What is the recommended dose and duration of cefazolin (Cefazolin) IV for treating post-surgical intravenous (IV) site infections?

Cefazolin IV for Post-Surgical IV Site Infections

For post-surgical IV site infections, cefazolin should NOT be used as treatment—it is exclusively indicated for surgical prophylaxis, not for established infections. 1

Critical Distinction: Prophylaxis vs. Treatment

The evidence provided addresses surgical prophylaxis only, not treatment of established infections. The FDA label for cefazolin does not list "IV site infections" as an approved indication. 1 Cefazolin is indicated for treatment of serious infections including:

• Respiratory tract infections
• Urinary tract infections
• Skin and skin structure infections
• Biliary tract infections
• Bone and joint infections
• Septicemia
• Endocarditis 1

However, a post-surgical IV site infection would require culture-directed therapy based on the causative organism, not empiric cefazolin. 1

If This Question Is About Surgical Prophylaxis Instead

If you are asking about prophylactic cefazolin dosing to prevent surgical site infections (not treat an established IV site infection), the recommendations are:

Standard Prophylactic Dosing

• Initial dose: 2g IV slow bolus administered 30-60 minutes before surgical incision 2, 3
• Intraoperative re-dosing: 1g IV only if procedure duration exceeds 4 hours 2, 3

Duration of Prophylaxis

• Most procedures: Single dose only with no postoperative continuation 2, 3
• Maximum duration: 24 hours for most cases, exceptionally 48 hours, and never beyond 48 hours 2, 3
• Specific exceptions requiring 48-hour duration:
  • Cranio-cerebral wounds: 2g every 8 hours for maximum 48 hours 2, 3
  • Limb amputation: 1g every 6 hours for 48 hours 2, 3

Important Caveats

The presence of surgical drains does NOT justify extending prophylaxis beyond recommended durations. 2 There is no indication for re-dosing during drain, probe, or catheter removal. 2

Weight-based dosing in obese patients lacks pharmacokinetic justification. Despite common practice of using 3g doses in obesity, cefazolin is hydrophilic and does not penetrate adipose tissue regardless of dose. 4 A standard 2g dose achieves peak serum concentrations of ~185 mcg/mL, providing adequate coverage for 6+ hours. 1, 4, 5

Clinical Bottom Line

If you have a patient with an established post-surgical IV site infection, obtain cultures and initiate appropriate treatment antibiotics—not prophylactic cefazolin. 1 Cefazolin prophylaxis should have been discontinued within 24-48 hours post-surgery per guidelines. 2, 3