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Increase in hospital admissions for AKI secondary to Cephazolin use

A review of multiple recent cellulitis cases has shown an increase in hospital admissions for Acute Kidney Injury (AKI) secondary to cephazolin use. In these cases, cephazolin doses have not been considered for reduction in patients with known or possible renal impairment, and Probenecid has been given. These cases have been reviewed by the POAC regional governance group Please note the following information:

IF IV cephazolin is indicated i.e.:

-Patient >/= 15 years

-No improvement or worsening symptoms after 48hrs appropriate oral antibiotics

-Limb cellulitis not suitable for trial orals (BMI>40, symptomatic PVD or venous insufficiency)

-Pre-approval from Infectious Diseases physicians to use IV as 1st line

Ensure renal function is considered prior  to starting antibiotics.  In patients >/= 65y or patients with known or possible impaired renal function:

-Check renal function

-If no creatinine level within the last 3 months, arrange creatinine test and eGFR

-A loading dose of 2 g cefazolin can be given while waiting for the creatinine result

-Withhold probenecid pending the creatinine result

Once results known:

e-GFR > 60 full dose Cephazolin 2g every 24hours + usual dose Probenecid

e-GFR 40-60 full dose Cephazolin 2g every 24hours + withhold Probenecid

e-GFR 20-40 reduce Cephazolin to 1g every 24hours + withhold Probenecid

e-GFR <20 reduce Cephazolin to 500mg every 24hours + withhold Probenecid

Full information is given in the Auckland Regional HealthPathway Intravenous Antibiotics for Cellulitis -  see sections 5 and 6.


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