Cefazolin in the Treatment of Central Nervous System Infections: A Narrative Review and Recommendation.

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 staphylococcal CNS infections. However, the use of antistaphylococcal penicillins present challenges, such as frequent dosing administrations and adverse events with protracted use. This narrative reviews available clinical and pharmacokinetic/pharmacodynamic (PK/PD) data for cefazolin use 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 hours or a continuous infusion of 8-10 grams daily instead of 2 g IV every 8 hours to optimize PK/PD properties.