Maximum Recommended Dose of Cefazolin for Pediatric Patients
The maximum recommended dose of cefazolin for pediatric patients is 150 mg/kg/day divided into three doses (every 8 hours), with no established absolute maximum daily dose in milligrams. 1
Dosing Guidelines for Cefazolin in Pediatric Patients
Standard Dosing
- For most mild to moderately severe infections, the total daily dosage is 25 to 50 mg/kg of body weight, divided into 3 or 4 equal doses 2
- For severe infections, the total daily dosage may be increased to 100 mg/kg of body weight 2
- For methicillin-susceptible Staphylococcus aureus infections, the preferred dosage is 150 mg/kg/day divided every 8 hours 1
Specific Clinical Scenarios
- For infective endocarditis in pediatric patients, cefazolin should be dosed at 100 mg/kg per 24 hours IV in 3 equally divided doses 1
- For surgical prophylaxis, the FDA label recommends weight-based dosing following the standard 25-50 mg/kg/day approach 2
- Recent research suggests that for surgical prophylaxis, children ≥50 kg should receive a 2-gram dose, while those between 25-50 kg should receive a 1-gram dose 3
Dosing Adjustments
Renal Impairment
- For pediatric patients with mild to moderate renal impairment (creatinine clearance of 70 to 40 mL/min), 60% of the normal daily dose given in equally divided doses every 12 hours is recommended 2
- For moderate impairment (creatinine clearance of 40 to 20 mL/min), 25% of the normal daily dose given in equally divided doses every 12 hours is adequate 2
- For severe renal impairment (creatinine clearance of 20 to 5 mL/min), 10% of the normal daily dose every 24 hours may be given 2
Important Clinical Considerations
- Safety for use in premature infants and neonates has not been established, so cefazolin is not recommended in these populations 2
- All dosage recommendations apply after an initial loading dose appropriate to the severity of the infection 2
- While some cephalosporins (like cefotaxime) have been studied with extended dosing intervals, cefazolin's pharmacokinetic profile generally requires more frequent dosing 4
- The FDA label does not specify an absolute maximum daily dose in milligrams for pediatric patients, unlike some other antibiotics that have both weight-based and absolute maximum dose limits 2
Administration Considerations
- For intravenous administration, reconstitute with Sterile Water for Injection according to the package insert guidelines 2
- For direct (bolus) injection, further dilute with approximately 5 mL Sterile Water for Injection and inject slowly over 3 to 5 minutes 2
- For intramuscular administration, reconstitute according to the dilution table in the package insert and inject into a large muscle mass 2