Cefazillin Special Precautions

Cross-allergenicity with penicillin: Administer cautiously with penicillin-sensitive patients. There is evidence of partial cross-allergenicity; cephalosporins cannot be assumed to be an absolutely safe alternative to penicillin in the penicillin-allergic patient. The estimated incidence of cross-sensitivity is 5% to 16%; however, it is possibly as low as 3% to 7%.
Serum sickness-like reactions: Erythema multiforme of skin rashes accompanied by polyarthritis, arthralgia, and, frequently, fever have been reported; these reactions usually occurred following a second course of therapy. Signs and symptoms occur after a few days of therapy and resolve a few days after drug discontinuation with no serious sequelae. Antihistamines and corticosteroids may be of benefit in managing symptoms.
CNS effects: Severe neurological reactions (some fetal) have been reported with some cephalosporins, including encephalopathy, myoclonus, seizures, and nonconvulsive status epilepticus. Risk may be increased in the present of renal impairment; ensure dose adjusted for renal function or discontinue therapy if patient develops neuro-toxicity; effects are often reversible upon discontinuation.
Coagulation abnormalities: Cephalosporins may be associated with increased international normalized ratio, especially in nutritionally-deficient patients, prolonged treatment, or hepatic or renal disease.
Clostridium difficile-associated diarrhea: C. difficile-associated diarrhea (CDAD) has been reported for nearly all antibacterial agents and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of C. difficile. Careful medical history is necessary because CDAD has been reported to occur more than 2 months after the administration of antibacterial agents.
Hemolytic anemia: Hemolytic anemia has been observed in patients receiving cephalosporin class antibiotics. Rare cases of severe hemolytic anemia, including fatalities, have been reported in association with cephalosporins. If a patient develops anemia any time within 2 to 3 weeks subsequent to the start of therapy, consider the diagnosis of cephalosporin-associated anemia and stop the drug until etiology is determined with certainty. Blood transfusions may be administered as needed. Periodically monitor patients who receive prolonged courses of cephalosporins for treatment of infections for signs and symptoms of hemolytic anemia, including measurement of hematological parameters when appropriate.
Granulocytopenia: Granulocytopenia and more rarely agranulocytosis may develop during prolonged treatment (more than 10 days) with cephalosporins.
Renal function impairment: Cephalosporins may be nephrotoxic, use with caution in the presence of markedly impaired renal function. In elderly patients and in patients with known or suspected renal impairment, monitor carefully prior to and during therapy.