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Pronunciation
(sef a DROKS il)
Generic Available (U.S.)
Yes
Index Terms
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Treatment of susceptible bacterial infections, including those caused by group A beta-hemolytic Streptococcus
Use: Dental
Alternative antibiotic for treatment of orofacial infections in patients allergic to penicillins; susceptible bacteria including aerobic gram-positive bacteria and anaerobes
Pregnancy Risk Factor
B
Pregnancy Considerations
Adverse events were not observed in animal reproduction studies; therefore, cefadroxil is classified as pregnancy category B. Cefadroxil crosses the placenta. Limited data is available concerning the use of cefadroxil in pregnancy; however, adverse fetal effects were not noted in a small clinical trial. Adequate and well-controlled studies have been not completed in pregnant women.
Lactation
Enters breast milk (small amounts)/use caution (AAP rates “compatible”; AAP 2001 update pending)
Breast-Feeding Considerations
Very small amounts of cefadroxil are excreted in breast milk. The manufacturer recommends that caution be exercised when administering cefadroxil to nursing women. Nondose-related effects could include modification of bowel flora.
Contraindications
Hypersensitivity to cefadroxil, any component of the formulation, or other cephalosporins
Warnings/Precautions
Concerns related to adverse effects:
• Penicillin allergy: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).
• 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:
• Renal impairment: Use with caution in patients with renal impairment; modify dosage in severe impairment.
Adverse Reactions
1% to 10%: Gastrointestinal: Diarrhea
<1%: Anaphylaxis, rash (maculopapular and erythematous), erythema multiforme, Stevens-Johnson syndrome, serum sickness, arthralgia, urticaria, pruritus, angioedema, pseudomembranous colitis, abdominal pain, dyspepsia, nausea, vomiting, cholestasis, vaginitis, neutropenia, agranulocytosis, thrombocytopenia, transaminases increased, fever
Reactions reported with other cephalosporins: Toxic epidermal necrolysis, abdominal pain, superinfection, renal dysfunction, toxic nephropathy, aplastic anemia, hemolytic anemia, hemorrhage, prothrombin time prolonged, BUN increased, creatinine increased, eosinophilia, pancytopenia, seizure
Metabolism/Transport Effects
None known.
Drug Interactions
BCG: Antibiotics may diminish the therapeutic effect of BCG. Risk X: Avoid combination
Probenecid: May increase the serum concentration of Cephalosporins. Risk C: Monitor therapy
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 24 hours after cessation of antibacterial agents. Risk D: Consider therapy modification
Ethanol/Nutrition/Herb Interactions
Food: Concomitant administration with food, infant formula, or cow's milk does not significantly affect absorption.
Reconstitution
Refrigerate suspension after reconstitution. Discard after 14 days.
Mechanism of Action
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.
Pharmacodynamics/Kinetics
Absorption: Rapid and well absorbed
Distribution: Widely throughout the body and reaches therapeutic concentrations in most tissues and body fluids, including synovial, pericardial, pleural, and peritoneal fluids; bile, sputum, and urine; bone, myocardium, gallbladder, skin, and soft tissue
Protein binding: 20%
Half-life elimination: 1-2 hours; Renal failure: 20-24 hours
Time to peak, serum: 70-90 minutes
Excretion: Urine (>90% as unchanged drug)
Dosage
Usual dosage range: Oral:
Children: 30 mg/kg/day divided twice daily up to a maximum of 2 g/day
Adults: 1-2 g/day in 2 divided doses
Indication-specific dosing: Orofacial infections: Adults: 250-500 mg every 8 hours
Dosing interval in renal impairment:
Clcr 10-25 mL/minute: Administer every 24 hours
Clcr <10 mL/minute: Administer every 36 hours
Dental Usual Dosing
Orofacial infections: Oral: Adults: Dosage range: 250-500 mg every 8 hours
Administration: Oral
Administer around-the-clock to promote less variation in peak and trough serum levels.
Monitoring Parameters
Observe for signs and symptoms of anaphylaxis during first dose.
Test Interactions
Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction
Patient Education
Take at regular intervals around-the-clock, with or without food. Must be refrigerated for stability purposes. Maintain adequate hydration, unless instructed to restrict fluid intake. May cause false test results with Clinitest®; use of another type of glucose testing is preferable. May cause diarrhea. Report rash; breathing or swallowing difficulty; persistent diarrhea, nausea, vomiting, or abdominal pain; changes in urinary pattern or pain on urination; opportunistic infection (eg, vaginal itching or drainage, sores in mouth, blood in urine or stool, unusual fever or chills); or CNS changes (eg, irritability, agitation, nervousness, insomnia, hallucinations).
Geriatric Considerations
Adjust dose for renal function in the elderly.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins
Mental Health: Effects on Psychiatric Treatment
May rarely cause neutropenia; use caution with clozapine and carbamazepine
Nursing: Physical Assessment/Monitoring
Assess results of culture/sensitivity tests and patient's allergy history prior to therapy. Assess anticoagulants patient may be taking for potential interactions. Hypersensitivity can occur several days after therapy is started. Advise patients with diabetes about use of Clinitest®. Teach patient to report hypersensitivity, opportunistic infection, renal dysfunction, and anemia.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, oral, as hemihydrate [strength expressed as base]: 500 mg
Capsule, oral, as monohydrate [strength expressed as base]: 500 mg
Powder for suspension, oral, as monohydrate [strength expressed as base]: 250 mg/5 mL (50 mL, 100 mL); 500 mg/5 mL (75 mL, 100 mL)
Tablet, oral, as hemihydrate [strength expressed as base]: 1 g
Tablet, oral, as monohydrate [strength expressed as base]: 1 g
Pricing: U.S. (www.drugstore.com)
Capsules (Cefadroxil)
500 mg (30): $34.99
Tablets (Cefadroxil)
1 g (30): $139.99
References
American Academy of Pediatrics Committee on Drugs, "Transfer of Drugs and Other Chemicals Into Human Milk," Pediatrics, 2001, 108(3):776-89.
Cutler RE, Blair AD, and Kelly MR, “Cefadroxil Kinetics in Patients With Renal Insufficiency,” Clin Pharmacol Ther, 1979, 25(5 Pt 1):514-21.
Donowitz GR and Mandell GL, “Beta-Lactam Antibiotics,” N Engl J Med, 1988, 318(7):419-26 and 318(8):490-500.
Marshall WF and Blair JE, “The Cephalosporins,” Mayo Clin Proc, 1999, 74(2):187-95.
Smith GH, “Oral Cephalosporins in Perspective,” DICP, 1990, 24(1):45-51.
International Brand Names
Lexi-Comp.com
Last full review/revision October 2011
Content last modified October 2011
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