Cefadroxil: Effective First-Line Oral Cephalosporin Antibiotic Therapy
Cefadroxil
Cefadroxil is a first-generation cephalosporin antibiotic indicated for the treatment of a wide range of bacterial infections. It exerts its bactericidal effect by inhibiting bacterial cell wall synthesis, leading to cell lysis and death. With its broad-spectrum activity and convenient once- or twice-daily dosing, cefadroxil remains a clinically relevant option in outpatient and community settings for susceptible Gram-positive and some Gram-negative pathogens.
Features
- Belongs to the first-generation cephalosporin class of antibiotics
- Bactericidal mechanism of action via inhibition of cell wall synthesis
- Available in oral formulations: 500 mg and 1 g capsules, and oral suspension (250 mg/5 mL and 500 mg/5 mL)
- Acid-stable, allowing for administration without regard to meals
- Demonstrates activity against streptococci, staphylococci (including penicillinase-producing strains), E. coli, Proteus mirabilis, and Klebsiella pneumoniae
- Extended half-life (~1.5 hours) compared to other first-generation cephalosporins, permitting less frequent dosing
Benefits
- Provides reliable coverage for common skin, soft tissue, and urinary tract infections in the outpatient setting
- Convenient dosing regimen enhances patient adherence and reduces dosing errors
- Well-established safety profile with extensive clinical use history
- Effective against beta-lactamase producing strains of staphylococci, offering an advantage over some penicillins
- Generally well-tolerated in both adult and pediatric populations when dosed appropriately
- Cost-effective therapeutic option for many community-acquired bacterial infections
Common use
Cefadroxil is commonly prescribed for the treatment of uncomplicated skin and skin structure infections, such as impetigo, cellulitis, and wound infections, caused by susceptible strains of Staphylococcus aureus and Streptococcus pyogenes. It is also indicated for pharyngitis and tonsillitis caused by Group A beta-hemolytic streptococci. In genitourinary infections, it demonstrates efficacy against uncomplicated urinary tract infections caused by E. coli, Proteus mirabilis, and Klebsiella species. Off-label uses may include dental prophylaxis in penicillin-allergic patients and treatment of mild to moderate respiratory tract infections, though its spectrum is less ideal for typical respiratory pathogens compared to later-generation cephalosporins.
Dosage and direction
For adults, the typical dosage for most infections is 1-2 grams daily, administered either as a single dose or in two divided doses. For urinary tract infections, a single daily dose of 1-2 grams is often sufficient. For streptococcal pharyngitis, the recommended dosage is 1 gram daily for 10 days. Pediatric dosing is based on body weight, typically 30 mg/kg/day in a single or divided dose. For children weighing more than 40 kg, adult dosing may be used. The oral suspension should be shaken well before each use. Administration with food may minimize potential gastrointestinal upset, though absorption is not significantly affected by food. Dosage adjustment is necessary in patients with renal impairment; for creatinine clearance less than 50 mL/min, dosing intervals should be extended.
Precautions
Use with caution in patients with a history of gastrointestinal disease, particularly colitis, as antibiotic use can predispose to Clostridium difficile-associated diarrhea. Renal function should be assessed prior to initiation and monitored during therapy, especially in elderly patients or those with pre-existing renal impairment. Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi. As with all beta-lactam antibiotics, there is potential for cross-hypersensitivity with penicillins; careful allergy history assessment is mandatory. Use during pregnancy should be reserved for cases where clearly needed (Category B). Cefadroxil is excreted in human milk; caution should be exercised when administering to nursing women.
Contraindications
Cefadroxil is contraindicated in patients with known hypersensitivity to cephalosporin antibiotics. A history of anaphylactic reaction to any beta-lactam antibiotic (penicillins, cephalosporins, or other) constitutes an absolute contraindication. It should not be administered to patients with a history of severe immediate hypersensitivity reactions to other beta-lactam antibiotics due to the risk of cross-reactivity. The oral suspension formulation contains sucrose and is contraindicated in patients with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase insufficiency.
Possible side effect
The most commonly reported adverse reactions involve the gastrointestinal system, including diarrhea (2-5%), nausea (1-3%), and abdominal discomfort. Dermatological reactions such as rash and urticaria occur in approximately 1-2% of patients. Transient elevations in liver enzymes have been reported. Less common side effects include vaginitis, dizziness, and headache. As with most antibiotics, pseudomembranous colitis caused by C. difficile may occur during or after treatment. Hematologic effects such as eosinophilia, neutropenia, and thrombocytopenia have been reported rarely. Serum sickness-like reactions characterized by fever, rash, and arthralgia may occur, particularly in children.
Drug interaction
Probenecid may decrease renal tubular secretion of cefadroxil, resulting in increased and prolonged blood levels. Concurrent use with potent diuretics may increase the risk of nephrotoxicity. Although clinical importance is uncertain, false-positive reactions for glucose in the urine may occur with Benedict’s or Fehling’s solutions but not with enzyme-based tests. Cefadroxil may cause false-positive direct Coombs test results. Oral anticoagulant effects may be potentiated, requiring closer monitoring of coagulation parameters. The absorption of cefadroxil may be reduced when taken with medications containing magnesium or aluminum, such as antacids.
Missed dose
If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed one. Maintenance of adequate blood levels is important for antibacterial efficacy, so adherence to the prescribed dosing schedule is recommended. Healthcare providers should educate patients on the importance of completing the full course of therapy even if symptoms improve before the antibiotic regimen is finished.
Overdose
Symptoms of overdose may include nausea, vomiting, epigastric distress, and diarrhea. In cases of significant overdose, particularly in patients with renal impairment, neurotoxicity including seizures may occur. Management is primarily supportive and symptomatic. Gastric lavage may be considered if performed soon after ingestion. Hemodialysis may be effective in removing cefadroxil from the bloodstream, particularly in patients with renal compromise. Serum levels of cefadroxil can be measured if quantitative assessment is needed. Patients should be monitored for signs of electrolyte imbalance and dehydration secondary to gastrointestinal symptoms.
Storage
Store capsules at controlled room temperature (20-25°C or 68-77°F) in a tightly closed container. Protect from moisture and light. The reconstituted oral suspension should be stored in the refrigerator (2-8°C or 36-46°F) and discarded after 14 days. Do not freeze the suspension. Keep all medications out of reach of children and pets. Do not use beyond the expiration date printed on the packaging. Proper disposal of unused medication through medication take-back programs is recommended to prevent accidental ingestion or environmental contamination.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read herein. Healthcare professionals should verify dosing, contraindications, and compatibility with the patient’s complete medical profile before prescribing.
Reviews
Clinical studies have demonstrated cefadroxil’s efficacy with cure rates of 85-95% for skin and soft tissue infections and 80-90% for urinary tract infections when caused by susceptible organisms. In comparative trials, cefadroxil has shown similar efficacy to other first-generation cephalosporins with the advantage of less frequent dosing. Patient satisfaction surveys indicate preference for once-daily dosing regimens when appropriate for the infection being treated. The antibiotic maintains its position in treatment guidelines as an effective option for specific outpatient indications, particularly in penicillin-allergic patients where cross-reactivity concerns are minimal. Long-term clinical experience spanning decades supports its favorable benefit-risk profile for approved indications.