Safety and Effectiveness of High-Dose Cefazolin in Patients With High Body Weight: A Retrospective Cohort Study

Abstract

Background Cefazolin is a commonly used antibiotic for the treatment of mild to severe infections. Despite the use of higher dose of cefazolin (3 g/dose) for surgical prophylaxis in patients with obesity, there is currently a paucity of data identifying the optimal dose to treat infections in this specific patient population. Methods This was a multicenter, retrospective cohort study of patients who received cefazolin at weight-based (up to 9 g/day) or standard doses (up to 6 g/day) for the treatment of bacteremia or skin and soft-tissue infections (SSTIs). Study groups were stratified by body weight and cefazolin dose received. Primary outcome was the composite of treatment-emergent adverse events (TEAEs) and secondary outcome was treatment failure rate. Results A total of 208 patients were included for study analysis. Fifty-nine patients had body weight over 120 kg. Of these, 33 received high-dose cefazolin while 26 received standard doses. The remaining 149 patients had body weight of 120 kg or less and received standard doses. The occurrence of TEAEs did not differ across the 3 groups. The study also did not find any difference between the rate of treatment failure between groups. Conclusion High-dose cefazolin (9 g/day) for the treatment of bacteremia or SSTIs in patients with high body weight was safe and well tolerated. Larger studies are needed to further explore the benefit of high-dose cefazolin in improving clinical outcomes.

Therapeutic Options for Adult Patients With Persistent Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Narrative Review

“…In 2022, Ryu and colleagues evaluated the safety and effectiveness of higher cefazolin dosing (9 g/d) in patients weighing more than 120 kg with those given standard cefazolin dosing (6 g/d). 32 No significant differences in treatment-emergent adverse events (TEAEs) were identified between high-dose cefazolin in patients weighing more than 120 kg and standard-dose cefazolin regardless of body weight. Similarly, Simpson and colleagues presented data indicating no differences in TEAEs between those receiving cefazolin 2 g every 4 to 6 hours to traditional dosing of 1 to 2 g every 8 hours.…”

Comprehensive guidance for antibiotic dosing in obese adults: 2022 update

“…Limited data are available on the safety and efficacy of cefazolin treatment dosing in obese patients. High‐dose cefazolin (up to 9 g/day) resulted in similar treatment outcomes and was well tolerated in the treatment of 33 patients weighing >120 kg versus 26 patients who received standard doses for the treatment of bacteremia or skin and soft tissue infection (SSTI) 6 …”

“…High-dose cefazolin (up to 9 g/ day) resulted in similar treatment outcomes and was well tolerated in the treatment of 33 patients weighing >120 kg versus 26 patients who received standard doses for the treatment of bacteremia or skin and soft tissue infection (SSTI). 6 Ceftriaxone Summary of previous recommendations. Not addressed in 2017 review due to lack of data.…”

Antibiotic prophylaxis in cardiac surgery: challenges and future perspectives

“…Ryu and colleagues conducted a retrospective study in patients to evaluate the results and side effects between 2 groups of patients: those who received a high dosage of cefazolin that was dose-adjusted for body weight and those who received a conventional dose that was not weight-adjusted. In patients with high body weight, high-dose cefazolin was shown to be generally well tolerated, with no appreciable increase in side effects compared with the standard-dose group 28 . Salm and colleagues study’s conclusions showed that bodyweight-adjusted antimicrobial prophylaxis reduced the incidence of SSIs.…”