Cefazolin in the treatment of central nervous system infections: A narrative review and recommendation

Abstract

Infections of the central nervous system (CNS) are complex to treat and associated with significant morbidity and mortality. Historically, antistaphylococcal penicillins such as nafcillin were recommended for the treatment of methicillin‐susceptible staphylococcal CNS infections. However, the use of antistaphylococcal penicillins presents challenges, such as frequent dosing administration and adverse events with protracted use. This narrative reviews available clinical and pharmacokinetic/pharmacodynamic (PK/PD) data for cefazolin in CNS infections and produces a recommendation for use. Based on the limited available evidence analyzed, dose optimized cefazolin is likely a safe and effective alternative to antistaphylococcal penicillins for a variety of CNS infections due to methicillin‐susceptible Staphylococcus aureus. Given the site of infection and wide therapeutic index of cefazolin, practitioners may consider dosing cefazolin regimens of 2 g IV every 6 h or a continuous infusion of 8–10 g daily instead of 2 g IV every 8 h to optimize PK/PD properties.

Heartbreaking Decisions: The Dogma and Uncertainties of Antimicrobial Therapy in Infective Endocarditis

“…Yet, evolving data, including case reports, PK studies, and expert opinions, continue to challenge this dogma. These reports suggest that cefazolin, if used at more aggressive dosing (e.g., 2 g IV every 6 h or 8–10 g/day as continuous infusion) could be considered as an alternative to ASP in infections involving the CNS [ 37 , 38 , 39 ].…”

‘’Myth Busting in Infectious Diseases’’: A Comprehensive Review

“…Cefazolin is a first-generation cephalosporin antibiotic known for its broad-spectrum antibacterial activity, especially against Streptococcal and Staphylococcal species. Historically, cefazolin, as a first-generation cephalosporin antibiotic, has been pivotal in managing CNS infections due to its effective pharmacokinetics and broad antibacterial activity [ 37 ]. However, a common misconception about cefazolin is the belief that it is inappropriate for treating bacterial meningitis.…”

Optimal drug therapy for Staphylococcus aureus bacteraemia in adults

“…Although cefazolin has traditionally been avoided for infections where penetration of the blood brain barrier is needed, doses of 2 g i.v. 6-hourly or 8–10 g over 24 h as a continuous infusion have been used successfully [49 ▪▪ ], and there is in fact no evidence to support the belief that cefazolin has inferior penetration into the central nervous system compared to antistaphylococcal penicillins [50,51 ▪▪ ]. Ceftaroline dosing of 600 mg i.v.…”