Cefradine

General

• Type: 1st generation Cephalosporin
• Dosage Forms: Capsules, Oral Suspension, Powder for injection
• Dosage Strengths: 250mg, 500mg; 125mg/5ml, 250mg/5ml; 500mg, 1g vials
• Routes of Administration: PO, IV, IM
• Common Trade Names: Velosef, Nicef

Adult Dosing

General

• Mild: 250-500mg PO q6h or 500mg-1g PO q12h
• Mod-Severe: 500mg-1g IM/IV q6h
• Max: 8g/day (IV), 4g/day (PO)

UTI, Uncomplicated

• 500mg PO q12h

Respiratory Tract Infections

• 250mg PO q6h or 500mg PO q12h

Skin and Soft Tissue

• 250mg PO q6h or 500mg PO q12h

Surgical Prophylaxis

• 1-2g IM/IV x1 (30-90 min before procedure)
• May repeat q4-6h for up to 24h

Pediatric Dosing

General (>9 Months)

• 25-50mg/kg/day PO/IM/IV divided q6h or q12h
• Severe: 75-100mg/kg/day PO/IM/IV divided q6h
• Max: 4g/day

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl >20: dose unchanged
    • CrCl 5-20: 250-500mg q6h (PO) or 50% of dose (IV)
    • CrCl <5: 250-500mg q12h (PO) or 25% of dose (IV)
    • Hemodialysis: Give dose after dialysis (250mg start, then 250mg q12h)
    • Peritoneal dialysis: Resistant to dialysis
  • Pediatric
    • Renal dosing adjustment required; specific guidelines vary, generally increase interval
• Hepatic
  • Not defined

Contraindications

• Allergy to class/drug (Cephalosporins)
• Immediate hypersensitivity to Penicillins

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Neutropenia
• Thrombocytopenia
• Clostridium difficile
• Nephrotoxicity (rare)
• Seizures (in renal impairment)

Common

• Diarrhea
• Nausea and Vomiting
• Rash
• Abdominal Pain
• Urticaria
• Pruritus
• Transient rise in BUN/Creatinine

Pharmacology

• Half-life: 0.7 - 1.3h (Extended in renal failure)
• Metabolism: Not significantly metabolized
• Excretion: Urine (>90% unchanged)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	R
	Moraxella catarrhalis	I
	H. influenzae	I
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	R
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	S
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	R
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	R
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	X1
	Clostridium difficile	X1
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)
• Cephalosporins