What is the recommended dosing for Cefadroxil (Cefadroxil) in the treatment of bacterial infections?

Cefadroxil Dosing for Bacterial Infections

For adults with bacterial infections, cefadroxil should be dosed at 1-2 grams per day in single or divided doses, depending on the infection type and severity. 1

Adult Dosing by Indication

Urinary Tract Infections

• Uncomplicated lower UTI (cystitis): 1-2 g per day as a single daily dose or divided twice daily 1
• Complicated UTI or pyelonephritis: 2 g per day in divided doses (1 g every 12 hours) 1

Skin and Soft Tissue Infections

• Standard dosing: 1 g per day as a single dose or divided twice daily 1
• This dosing has proven effective for abscesses, carbuncles, cellulitis, furunculosis, and impetigo caused by susceptible organisms 2
• Cefadroxil 500 mg twice daily demonstrated 89% clinical cure rates for uncomplicated skin infections, equivalent to cefuroxime axetil 3

Pharyngitis and Tonsillitis

• Group A beta-hemolytic streptococcal infections: 1 g per day as a single dose or divided twice daily for 10 days 1
• Must complete full 10-day course for streptococcal infections to prevent rheumatic fever 1

Periprocedural Prophylaxis (Urologic Surgery)

• 500 mg orally every 12 hours when used for antimicrobial prophylaxis in urologic procedures 4
• This represents a first-generation cephalosporin option for surgical prophylaxis 4

Pediatric Dosing

For children, the standard dose is 30 mg/kg/day, with administration frequency varying by indication. 1

By Indication

• UTI: 30 mg/kg/day divided every 12 hours 1
• Pharyngitis, tonsillitis, impetigo: 30 mg/kg/day as a single daily dose or divided every 12 hours 1
• Other skin/soft tissue infections: 30 mg/kg/day divided every 12 hours 1
• Streptococcal pharyngitis: Must treat for minimum 10 days 1, 5

Practical Pediatric Dosing Chart

The FDA label provides weight-based dosing using 250 mg/5 mL or 500 mg/5 mL suspensions, ranging from ½ teaspoon for 10 lb children to 2 teaspoons for children ≥70 lbs when using the 500 mg/5 mL formulation 1

Renal Impairment Adjustments

Dosing must be adjusted based on creatinine clearance to prevent drug accumulation. 1

• Initial dose: 1000 mg for all patients 1
• Maintenance dosing (500 mg at intervals based on CrCl):
  • CrCl >50 mL/min: Normal dosing (every 12 hours) 1
  • CrCl 25-50 mL/min: Every 12 hours 1
  • CrCl 10-25 mL/min: Every 24 hours 1
  • CrCl 0-10 mL/min: Every 36 hours 1

Key Pharmacokinetic Advantages

Cefadroxil offers distinct advantages over other first-generation oral cephalosporins (cephalexin, cephradine):

• Longer serum half-life allowing once or twice daily dosing versus four times daily for alternatives 6
• Food does not affect absorption, permitting administration with meals to reduce GI side effects 1, 6
• Higher and more sustained tissue concentrations than cephalexin or cephradine 6
• These properties enhance compliance, critical for outpatient infection management 6

Administration Considerations

• Can be given with or without food 1
• Administration with food may reduce GI complaints without affecting efficacy 1
• Suspension preparation: Reconstitute with specified water volume, shake well, refrigerate after reconstitution, discard after 14 days 1
• Shake suspension well before each use 1

Common Pitfalls

• Inadequate treatment duration for streptococcal infections: Must complete full 10-day course to prevent rheumatic fever and glomerulonephritis, even if symptoms resolve earlier 1
• Failure to adjust for renal impairment: Drug accumulation occurs with reduced creatinine clearance, requiring interval extension 1
• Inappropriate use for resistant organisms: Cefadroxil has no activity against MRSA, Pseudomonas, or atypical pathogens 3
• Assuming four-times-daily dosing: Unlike older oral cephalosporins, cefadroxil's pharmacokinetics support once or twice daily administration 6