What is the recommended dosing for cefazolin (a first-generation cephalosporin antibiotic) in the treatment of tracheitis?

Cefazolin Dosing for Tracheitis

For tracheitis treatment, cefazolin should be administered at a dose of 100 mg/kg/day IV divided every 8 hours up to a maximum of 12 g daily. 1

Dosing Considerations

Adult Dosing

• Standard adult dose: 1-2 g IV every 8 hours 2
• For severe infections: Consider 2 g IV every 8 hours
• Maximum daily dose: 12 g daily 1

Pediatric Dosing

• Children: 100 mg/kg/day IV divided every 8 hours 2, 1
• Maximum daily dose: 12 g daily

Renal Adjustment

• For patients with renal impairment, dose adjustment is essential to prevent neurotoxicity 3:
  • CrCl 35-54 mL/min: Full dose every 8-12 hours
  • CrCl 11-34 mL/min: Full dose every 12 hours
  • CrCl ≤10 mL/min: Full dose every 24 hours

Treatment Duration

• For uncomplicated tracheitis: 5-7 days
• For severe infections: 7-14 days
• Continue treatment until clinical improvement is observed and for at least 48-72 hours after fever resolution

Monitoring Parameters

• Clinical response within 72 hours
• Signs of neurotoxicity, especially in patients with renal impairment 3
• Complete blood count and renal function tests periodically

Alternative Agents

If cefazolin is not appropriate (e.g., allergy, resistance):

• For beta-lactam allergic patients:

  • Clindamycin: 600-900 mg IV every 8 hours (adults) or 30-40 mg/kg/day divided every 6-8 hours (children) 1
  • Vancomycin: 15-20 mg/kg IV every 8-12 hours (adults) or 40 mg/kg/day divided every 8-12 hours up to 2 g daily (children) 2

• For suspected MRSA:

  • Vancomycin: 15-20 mg/kg IV every 8-12 hours (adults) or 40 mg/kg/day divided every 8-12 hours up to 2 g daily (children) 2, 1

Pharmacokinetic Considerations

• Cefazolin demonstrates excellent tissue penetration with a tissue/serum ratio of approximately 1.06 4
• Peak serum concentrations after standard dosing are typically 25-216 μg/mL, which exceeds the MIC for most susceptible pathogens 5, 6
• The drug has a half-life of 1.5-2.5 hours in patients with normal renal function 7

Practical Administration Tips

• Administer IV doses slowly over 30 minutes to reduce the risk of adverse reactions
• For IV administration, reconstitute with appropriate diluent per institutional protocols
• Monitor injection sites for signs of phlebitis or inflammation

Cautions

• Risk of seizures with excessive dosing, particularly in patients with renal impairment 3
• Potential for cross-reactivity in patients with penicillin allergy (approximately 10%)
• Monitor for superinfection, especially with prolonged use

Cefazolin is an effective first-generation cephalosporin with excellent activity against many pathogens commonly associated with tracheitis, including methicillin-susceptible Staphylococcus aureus and streptococci 6, 7.