Prosthetic joint infection, staphylococci (oxacillin-susceptible), chronic oral antimicrobial suppression (off-label use): Oral: 500 mg every 12 hours (Ref).
Skin and soft tissue infection:
Note: Not an appropriate agent if methicillin-resistant Staphylococcus aureus is suspected or confirmed (Ref).
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 (Ref).
Cellulitis, long-term suppression of recurrent infection: Note: For patients with recurrent presumptive staphylococcal cellulitis at the same anatomical site despite addressing predisposing factors (Ref).
Oral: 500 mg twice daily after completion of treatment (Ref).
Urinary tract infection (alternative agent):
Note: Use only when preferred agents cannot be used; limited evidence suggests inferior efficacy of oral beta-lactams (Ref).
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 (Ref).
Urinary tract infection, complicated (including pyelonephritis): Oral: 1 g twice daily for 10 to 14 days (Ref); for patients with symptomatic improvement within the first 48 to 72 hours of therapy, some experts recommend shorter courses of 7 to 10 days (Ref). Note: Oral beta-lactam therapy should generally follow appropriate parenteral therapy (Ref).
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.
Refer to adult dosing.
(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 (Ref).
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 (Ref). 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 (Ref).
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 (Ref).
Urinary tract infection: Children and Adolescents: Oral: 30 mg/kg/day divided every 12 hours; maximum daily dose: 2,000 mg/day (Ref). 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) (Ref).
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 (Ref):
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) (Ref):
Infants, Children, and Adolescents: Oral: 15 mg/kg/dose every 24 hours (Ref). Based on adult pharmacokinetic studies, three-times-weekly dosing after dialysis has also been recommended (Ref).
Peritoneal dialysis:
Infants, Children, and Adolescents: Oral: 15 mg/kg/dose every 36 hours (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
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).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Generic: 500 mg
Suspension Reconstituted, Oral:
Generic: 250 mg/5 mL (100 mL); 500 mg/5 mL (75 mL, 100 mL)
Tablet, Oral:
Generic: 1 g
Yes
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
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
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
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
Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination
Furosemide: May enhance the nephrotoxic effect of Cephalosporins. Risk C: Monitor therapy
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). 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).
Anti-infective considerations:
Parameters associated with efficacy: Time dependent; associated with time free drug concentration (fT) > minimum inhibitory concentration (MIC). Goal: ≥40% to 50% (fT) > MIC (bacteriostatic), ≥60% to 70% (bactericidal) (Craig 1996; Craig 1998; Turnidge 1998).
Expected drug concentration in normal renal function:
Pediatric patients, Cmax (peak), single dose, oral:
Infants ≤10 months of age: 25 mg/kg: 24.8 ± 5.3 mg/L (Windorfer 1982).
Children:
15 mg/kg: ≤11 years of age: 11 to 13.7 mg/L (Ginsburg 1982).
25 mg/kg: ≤5 years of age: 21.2 ± 5 mg/L (Windorfer 1982).
Adults, Cmax (peak), oral:
Single dose:
500 mg: 17.9 ± 1 mg/L (La Rosa 1982).
1 g: 35.2 ± 0.6 mg/L (La Rosa 1982).
Steady state: 1 g every 8 hours: 35.5 ± 5.9 mg/L (Hampel 1982).
Postantibiotic effect : Generally <1 hour; varies by organism (Craig 1991; Craig 1998).
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