What is the optimal prophylactic dosing regimen for cefazolin during on-pump cardiac surgery in children?

In our recent publication, we developed a population pharmacokinetic model of cefazolin in South African children undergoing cardiac surgery with cardiopulmonary bypass (CPB). The model captured the effect of the CPB pump on cefazolin pharmacokinetics and identified weight and renal function as predictors of cefazolin pharmacokinetics.  

Based on our model, we developed a personalized continuous infusion dosing regimen which can be adjusted according to weight and renal function. Our simulations illustrate that this regimen outperforms intermittent mg/kg bolus dosing, ensuring consistent cefazolin exposures and achieving target concentrations while mitigating the risk of toxicity across diverse weight and renal function categories. Moreover, unlike intermittent bolus dosing, integrating an additional dose into the CPB pump with this regimen incurs no toxicity risk and could counteract potential drug loss through the CPB pump. 

The publication titled “Dose optimization of cefazolin in South African children undergoing cardiac surgery with cardiopulmonary bypass” and published in CPT: Pharmacometrics & Systems Pharmacology can be found here.