Neonatal Drug Therapy Manual


Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
Ancef, Kefzol
Cephalosporin Antibiotic (First Generation)
Original Date: 
June 1996
Revised Date: 
September 2018
  • Infection due to susceptible organisms (many Gram (+) cocci except enterococcus and some Gram (-) bacilli)
  • Surgical prophylaxis
  • IV Direct: over 3 - 5 minutes
  • IV intermittent infusion: over 15 minutes


  • Neonates:

< 2 kg: 50 mg/kg/day divided Q12h

> 2 kg:

  • 0-7 days: 50 mg/kg/day divided Q12h
  • > 7 days: 75 mg/kg/day divided Q8h


  • Infants: (corrected GA > 42 weeks and PNA > 4 weeks):
    • 100 - 150 mg/kg/day divided Q8h


  • PDA ligation prophylaxis:
    • 40 mg/kg x 1 dose on call to the OR then 40 mg/kg x 1 dose given at 12 hours post-op


Dosage adjustment required in renal impairment.  Refer to available references or clinical pharmacist for dosage adjustment.

Side Effects: 
  • Hematologic: leukopenia, thrombocytopenia, eosinophilia
  • Hepatic: transient elevation of liver enzymes
  • Local: phlebitis
  • Renal: BUN and serum creatinine elevated
Parameters to Monitor: 
  • CBC
  • Hepatic function tests
  • Renal function (when used in combination with other nephrotoxic drugs)
Reconstitution and Stability: 


  • Cefazolin 1 g vial (doses < 200 mg)
    • Add 9.5 mL SWFI to vial
    • Take 4 mL (400 mg) and add to 16 mL D5W
    • Final concentration: 20 mg/mL
  • Cefazolin 1 g vial (doses > 200 mg)
    • Add 9.5 mL SWFI to vial
    • Final concentration: 100 mg/mL


  • Cefazolin 1 g vial
    • Add 9.5 mL SWFI to vial
    • Take 4 mL (400 mg) and add to 16 mL D5W
    • Final concentration: 20 mg/mL

- Solutions Compatible: D5W, D10W, 0.9% NaCl

- Y-site Compatible: calcium gluconate, dexmedetomidine, famotidine, fluconazole, heparin, insulin, KCl, midazolam, milrinone, morphine, pantoprazole, ranitidine

- Incompatible: hydromorphone, tobramycin, vancomycin


-Taketomo CK, Hodding JH, Kraus DM. Pediatric& Neonatal Dosage Handbook 22thEdition. Hudson: Lexi-Comp Inc.; 2015

-American Society on Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: American Society of Health-System Pharmacists; 2017.

- Murray MT, Corda R, Turcotte R, Bacha E, Saiman L, Krishnamurthy G.  Implementing a standardized perioperative antibiotic prophylaxis protocol for neonates undergoing cardiac surgery.  Ann Thorac Surg. Sept. 2014; 98 (3): 927-933


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