Medically reviewed on August 12, 2018
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- Cefadroxil Monohydrate
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Generic: 500 mg
Suspension Reconstituted, Oral:
Generic: 250 mg/5 mL (50 mL, 100 mL); 500 mg/5 mL (75 mL, 100 mL)
Generic: 1 g
- Antibiotic, Cephalosporin (First Generation)
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.
Rapid and well absorbed from GI tract
Vd: 0.31 L/kg
Urine (>90% as unchanged drug within 24 hours)
Time to Peak
Serum: Within 70 to 90 minutes
1 to 2 hours; 20 to 24 hours in renal failure
Use: Labeled Indications
Pharyngitis and/or tonsillitis: Treatment of pharyngitis and/or tonsillitis caused by Streptococcus pyogenes (group A beta-hemolytic streptococci).
Skin and skin structure infections: Treatment of skin and skin structure infections caused by staphylococci and/or streptococci.
Urinary tract infection: Treatment of urinary tract infections caused by Escherichia coli, Proteus mirabilis, and Klebsiella species.
Off Label Uses
Prosthetic joint infection with Staphylococci (oxacillin-susceptible)
Based on the Infectious Diseases Society of America (IDSA) guidelines for the management of prosthetic joint infection, cefadroxil is an effective and recommended agent for chronic oral antimicrobial suppression of prosthetic joint infection with Staphylococci (oxacillin-susceptible) after completion of parenteral therapy.
Hypersensitivity to cefadroxil, any component of the formulation, or other cephalosporins
Manufacturer’s labeling: 1 g/day in a single or 2 divided doses for 10 days
Alternate dosing: 30 mg/kg/dose once daily (maximum: 1 g daily) for 10 days (Shulman 2012). Note: Recommended as an alternative agent in penicillin-allergic patients; however, avoid in patients with immediate type hypersensitivity to penicillin.
Prosthetic joint infection, staphylococci (oxacillin-susceptible), chronic oral antimicrobial suppression (off-label use): 500 mg every 12 hours (Osmon 2013)
Skin and skin structure infections: Oral: 1 g daily in a single or 2 divided doses
Tonsillitis: Oral: 1 g daily in a single or 2 divided doses for 10 days
Urinary tract infection (UTI) (alternative agent):
Note: Use with caution and only when recommended agents cannot be used (due to decreased efficacy of oral beta-lactams compared to other agents) (Hooton 2018a; ESMID/IDSA [Gupta 2011]; Greenberg 1986; Sandberg 1990).
Cystitis, acute uncomplicated: Oral: 500 mg twice daily (Greenberg 1986; Hooton 1995) for 5 to 7 days (Greenberg 1986; Hooton 2018a)
UTI, complicated (including pyelonephritis): Oral: 1 g twice daily (Sandberg 1990) for 10 to 14 days (Hooton 2018b; Sandberg 1990). Note: Oral therapy should follow appropriate parenteral therapy. For outpatient treatment of mild infection, a single dose of a long-acting parenteral agent is acceptable; for outpatients who are more ill or are at risk for more severe illness, consider continuing parenteral therapy until culture and susceptibility results are available (ESMID/IDSA [Gupta 2011]; Hooton 2018b).
Refer to adult dosing.
Pharyngitis: Children and Adolescents: Oral:
Manufacturer’s labeling: 30 mg/kg/day in a single dose or divided every 12 hours
Alternate dosing: Refer to adult dosing
Skin and skin structure infections: Children and Adolescents: Oral: 30 mg/kg/day in divided doses every 12 hours. For impetigo: 30 mg/kg/day in a single dose or divided every 12 hours.
Tonsillitis: Children and Adolescents: Oral: 30 mg/kg/day in a single dose or divided every 12 hours
Urinary tract infections: Children and Adolescents: Oral: 30 mg/kg/day in divided doses every 12 hours
Dosing: Renal Impairment
Initial: 1 g as a single dose.
CrCl >50 mL/minute: No dosage adjustment necessary.
CrCl 25 to 50 mL/minute: 500 mg every 12 hours.
CrCl 10 to 25 mL/minute: 500 mg every 24 hours.
CrCl <10 mL/minute: 500 mg every 36 hours.
Dosing: Hepatic Impairment
There are no dosage adjustments provided in the manufacturer’s labeling.
Powder for suspension: Refer to manufacturer’s product labeling for reconstitution instructions. Shake vigorously until suspended.
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.
Store capsules, tablets and unreconstituted oral suspension at 20°C to 25°C (68°F to 77°F); excursions are permitted to 15°C to 30°C (59°F to 86°F). After reconstitution, oral suspension may be stored for 14 days under refrigeration (4°C).
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). 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. Avoid combination
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Monitor therapy
Probenecid: May increase the serum concentration of Cephalosporins. 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. Consider therapy modification
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 3 days after cessation of antibacterial agents. Consider therapy modification
Vitamin K Antagonists (eg, warfarin): Cephalosporins may enhance the anticoagulant effect of Vitamin K Antagonists. Monitor therapy
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
1% to 10%: Gastrointestinal: Diarrhea
<1%: postmarketing, and/or case reports: Abdominal pain, agranulocytosis, anaphylaxis, angioedema, arthralgia, cholestasis, Clostridium 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
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.
• 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.
Concurrent drug therapy issues:
• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.
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).
• Appropriate use: Only IM penicillin has been shown to be effective in the prophylaxis of rheumatic fever. Cefadroxil is generally effective in the eradication of streptococci from the oropharynx; efficacy data for cefadroxil in the prophylaxis of subsequent rheumatic fever episodes are not available.
Monitor renal function. Observe for signs and symptoms of anaphylaxis during first dose.
Pregnancy Risk Factor
Adverse events have not been observed in animal reproduction studies. 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.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience diarrhea. Have patient report immediately to prescriber signs of liver problems (dark urine, fatigue, lack of appetite, nausea, abdominal pain, light-colored stools, vomiting, or jaundice), chills, pharyngitis, seizures, vaginitis, or signs of Clostridium difficile (C. diff)-associated diarrhea (abdominal pain or cramps, severe diarrhea or watery stools, or bloody stools) (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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- Drug class: first generation cephalosporins
- Cefadroxil (AHFS Monograph)
- Cefadroxil (FDA)
- Cefadroxil Capsules (FDA)
- Cefadroxil Oral Suspension (FDA)
Other brands: Duricef