Cefadroxil
Cefadroxil is a semisynthetic, first generation cephalosporin antibiotic.
Administration
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Cefadroxil is administered orally. Adverse GI effects may be minimized by administering the drug with food.
Dosage
Adult Dosage
For the treatment of uncomplicated urinary tract infections (i.e., cystitis), the usual adult dosage of cefadroxil is 1 or 2 g daily given as a single dose or in 2 equally divided doses; for the treatment of other urinary tract infections, the usual adult dosage is 1 g twice daily. For the treatment of skin and skin structure infections, the usual adult dosage is 1 g daily given as a single dose or in 2 equally divided doses. For the treatment of pharyngitis and tonsillitis caused by Streptococcus pyogenes (group A b-hemolytic streptococci), the usual adult dosage is 1 g daily given as a single dose or in 2 equally divided doses for at least 10 days.
Pediatric Dosage
For the treatment of urinary tract infections and skin and skin structure infections, the usual pediatric dosage of cefadroxil is 30 mg/kg daily given in divided doses every 12 hours. For the treatment of impetigo, children should receive 30 mg/kg daily given as a single dose or in 2 equally divided doses. For the treatment of group A b-hemolytic streptococcal pharyngitis and tonsillitis, the usual pediatric dosage is 30 mg/kg daily given as a single dose or in 2 equally divided doses for at least 10 days.
Prevention of Bacterial Endocarditis
If cefadroxil is used as an alternative to amoxicillin or ampicillin for prevention of a-hemolytic (viridans group) streptococcal endocarditis in penicillin-allergic individuals considered to be at risk for bacterial endocarditis following certain dental or upper respiratory tract procedures, adults should receive a single 2-g dose and pediatric patients should receive a single 50-mg/kg dose (no more than 2 g) administered 1 hour prior to the procedure. Cefadroxil should not be used for such prophylaxis in individuals with a history of immediate-type hypersensitivity reactions to penicillin (e.g., urticaria, angioedema, anaphylaxis). For information regarding indications for prophylaxis against bacterial endocarditis, see Uses: Prevention of Bacterial Endocarditis, in the Aminopenicillins General Statement 8:12.16.08.
Dosage in Renal Impairment
Modification of usual dosage of cefadroxil does not appear to be necessary in patients with creatinine clearances greater than 50 mL/minute per 1.73 m. In patients with greater renal impairment, doses and/or frequency of administration of cefadroxil must be modified in response to the degree of renal impairment. The manufacturers recommend that adults receive an initial dose of 1 g followed by 500-mg maintenance doses at the following dosage intervals based on the patient’s creatinine clearance:100
Creatinine Clearance (mL/minute per Dosage Interval 1.73 m)
25-50 every 12 hours
10-25 every 24 hours
0-10 every 36 hours
Spectrum
Based on its spectrum of activity, cefadroxil is classified as a first generation cephalosporin. For information on the classification of cephalosporins and closely related b-lactam antibiotics based on spectra of activity, see Spectrum in the Cephalosporins General Statement 8:12.06. Like other first generation cephalosporins (e.g., cefazolin, cephalexin, cephradine), cefadroxil is active in vitro against many gram-positive aerobic cocci but has limited activity against gram-negative bacteria.
Pharmacokinetics
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Absorption
Cefadroxil is acid-stable and is rapidly and almost completely absorbed from the GI tract. The rate of absorption and peak serum concentrations of cefadroxil are not affected when the drug is administered with food. Following oral administration in healthy adults with normal renal function, peak serum cefadroxil concentrations are attained within 1-2 hours and average about 10-18 mcg/mL following a single 500-mg dose and 24-35 mcg/mL following a single 1-g dose. In a group of children 13 months to 12 years of age with normal renal function, peak serum concentrations of cefadroxil averaged 13.7 mcg/mL and were attained within 1 hour after a single oral dose of 15 mg/kg; serum concentrations of the drug were 0.6-1. mcg/mL at 6 hours.
Elimination
The serum half-life of cefadroxil is 1.1-2 hours in adults with normal renal function.
Cefadroxil is excreted unchanged in urine. In adults with normal renal function, from 70 to more than 90% of a single 500-mg or 1-g oral dose of the drug is excreted unchanged in urine within 24 hours, principally within the first 6-9 hours after administration. In adults with normal renal function, peak urine concentrations of cefadroxil of 1.8 mg/mL may be attained following a single 500-mg oral dose.
The serum half-life of cefadroxil is prolonged in patients with impaired renal function. The half-life of cefadroxil is 2.5-8. hours in patients with creatinine clearances of 20-50 mL/minute per 1.73 m and 13.-25. hours in patients with creatinine clearances less than 20 mL/minute per 1.73 m. Renal elimination of cefadroxil is substantially reduced in patients with creatinine clearances less than 20 mL/minute per 1.73 m, with about 10-30% of a single oral dose excreted unchanged in urine within 24 hours.
Cefadroxil is removed by hemodialysis.
Chemistry and Stability
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Chemistry
Cefadroxil is a semisynthetic cephalosporin antibiotic. Cefadroxil is commercially available as the monohydrate which occurs as a white to yellowish-white, crystalline powder and is soluble in water and slightly soluble in alcohol.
Stability
Cefadroxil capsules, tablets, and powder for oral suspension should be stored in tight containers at 15-30°C. Following reconstitution, cefadroxil oral suspensions are stable for 14 days at 2-8°C.
For further information on chemistry, mechanism of action, spectrum, resistance, pharmacokinetics, uses, cautions, drug interactions, laboratory test interferences, and dosage and administration of cefadroxil, see the Cephalosporins General Statement 8:12.06.
Preparations
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Cefadroxil
Oral
Capsules 500 mg Cefadroxil Capsules, Barr
Sandoz IVAX Ranbaxy
Duricef®, Warner-
Chilcott
For suspension 250 mg/5 mL Duricef®, Warner-
Chilcott
500 mg/5 mL Duricef®, Warner-
Chilcott
Tablets 1 g Cefadroxil Tablets, IVAX
Ranbaxy
Tablets, film- 1 g Duricef®, (scored) Warner-
coated Chilcott