Prosthetic joint infection, staphylococci (oxacillin-susceptible), chronic oral antimicrobial suppression (off-label use): Oral: 500 mg every 12 hours (IDSA [Osmon 2013]).
Skin and soft tissue infection:
Note: Not an appropriate agent if methicillin-resistant Staphylococcus aureus is suspected or confirmed (Baddour 2021; IDSA [Stevens 2014]).
Cellulitis (nonpurulent)/erysipelas, mild, treatment (alternative agent): Oral: 1 g once daily or 500 mg twice daily for 5 days; duration may be extended up to 14 days if not resolved/slow response (Ballantyne 1985; Bucko 2002; IDSA [Stevens 2014]; Spelman 2022; manufacturer’s labeling).
Cellulitis, long-term suppression of recurrent infection: Note: For patients with ≥3 episodes/year of known or presumed staphylococcal cellulitis when predisposing factors cannot be controlled (Spelman 2022).
Oral: 500 mg twice daily after completion of treatment (Spelman 2022).
Streptococcal pharyngitis, group A (alternative agent for mild, nonanaphylactic penicillin allergy):
Note: Cephalosporin selection depends on the type of hypersensitivity reaction to penicillin (Pichichero 2021).
Oral: 1 g once daily for 10 days (IDSA [Shulman 2012]; Pichichero 2021; manufacturer's labeling).
Urinary tract infection (alternative agent):
Note: Use only when first-line agents cannot be used; limited evidence suggests inferior efficacy of oral beta-lactams (Greenberg 1986; IDSA/ESCMID [Gupta 2011]; Sandberg 1990).
Cystitis, acute uncomplicated or acute simple cystitis (infection limited to the bladder without signs/symptoms of upper tract, prostate, or systemic infection): Oral: 500 mg twice daily for 5 to 7 days (Greenberg 1986; Gupta 2021; Hooton 1995; Hooton 2021a).
Urinary tract infection, complicated (including pyelonephritis): Oral: 1 g twice daily for 10 to 14 days. Note: Oral beta-lactam therapy should generally follow appropriate parenteral therapy (Hooton 2021c; IDSA/ESCMID [Gupta 2011]; Sandberg 1990).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function:
CrCl |
If the usual dose is 1 g every 24 hours or 500 mg every 12 hoursb |
If the usual dose is 1 g twice dailyb,c |
---|---|---|
a Administer an initial dose of 1 g in all patients, then begin the recommended maintenance dose. b Expert opinion. c Leroy 1982. | ||
≥40 mL/minute |
No dosage adjustment necessary |
No dosage adjustment necessary |
20 to <40 mL/minute |
500 mg every 24 hours |
500 mg every 12 hours |
<20 mL/minute |
500 mg every 48 hours |
500 mg every 24 hours |
Hemodialysis, intermittent (thrice weekly): Dialyzable (63% removal following a 6- to 8-hour hemodialysis session) (Ref):
Oral:
If the usual recommended dose is 1 g every 24 hours or 500 mg every 12 hours: Administer 1 g once initially, followed by 500 mg 3 times weekly after hemodialysis sessions on hemodialysis days only (Ref).
If the usual recommended dose is 1 g every 12 hours: Administer 1 g once initially, followed by 1 g 3 times weekly after hemodialysis sessions on hemodialysis days only (Ref).
Peritoneal dialysis:
Oral:
If the usual recommended dose is 1 g every 24 hours or 500 mg every 12 hours: 1 g once initially, followed by 500 mg every 48 hours (Ref).
If the usual recommended dose is 1 g every 12 hours: 1 g once initially followed by 500 mg every 24 hours (Ref).
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Cefadroxil: Pediatric drug information")
General dosing: Infants, Children, and Adolescents: Oral: 30 mg/kg/day divided every 12 hours; maximum daily dose: 2,000 mg/day (Red Book [AAP 2021]).
Impetigo: Children and Adolescents: Oral: 30 mg/kg/day once daily or in divided doses every 12 hours; maximum daily dose: 1,000 mg/day (manufacturer's labeling). Recommended duration is 7 days (IDSA [Stevens 2014]; Schanchner 2020).
Osteoarticular infection, acute (eg, septic [bacterial] arthritis, osteomyelitis): Step down therapy following parenteral treatment: Limited data available:
Infants, Children, and Adolescents: Oral: 75 to 150 mg/kg/day in divided doses every 6 to 8 hours; maximum dose: 4,000 mg/day (DeRonde 2018; Donaldson 2020; ESPID [Saavedra-Lozano 2017]; Lorrot 2017; Peltola 2010). Minimum total duration is 2 to 3 weeks for septic arthritis and 3 to 4 weeks for osteomyelitis; however, duration should be individualized based on several factors, including causative pathogen, response to therapy, and normalization of inflammatory markers (ESPID [Saavedra-Lozano 2017]; PIDS/IDSA [Woods 2021]).
Skin and soft tissue infections: Children and Adolescents: Oral: 30 mg/kg/day in divided doses every 12 hours; maximum daily dose: 1,000 mg/day (Wible 2003; manufacturer's labeling). Typical duration for uncomplicated infection is 5 days, but may be extended if clinical response is inadequate (IDSA [Stevens 2014]).
Streptococcus, group A; pharyngitis/tonsillitis (alternative agent for nonanaphylactic penicillin allergy):
Children and Adolescents: Oral: 30 mg/kg/day once daily or in divided doses every 12 hours for 10 days; maximum daily dose: 1,000 mg/day (IDSA [Shulman 2012]; manufacturer's labeling).
Urinary tract infections: Children and Adolescents: Oral: 30 mg/kg/day divided every 12 hours; maximum daily dose: 2,000 mg/day (manufacturer's labeling). Duration of therapy should be individualized based on patient age, severity/extent of infection, and clinical response; typical duration is 7 to 14 days, though it may be as short as 3 to 5 days (eg, for uncomplicated cystitis in patients ≥2 years of age) (Afolabi 2020; Balighian 2018; Fox 2020; Lashkar 2018; Stein 2015).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Note: Dosing based on a usual dose of 30 mg/kg/day in divided doses every 12 hours.
Altered kidney function:
Infants, Children, and Adolescents (Aronoff 2007):
GFR ≥30 mL/minute/1.73 m2: Oral: No dosage adjustment necessary.
GFR 10 to 29 mL/minute/1.73 m2: Oral: 15 mg/kg/dose every 24 hours.
GFR <10 mL/minute/1.73 m2: Oral: 15 mg/kg/dose every 36 hours.
Hemodialysis, intermittent: Dialyzable (63% removal following a 6- to 8-hour hemodialysis session) (Leroy 1982):
Infants, Children, and Adolescents: Oral: 15 mg/kg/dose every 24 hours (Aronoff 2007). Based on adult pharmacokinetic studies, three-times-weekly dosing after dialysis has also been recommended (Leroy 1982).
Peritoneal dialysis:
Infants, Children, and Adolescents: Oral: 15 mg/kg/dose every 36 hours (Aronoff 2007).
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral:
Generic: 500 mg
Suspension Reconstituted, Oral:
Generic: 250 mg/5 mL (50 mL [DSC], 100 mL); 500 mg/5 mL (75 mL, 100 mL)
Tablet, Oral:
Generic: 1 g
Yes
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Generic: 500 mg
Oral: Administer around-the-clock to promote less variation in peak and trough serum levels. Administer without regards to meals; administration with food may diminish GI complaints.
Oral: May be administered without regard to food; administration with food may decrease GI complaints; shake suspension well before use.
Skin and soft tissue infections: Treatment of skin and soft tissue infections caused by staphylococci and/or streptococci.
Streptococcal pharyngitis, group A: Treatment of pharyngitis and/or tonsillitis caused by Streptococcus pyogenes.
Urinary tract infection: Treatment of urinary tract infections caused by Escherichia coli, Proteus mirabilis, and Klebsiella species.
Prosthetic joint infection with Staphylococci (oxacillin-susceptible)
Duricef may be confused with Ultracet
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%: Gastrointestinal: Diarrhea
<1%: postmarketing, and/or case reports: Abdominal pain, agranulocytosis, anaphylaxis, angioedema, arthralgia, cholestasis, Clostridioides difficile-associated diarrhea, dyspepsia, erythema multiforme, erythematous rash, fever, genital candidiasis, hepatic failure, increased serum transaminases, maculopapular rash, nausea, neutropenia, pruritus, pseudomembranous colitis, serum sickness, Stevens-Johnson syndrome, thrombocytopenia, urticaria, vaginitis, vomiting
Hypersensitivity to cefadroxil, any component of the formulation, or other cephalosporins
Concerns related to adverse effects:
• Hypersensitivity reactions: Hypersensitivity reactions, including anaphylaxis, may occur. If an allergic reaction occurs, discontinue treatment and institute appropriate supportive measures.
• Penicillin allergy: Use with caution in patients with a history of penicillin allergy.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Colitis: Use with caution in patients with a history of gastrointestinal disease, particularly colitis.
• Renal impairment: Use with caution in patients with renal impairment (CrCl <50 mL/minute/1.73 m2); dosage adjustment may be needed.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Zar 2007). See manufacturer’s labeling.
• Suspension: May contain sulfur dioxide (sulfite); hypersensitivity reactions, including anaphylaxis and/or asthmatic exacerbations, may occur (may be life threatening).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Substrate of OAT1/3
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Aminoglycosides: Cephalosporins may enhance the nephrotoxic effect of Aminoglycosides. Cephalosporins may decrease the serum concentration of Aminoglycosides. Risk C: Monitor therapy
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Furosemide: May enhance the nephrotoxic effect of Cephalosporins. Risk C: Monitor therapy
Immune Checkpoint Inhibitors: Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy
Probenecid: May increase the serum concentration of Cephalosporins. Risk C: Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Risk C: Monitor therapy
Cefadroxil crosses the placenta (Takase 1980).
Based on available data, cephalosporin antibiotics are generally considered compatible for use during pregnancy; however, outcome information specific to maternal use of cefadroxil during pregnancy is limited compared to other cephalosporins (Ailes 2016; Bookstaver 2015; Crider 2009; Czeizel 2001; Lamont 2014; Muanda 2017a; Muanda 2017b; Nathorst-Böös 1995; Schedvins 1986).
Cefadroxil is present in breast milk.
The relative infant dose (RID) of cefadroxil is 2.6% when calculated using the highest breast milk concentration located and compared to a weight-adjusted maternal dose of 1 g/day.
In general, breastfeeding is considered acceptable when the RID of a medication is <10% (Anderson 2016; Ito 2000).
The RID of cefadroxil was calculated using a milk concentration of 2.4 mcg/mL, providing an estimated daily infant dose via breast milk of 360 mcg/kg/day. This milk concentration was obtained following maternal administration of cefadroxil 1 g to 6 mothers on the third postpartum day. The mean peak milk concentration was 1.83 mcg/mL (range: 1.2 to 2.4 mcg/mL) at 6 to 7 hours after the dose (Kafetzis 1981).
In general, antibiotics that are present in breast milk may cause non-dose-related modification of bowel flora. Monitor infants for GI disturbances (WHO 2002). The manufacturer recommends that caution be exercised when administering cefadroxil to breastfeeding women.
Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose.
Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin-binding proteins (PBPs) which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Absorption: Rapid and well absorbed from GI tract.
Distribution: Vd: 0.31 L/kg.
Protein binding: 20%.
Half-life elimination:
Infants: 2.3 ± 0.5 hours (Windorfer 1982).
Children: Mean range: ~1.3 to 1.8 hours (Ginsburg 1978; Windorfer 1982).
Adults: 1 to 2 hours; 20 to 24 hours in renal failure.
Time to peak serum concentration: Within 70 to 90 minutes.
Excretion: Urine (>90% as unchanged drug within 24 hours).
Capsules (Cefadroxil Oral)
500 mg (per each): $3.72
Suspension (reconstituted) (Cefadroxil Oral)
250 mg/5 mL (per mL): $0.61
500 mg/5 mL (per mL): $0.84
Tablets (Cefadroxil Oral)
1 g (per each): $7.78
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