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Pronunciation |
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(sef
a DROKS
il) |
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U.S. Brand
Names |
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Duricef® |
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Generic
Available |
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No |
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Synonyms |
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Cefadroxil Monohydrate |
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Pharmacological Index |
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Antibiotic, Cephalosporin (First Generation) |
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Use |
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Dental: Alternative antibiotic for prevention of bacterial endocarditis.
Individuals allergic to amoxicillin (penicillins) may receive cefadroxil
provided they have not had an immediate, local, or systemic IgE-mediated
anaphylactic allergic reaction to penicillin.
Medical: Treatment of susceptible bacterial infections, including those
caused by group A beta-hemolytic Streptococcus; prophylaxis against
bacterial endocarditis in patients who are allergic to penicillin and undergoing
surgical or dermal procedures |
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Pregnancy Risk
Factor |
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B |
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Contraindications |
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Hypersensitivity to cefadroxil or other cephalosporins |
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Warnings/Precautions |
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Modify dosage in patients with severe renal impairment; prolonged use may
result in superinfection; use with caution in patients with a history of
penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis,
urticaria); may cause antibiotic-associated colitis or colitis secondary to
C. difficile |
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Adverse
Reactions |
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1% to 10%: Gastrointestinal: Diarrhea
<1%: Anaphylaxis, rash (maculopapular and erythematous), erythema
multiforme, Stevens-Johnson syndrome, serum sickness, arthralgia, urticaria,
pruritus, angioedema, pseudomembranous colitis, abdominal pain, dyspepsia,
nausea, vomiting, elevated transaminases, cholestasis, vaginitis, neutropenia,
agranulocytosis, thrombocytopenia, fever
Reactions reported with other cephalosporins include toxic epidermal
necrolysis, abdominal pain, superinfection. renal dysfunction, toxic
nephropathy, aplastic anemia, hemolytic anemia, hemorrhage, prolonged
prothrombin time, increased BUN, increased creatinine, eosinophilia,
pancytopenia, seizures |
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Overdosage/Toxicology |
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After acute overdose, most agents cause only nausea, vomiting, and diarrhea,
although neuromuscular hypersensitivity and seizures are possible, especially in
patients with renal insufficiency; many beta-lactam antibiotics have the
potential to cause neuromuscular hyperirritability or seizures
Hemodialysis may be helpful to aid in the removal of the drug from the blood
but not usually indicated, otherwise most treatment is supportive or symptom
directed following GI decontamination |
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Drug
Interactions |
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Increased effect: Probenecid may decrease cephalosporin elimination
Increased toxicity: Furosemide, aminoglycosides may be a possible additive to
nephrotoxicity |
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Stability |
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Refrigerate suspension after reconstitution; discard after 14
days |
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Mechanism of
Action |
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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. |
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Pharmacodynamics/Kinetics |
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Absorption: Oral: Rapid and well absorbed from GI tract
Distribution: Widely distributed throughout the body and reaches therapeutic
concentrations in most tissues and body fluids, including synovial, pericardial,
pleural, and peritoneal fluids; also bile, sputum, and urine; also bone, the
myocardium, gallbladder, skin and soft tissue; crosses the placenta and appears
in breast milk
Protein binding: 20%
Half-life: 1-2 hours; 20-24 hours in renal failure
Time to peak serum concentration: Within 70-90 minutes
Elimination: >90% of dose excreted unchanged in urine within 8 hours
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Usual Dosage |
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Oral:
Adults: 1-2 g/day in 2 divided doses
Prophylaxis against bacterial endocarditis: 2 g 1 hour prior to the procedure
Dosing interval in renal impairment:
Clcr 10-25 mL/minute: Administer every 24 hours
Clcr <10 mL/minute: Administer every 36 hours
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Dietary
Considerations |
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Concomitant administration with food, infant formula, or cow's milk does
not significantly affect absorption |
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Monitoring
Parameters |
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Observe for signs and symptoms of anaphylaxis during first
dose |
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Test
Interactions |
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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 |
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Mental Health: Effects
on Mental Status |
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May cause nervousness; case reports of euphoria, delusion, illusions, and
depersonalization with cephalosporins |
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Mental Health:
Effects on Psychiatric
Treatment |
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May rarely cause neutropenia; use caution with clozapine and
carbamazepine |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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Take as directed, at regular intervals around-the-clock (with or without
food). Chilling oral suspension improves flavor (do not freeze). Complete full
course of medication, even if you feel better. Drink 2-3 L fluid/day. If
diarrhea occurs, yogurt or buttermilk may help. May cause false-positive test
with Clinitest®; use another form of testing. May
interfere with oral contraceptives; additional contraceptive measures are
necessary. Report severe, unresolved diarrhea; vaginal itching or drainage;
sores in mouth; blood, pus, or mucus in stool or urine; easy bleeding or
bruising; unusual fever or chills; rash; or respiratory difficulty.
Breast-feeding precautions: Consult prescriber if
breast-feeding. |
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Nursing
Implications |
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Administer around-the-clock to promote less variation in peak and trough
serum levels |
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Dosage Forms |
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Capsule, as monohydrate: 500 mg
Suspension, oral, as monohydrate: 125 mg/5 mL, 250 mg/5 mL, 500 mg/5 mL (50
mL, 100 mL)
Tablet, as monohydrate: 1 g |
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References |
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"Advisory Statement. Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements. American Dental Association; American Academy of Orthopedic Surgeons,"
J Am Dent Assoc, 1997, 128(7):1004-8.
Cutler RE, Blair AD, and Kelly MR,
"Cefadroxil Kinetics in Patients With Renal Insufficiency," Clin Pharmacol
Ther, 1979, 25(5 Pt 1):514-21.
Dajani AS, Taubert KA, Wilson W, et al,
"Prevention of Bacterial Endocarditis Recommendations by the American Heart Association,"
JAMA, 1997, 277(22):1794-801.
Donowitz GR and Mandell GL, "Beta-Lactam Antibiotics," N Engl J Med,
1988, 318(7):419-26 and 318(8):490-500.
Marshall WF and Blair JE, "The Cephalosporins," Mayo Clin Proc, 1999,
74(2):187-95.
Smith GH, "Oral Cephalosporins in Perspective," DICP, 1990,
24(1):45-51. |
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