What is the recommended dose of cefadroxyl (Cefadroxil) for treating cellulitis in adults?

Recommended Dosage of Cefadroxil for Cellulitis in Adults

For adults with cellulitis, cefadroxil should be administered at a dosage of 1 gram per day in a single (once daily) or divided doses (twice daily). 1

Dosing Recommendations

The FDA-approved dosing for cefadroxil in skin and skin structure infections, including cellulitis, is:

• 1 gram per day, which can be given as:
  • 1 gram once daily (q.d.)
  • 500 mg twice daily (b.i.d.)

This dosing regimen is supported by the FDA drug label for cefadroxil, which specifically addresses skin and skin structure infections 1.

Advantages of Cefadroxil

• Acid-stable and may be administered without regard to meals
• Once-daily dosing option improves compliance compared to medications requiring more frequent administration
• Similar efficacy to cephalexin but with more convenient dosing schedule 2

Alternative First-Line Options for Cellulitis

If cefadroxil is unavailable or not preferred, the Infectious Diseases Society of America (IDSA) guidelines recommend the following alternatives for non-purulent cellulitis 3:

• Cephalexin: 500 mg four times daily
• Dicloxacillin: 500 mg four times daily
• Clindamycin: 300-450 mg four times daily (for penicillin-allergic patients)

Special Considerations

MRSA Coverage

• Standard cefadroxil dosing does not provide adequate coverage for MRSA
• If MRSA is suspected, consider alternative agents such as:
  • Trimethoprim-sulfamethoxazole: 1-2 double-strength tablets twice daily
  • Doxycycline: 100 mg twice daily
  • Clindamycin: 300-450 mg four times daily 3, 4

Renal Impairment

For patients with renal impairment, the dosage of cefadroxil should be adjusted according to creatinine clearance 1:

• Creatinine clearance 25-50 mL/min: 500 mg every 12 hours
• Creatinine clearance 10-25 mL/min: 500 mg every 24 hours
• Creatinine clearance 0-10 mL/min: 500 mg every 36 hours

Treatment Duration

• Standard duration for uncomplicated cellulitis is 7-14 days 4
• The National Institute for Health and Care Excellence (NICE) recommends 5-7 days for uncomplicated cases 4
• For beta-hemolytic streptococcal infections, treatment should continue for at least 10 days 1

Monitoring and Follow-up

• Monitor daily for clinical response
• If no improvement is seen after 5 days, consider:
  • Extending treatment duration
  • Changing antibiotics
  • Reevaluating for deeper infection 4

Potential Pitfalls

• Be aware that patients with chronic venous disease (CVD) may have higher rates of treatment failure with cephalosporins and may require closer monitoring 5
• Consider adding an NSAID (such as ibuprofen) to hasten resolution of inflammation, as some evidence suggests this may speed recovery 6
• Recent research suggests that higher doses of cephalosporins may result in fewer treatment failures for cellulitis, though with potentially more minor adverse effects 7

Remember that cefadroxil is acid-stable and can be taken with or without food, though administration with food may help reduce gastrointestinal complaints sometimes associated with oral cephalosporin therapy 1.