Cefazolin Shortage: A Provider Briefing for 2026

Cefazolin remains one of the most prescribed injectable antibiotics in the United States — and one of the most frequently disrupted. As a provider, you're likely already familiar with the challenges: delayed surgeries, modified antibiotic protocols, and patients calling your office because they can't fill their prescriptions.

This article provides a comprehensive update on the Cefazolin shortage as of 2026, including the current timeline, prescribing implications, availability landscape, cost considerations, and practical tools to help your patients access treatment.

Shortage Timeline: How We Got Here

Cefazolin's shortage history spans over 15 years:

• 2010-2012: First reported shortages linked to manufacturing quality issues at sterile injectable facilities.
• 2013: A significant shortage period driven by production line shutdowns at multiple manufacturers. Hospitals implemented conservation protocols and substitution guidelines.
• 2017: Renewed shortage activity as raw material (API) supply disruptions affected production schedules.
• 2019-2020: The most severe shortage period. Simultaneous production issues at multiple manufacturers, compounded by pandemic-related supply chain disruptions, led to widespread rationing at hospitals nationwide.
• 2021-2023: Gradual improvement as manufacturers restored capacity, though intermittent spot shortages continued.
• 2024-2026: The shortage persists at a lower intensity. Supply is intermittently constrained, particularly for premixed frozen solutions. Powder vials have been more consistently available.

Prescribing Implications

The ongoing Cefazolin shortage has several clinical implications that prescribers should be aware of:

Surgical Prophylaxis

Cefazolin is the gold standard for surgical prophylaxis per guidelines from the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), and the Surgical Infection Society (SIS). When Cefazolin is unavailable, many institutions have adopted the following substitution hierarchy:

1. Ceftriaxone 2 g IV — broadest availability, once-daily dosing, but broader spectrum than necessary for most surgical prophylaxis
2. Cefuroxime 1.5 g IV — second-generation cephalosporin with similar spectrum to Cefazolin
3. Clindamycin 900 mg IV + Gentamicin — for patients with severe beta-lactam allergies or when all cephalosporins are unavailable

Review your institution's surgical prophylaxis shortage protocol and ensure your perioperative teams are current on approved alternatives.

MSSA Infections

Cefazolin has become a preferred agent for MSSA bacteremia and endocarditis, supported by growing evidence of non-inferiority to Nafcillin/Oxacillin with fewer adverse effects. When Cefazolin is unavailable for MSSA infections:

• Nafcillin or Oxacillin remain the traditional alternatives — effective but associated with higher rates of phlebitis, hepatotoxicity, and interstitial nephritis
• Ceftriaxone may be considered for less severe MSSA infections, though it is not recommended as first-line for MSSA bacteremia by current IDSA guidelines

Outpatient Parenteral Antibiotic Therapy (OPAT)

For OPAT patients, Cefazolin's q8h dosing schedule is already a barrier. When Cefazolin supply is limited, consider:

• Ceftriaxone — once-daily dosing is significantly more convenient for OPAT patients and their caregivers
• Step-down to oral Cephalexin when clinically appropriate — reduces IV drug supply pressure and improves patient quality of life

Current Availability Picture

As of early 2026, the Cefazolin supply situation is best characterized as intermittently constrained:

• Powder vials (500 mg, 1 g, 2 g): More consistently available. Multiple manufacturers (Hikma, Sandoz, Sagent, WG Critical Care) are producing, though not all NDCs are in full supply at all times.
• Premixed frozen bags (1 g/50 mL, 2 g/50 mL): More frequently affected by shortages. Baxter and other premix manufacturers have had intermittent supply disruptions.
• Bulk pharmacy vials (10 g, 20 g): Generally available for hospital pharmacies that compound their own IV solutions.

Supply varies significantly by region and distributor. Hospital pharmacies with contracts through group purchasing organizations (GPOs) may have more stable access than independent infusion pharmacies.

Cost and Access Considerations

Cefazolin remains one of the most cost-effective injectable antibiotics available:

• Hospital acquisition cost: Approximately $5 to $15 per 1 g vial
• Premixed bags: $15 to $50 per unit
• Patient out-of-pocket (home infusion): Highly variable depending on insurance. Uninsured patients may pay $50 to $500+ for a full course including supplies and nursing

During shortage periods, some gray-market distributors may charge inflated prices. Advise patients and pharmacy partners to source only through verified distributors.

Insurance coverage for Cefazolin is generally straightforward — it's covered under the medical benefit when administered in facility settings and often under specialty pharmacy benefits for home infusion. Prior authorization is rarely required for the drug itself, though home infusion services may require pre-authorization.

Tools and Resources for Providers

Several resources can help you navigate Cefazolin availability for your patients:

• Medfinder for Providers: Track real-time Cefazolin availability across pharmacies and suppliers. Recommend this tool to patients who are struggling to locate their medication.
• ASHP Drug Shortage Resource Center: Maintains current shortage status and clinical recommendations for managing Cefazolin shortages.
• FDA Drug Shortage Database: Official shortage status and manufacturer-specific information.
• Your hospital's P&T committee: Should have updated shortage management protocols including approved Cefazolin alternatives.

For patient-facing resources you can share, see How to Find Cefazolin in Stock Near You and How to Save Money on Cefazolin.

Looking Ahead

The structural factors driving Cefazolin shortages — limited manufacturers, low margins, complex sterile manufacturing, and global API dependency — are not likely to resolve quickly. However, several trends are encouraging:

• FDA efforts to diversify manufacturing: The FDA has prioritized bringing additional manufacturers online for critical injectable drugs
• Hospital resilience programs: More health systems are implementing strategic stockpiling and alternative protocol planning
• Policy discussions: Ongoing legislative and regulatory conversations about incentivizing generic injectable manufacturing and addressing root causes of drug shortages

In the meantime, proactive communication with your pharmacy team, early identification of patients at risk for supply disruptions, and familiarity with appropriate alternatives remain the best strategies for managing this shortage.

Final Thoughts

The Cefazolin shortage is a systemic issue that requires systemic solutions. As individual providers, the most impactful steps you can take are: staying informed about current availability, having alternative protocols ready, leveraging tools like Medfinder to help patients locate supply, and advocating for broader policy changes to prevent future shortages.

For a step-by-step guide on helping patients navigate this shortage, see How to Help Your Patients Find Cefazolin in Stock: A Provider's Guide.