max 2 g per dose; re-dose if >4h operative time

Dose adjustments

Renal

Extend interval to every 12h if eGFR 10–35 ml/min; every 24h if eGFR <10 ml/min

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

Surgical prophylaxis: 30 mg/kg IV within 60 min before incision; max 2 g per dose; re-dose if >4h operative time

Clinical pearls

Gold standard surgical prophylaxis antibiotic — most evidence base across surgical specialties
Re-dosing mandatory for prolonged burns procedures — every 2–4h intraoperatively or after significant blood loss (>1500 mL)
MRSA burns: requires vancomycin — cefazolin does not cover MRSA

Contraindications

Severe penicillin allergy (10% cross-reactivity)
Hypersensitivity to cephalosporins

Side effects

GI upset
Injection site pain
Hypersensitivity
Pseudomembranous colitis (C. difficile)
Thrombophlebitis (IV)

Interactions

Probenecid (increased cefazolin levels)
Aminoglycosides (nephrotoxicity)
Live typhoid vaccine (reduced response)

Monitoring

Signs of wound infection
Renal function in prolonged use
C. difficile risk

Reference: BNFc; BNF 86; NICE NG125; ASHP antimicrobial prophylaxis guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Cefradine · First-generation cephalosporin