Cephazolin Treatment of Pneumonia in the Elderly

Abstract

Cephazolin, a semi-synthetic cephalosporin for parenteral use, was evaluated in 39 elderly hospital patients. Thirty-three of these patients were seriously ill at the start of treatment, suffering from pulmonary infections. In the other six patients, the drug was used post-operatively as a prophylactic, and it was effective in all cases in preventing any subsequent infection. Cephazolin was very effective in the treatment of 27 of the severely ill patients; the primary pathogen was eradicated and there was good clinical improvement. In two patients the primary pathogens were resistant to cephazolin, and the antibiotic therapy was changed after sensitivities were known. Of four patients with Haemophilus influenzae infection, clinical cure was obtained in two. Cephazolin therapy was discontinued in one woman because she developed a rash. However, there were no major toxic effects of therapy in terms of hepatic, renal or haematological function. No patient complained of pain when the intramuscular therapy was given. A dose of 1 g IM twice daily was shown to produce consistently high serum concentrations. Thus, in the elderly, the advantages of cephazolin are its lack of nephrotoxicity even when diuretic therapy is being administered concurrently, its lack of pain on intramuscular injection, and its sustained concentrations in the blood and urine so that it only requires to be given twice daily. In vitro studies showed that cephazolin is more active than cephaloridine against hospital pathogens.

Assessment of the Frequency of Dual Allergy to Penicillins and Cefazolin

“…We included 30 primary studies that assessed the frequency of cefazolin allergy in series of patients with self-reported or confirmed penicillin allergy (Table 1). The included primary studies had been published between 1976 and 2020, assessing a total of 6001 participants. In 9 studies, penicillin allergy was confirmed by diagnostic testing (skin, in vitro, and/or drug challenges).…”

“…In 9 studies, penicillin allergy was confirmed by diagnostic testing (skin, in vitro, and/or drug challenges). In 13 studies, cefazolin allergy was assessed by means of skin tests or drug challenges, whereas prophylactic or therapeutic introduction of cefazolin occurred in 18 studies …”

“…In 13 studies, 18,20,22,23,25,31,32,34,[37][38][39][40]44 cefazolin allergy was assessed by means of skin tests or drug challenges, whereas prophylactic or therapeutic introduction of cefazolin occurred in 18 studies. 17,19,21,24,[26][27][28][29][30]33,[35][36][37][41][42][43]45,46 Cefazolin allergy was identified in 44 participants, resulting in a meta-analytical frequency of 0.7% (95% CrI, 0.1%-1.7%; I 2 = 74.9%) (Figure 2A). Such frequency was lower for participants with self-reported penicillin allergy (0.6%; 95% CrI, 0.1%-1.3%; I 2 = 54.3%) than for those with confirmed allergic reactions (3.0%; 95% CrI, 0.01%-17.0%; I 2 = 88.2%) (OR, 0.4; 95% CrI, 0.02-1.8; 92% probability of OR <1).…”