Cefazolin (Perioperative Burns)

SOURCE: UK SPC (eMC) for Cefazolin 2g Powder for solution for infusion/injection vials, section 4.2 (https://www.medicines.org.uk/emc/product/102464/smpc). The prophylaxis regimen above is quoted from the SPC's own 'Special dosage recommendations - Perioperative prophylaxis' subsection for the prevention of postoperative infection in contaminated or potentially contaminated surgery. The SPC contains NO burns-specific regimen: burns, burn-excision surgery and grafting are not named anywhere in the fetched sections, so the timing and re-dosing above are the general surgical-prophylaxis figures and any burns-unit-specific protocol (e.g. re-dosing for large blood loss or altered clearance in major burns) must come from local guidance. SPC rationale for the timing: the preoperative dose must be given just (30 minutes to 1 hour) prior to the start of surgery so that adequate antibiotic levels are present in the serum and tissues at the time of initial surgical incision, and cefazolin should be administered, if necessary, at appropriate intervals during surgery to provide sufficient levels at the anticipated moments of greatest exposure to infective organisms. TREATMENT DOSES (for context, not for prophylaxis) - adults and adolescents above 12 years and 40 kg or more: infections caused by sensitive microorganisms 1 g to 2 g per day divided into 2-3 equal doses; moderately sensitive microorganisms 3 g to 4 g per day divided into 3-4 equal doses; severe infections up to 6 g per day in three or four equal doses. Duration of treatment depends on the severity of the infection and on clinical and bacteriological progress. Elderly: no dose adjustment is required in elderly patients with normal renal function. US CROSS-CHECK (openFDA, Cefazolin for Injection, WG Critical Care - US labelling, differs from the UK SPC and is NOT the regimen above): 1 gram IV or IM half an hour to 1 hour before surgery; 500 mg to 1 gram IV or IM during surgery for lengthy procedures (e.g. 2 hours or more); and 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively, continued for 3 to 5 days after surgery where infection would be particularly devastating (e.g. open-heart surgery and prosthetic arthroplasty). The UK SPC defers postoperative continuation to national official guidance instead. PAEDIATRIC: this SPC gives NO paediatric perioperative prophylaxis dose - its paediatric figures are per-kg daily doses for the treatment of infection (divided into 2 to 4 doses per day) and must not be carried onto this perioperative page; the numbers are therefore not reproduced here. Use of cefazolin is not recommended in premature babies and infants below the age of 1 month, as safety has not been established. Verify all paediatric dosing against a children's formulary. Section 4.5 (interactions) was not retrieved in this bundle - the interaction entries below come from the SPC's section 4.4 and from US labelling, and the full section 4.5 should be verified.