Cefazolin Dosing in Pediatric Trauma
For pediatric trauma cases, cefazolin should be dosed at 25-50 mg/kg/day divided into 3-4 doses, with a maximum of 100 mg/kg/day for severe infections. This dosing regimen provides appropriate antimicrobial coverage for most trauma-related infections while maintaining safety in the pediatric population 1.
Dosing Guidelines Based on Severity
Standard Dosing
- Mild to moderate infections: 25-50 mg/kg/day divided into 3-4 equal doses 1
- For q8h dosing: Approximately 8-17 mg/kg per dose
- For q6h dosing: Approximately 6-12.5 mg/kg per dose
Severe Infections
- Severe infections: Up to 100 mg/kg/day divided into 3-4 doses 1
- For life-threatening infections such as septicemia or complicated trauma
Perioperative Prophylaxis
For surgical prophylaxis in trauma cases requiring operative intervention:
- Initial dose: 25-50 mg/kg given 30-60 minutes before incision 2
- Intraoperative redosing: Additional dose if procedure exceeds 4 hours 2
- Duration: Single dose is typically sufficient; may continue for 24 hours post-operatively in contaminated wounds 2
Specific Trauma Scenarios
Open Fractures
- Cefazolin is the preferred agent for type I and II open fractures 2
- Short course (≤24 hours) is recommended after injury 2
- For type III open fractures with bone loss, additional antibiotic therapy may be required 2
Penetrating Trauma
- Particularly effective in preventing infectious complications in penetrating injuries 2
- Reduces risk of post-traumatic empyema and pneumonia 2
Dosage Adjustments
Renal Impairment
Adjust dosing in pediatric patients with renal impairment 1:
- Mild impairment (CrCl 70-40 mL/min): 60% of normal daily dose every 12 hours
- Moderate impairment (CrCl 40-20 mL/min): 25% of normal daily dose every 12 hours
- Severe impairment (CrCl 20-5 mL/min): 10% of normal daily dose every 24 hours
Age Considerations
- Not recommended for premature infants and neonates due to lack of safety data 1
- For older children, follow the weight-based dosing guidelines
Administration
Routes
- Intravenous: Preferred in trauma settings for rapid achievement of therapeutic levels
- Intramuscular: Alternative when IV access is limited, but may cause pain at injection site
Preparation
- Reconstitute with Sterile Water for Injection
- For IV administration, further dilute in 50-100 mL of compatible solution
- Administer IV doses slowly over 3-5 minutes for direct injection 1
Clinical Considerations
Tissue Penetration
- Cefazolin shows better penetration in proximal extremities compared to distal sites 3
- Higher concentrations are observed in hip versus knee (mean difference: 4 μg/g) 3
- Consider higher doses for distal extremity injuries to ensure adequate tissue concentrations
Efficacy in Trauma
- Prehospital administration of cefazolin in trauma patients with open fractures has shown an infection rate of only 6% 4
- Providers can reliably identify open fractures requiring antibiotic prophylaxis 4
Potential Pitfalls
- Cross-reactivity: Up to 10% of penicillin-allergic patients may have cross-reactivity with cephalosporins 5
- Inadequate distal concentrations: May need higher doses for distal extremity injuries 3
- Timing: Critical to administer 30-60 minutes before incision for surgical prophylaxis 2
Cefazolin remains a first-line agent for pediatric trauma cases due to its excellent activity against common pathogens including Staphylococcus aureus, which is responsible for many trauma-related infections 6.