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# Forcef (cephradine)
## Overview
Cephradine is a first-generation **cephalosporin** antibiotic. It is bactericidal, inhibiting bacterial cell wall synthesis. Primarily active against **gram-positive** organisms (including staphylococci and streptococci, but not MRSA) and some **gram-negative** organisms (e.g., *E. coli*, *Klebsiella*). It is **acid-stable** and available in oral and parenteral forms.
## Primary Indications
- **Upper/lower respiratory tract infections** (e.g., pharyngitis, tonsillitis, bronchitis, pneumonia)
- **Urinary tract infections** (UTIs)
- **Skin and soft tissue infections** (uncomplicated)
- **Otitis media**
- **Bone and joint infections** (limited use; often requires higher-dose or longer therapy)
- Used for **surgical prophylaxis** in some protocols (local guidelines may vary)
## Adult Dosing
- **Oral:** 250-500 mg every 6 hours (depending on severity); maximum 4 g/day
- **IM/IV:** 500 mg-1 g every 6 hours; severe infections may require 2-4 g/day in divided doses
- **For uncomplicated UTI:** 500 mg every 12 hours
## Pediatric Dosing
- **Oral suspension** (25, 50, or 100 mg/mL)
- **General:** 25-50 mg/kg/day in 3-4 divided doses
- **Severe infections:** 50-100 mg/kg/day in 3-4 divided doses
- **Maximum:** 4 g/day (do not exceed adult dose)
- **Otitis media:** 75-100 mg/kg/day in 3-4 divided doses
*Note: Exact dosing frequency (e.g., q6h vs. q8h) varies by local protocol and formulation.*
## Dose Adjustments
- **Renal impairment:** Reduce dose or extend interval for CrCl <20 mL/min. No established precise guideline; consider:
- CrCl 10-50 mL/min: reduce to 50% of normal dose
- CrCl <10 mL/min: reduce to 25% of normal dose
- **Hepatic impairment:** No specific adjustment needed in mild-moderate disease; caution in severe dysfunction
## Contraindications
- **Hypersensitivity** to cephalosporins or penicillins (severe cross-reaction risk)
- **Severe anaphylaxis** to betalactam antibiotics
## Adverse Effects
- **Common:** Diarrhea, nausea, rash, mild transaminitis
- **Serious:**
- **C. difficile** colitis (especially with prolonged use)
- **Anaphylaxis** (rare)
- **Acute interstitial nephritis** (rare)
- **Hemolytic anemia** (very rare)
- **Injection site reactions** (phlebitis, pain)
## Key Drug Interactions
- **Probenecid** (reduces renal excretion, increases cephradine levels)
- **Warfarin** (may enhance INR; monitor if concurrent)
- **Loop diuretics** (increased nephrotoxicity risk; avoid co-administration)
- **Live vaccines** (may reduce efficacy; avoid if possible during therapy)
## Monitoring
- **Renal function** (baseline and periodic, especially in elderly or those with renal disease)
- **CBC** (for anemia or leukopenia)
- **Allergic symptoms** (first dose and throughout)
- **INR** (if on warfarin)
## Clinical Pearls
- **Not active** against MRSA, most anaerobes, or *Pseudomonas*
- **Oral absorption** is stable in presence of food (less effect than some other cephalosporins)
- **Cross-reactivity** with penicillin allergy: ~1-10% risk; use caution
- **Storage** of oral suspension: refrigerate or room temperature; discard after 7-14 days per label
- **Short half-life** (~0.5-1 hour); requires frequent dosing (q6h)
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**Disclaimer:** This information is for educational purposes only and does not replace clinical judgment or current local guidelines. Always verify with the most recent prescribing information and product-specific labeling for dosing, indications, and safety updates.
