Cefazolin Dosage and Treatment Duration for Skin and Soft Tissue Infections
For skin and soft tissue infections, cefazolin should be administered at a dose of 500 mg to 1 gram every 6 to 8 hours for 5-7 days in adults with moderate to severe infections. 1
Dosing Recommendations
Adult Dosing
- Mild infections: 250-500 mg every 8 hours 1
- Moderate to severe infections: 500 mg to 1 gram every 6 to 8 hours 1
- Severe, life-threatening infections: 1 gram to 1.5 grams every 6 hours 1
Pediatric Dosing
- Total daily dosage: 25-50 mg/kg divided into 3-4 equal doses
- For severe infections: May increase up to 100 mg/kg daily
- Not recommended for premature infants and neonates 1
Treatment Duration
- Standard treatment duration for most bacterial skin and soft tissue infections should be 7-14 days 2
- For uncomplicated infections, 5-6 days may be sufficient 3
Alternative Antibiotics for Skin and Soft Tissue Infections
When cefazolin is not appropriate, consider these alternatives:
- Cephalexin: 500 mg 3-4 times daily for 5-6 days 3
- Clindamycin: 300-450 mg orally three times daily for 5-6 days 3
- Amoxicillin-clavulanate: 875/125 mg twice daily orally for 5-6 days 3
Special Considerations
Renal Dosing Adjustments
- CrCl ≥55 mL/min: Standard dosing
- CrCl 35-54 mL/min: Standard dose at 8-hour intervals
- CrCl 11-34 mL/min: Half the usual dose every 12 hours
- CrCl ≤10 mL/min: Half the usual dose every 18-24 hours 1
Administration Routes
- Intravenous (IV) administration is standard for hospitalized patients
- Subcutaneous (SC) administration may be considered as an alternative to IV in certain situations, though with 74.8% bioavailability compared to IV 4
Diagnostic Considerations
- Obtain bacterial cultures from the affected area before starting antibiotics to guide targeted therapy 3
- Blood cultures should be collected if systemic infection is suspected 3
Clinical Pearls and Pitfalls
Pearls
- Cefazolin provides excellent coverage against most gram-positive organisms commonly causing skin infections, including methicillin-sensitive Staphylococcus aureus (MSSA) and streptococci
- For severe infections, initial loading dose should be administered regardless of renal function 1
Pitfalls
- Cefazolin alone may not provide adequate coverage for polymicrobial infections with anaerobic involvement; consider adding metronidazole in these cases 3
- For suspected MRSA infections, vancomycin or other MRSA-active agents should be used instead of cefazolin 3
- Patients with beta-lactam allergies will require alternative therapy
Follow-up Recommendations
- Patients should show clinical improvement within 48-72 hours of starting appropriate therapy
- If no improvement is seen after 72 hours, reassess diagnosis and consider changing the antibiotic regimen 3