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# Forcef (cephradine)
## Overview
Cephradine is a first-generation cephalosporin antibiotic. It is bactericidal, inhibiting bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). It has significant activity against Gram-positive cocci (e.g., *Staphylococcus aureus*, *Streptococcus pyogenes*) and limited activity against some Gram-negative bacilli (e.g., *E. coli*, *Proteus mirabilis*, *Klebsiella*).
## Primary Indications
* Respiratory tract infections
* Urinary tract infections (UTIs)
* Skin and soft tissue infections
* Bone and joint infections
* Otitis media
## Adult Dosing
* **Mild to moderate infections:** 250 mg to 500 mg orally every 6 or 12 hours.
* **Severe infections:** Up to 1 gram orally every 6 hours.
* **Maximum daily dose:** 4 grams per day.
## Pediatric Dosing
* **General infections:** 25 mg/kg to 50 mg/kg per day in divided doses every 6 or 12 hours.
* **Otitis media:** 75 mg/kg per day in divided doses every 12 hours.
* **Maximum daily dose:** Do not exceed 4 grams per day; specific pediatric upper limits based on weight should be verified against local institutional protocols.
## Dose Adjustments
* **Renal Impairment:** Requires dose interval extension or reduction based on creatinine clearance (CrCl).
* CrCl 20–50 mL/min: 250 mg every 6–12 hours.
* CrCl 5–20 mL/min: 250 mg every 12–24 hours.
* CrCl <5 mL/min: 250 mg every 24–48 hours.
## Contraindications
* Known hypersensitivity to cephradine or other cephalosporins.
* History of severe allergic reactions (anaphylaxis/urticaria) to penicillins (due to the potential for cross-reactivity).
## Adverse Effects
* **Gastrointestinal:** Diarrhea, nausea, vomiting, abdominal pain.
* **Hypersensitivity:** Rash, urticaria, fever, pruritus.
* **Hematologic:** Transient neutropenia, eosinophilia.
* **Other:** Superinfection (e.g., *C. difficile*-associated diarrhea, candidiasis) with prolonged use.
## Key Drug Interactions
* **Probenecid:** Decreases the renal tubular secretion of cephalosporins, increasing serum concentrations.
* **Aminoglycosides:** Potential for additive nephrotoxicity.
* **BCG Vaccine:** Cephalosporins may diminish the therapeutic effect of the vaccine.
## Monitoring
* Monitor for signs of hypersensitivity reactions.
* Monitor renal baseline and periodic function during extended therapy.
* Assess for resolution of infection; monitor for secondary infections if treatment is prolonged.
## Clinical Pearls
* Cephradine is unique among first-generation cephalosporins as it is available in both oral and parenteral formulations (though oral is most common in ambulatory settings).
* Food may delay absorption but does not significantly decrease the total amount absorbed.
* Cross-reactivity between penicillins and cephalosporins is estimated at <5–10%; use extreme caution in patients with a history of IgE-mediated reactions to penicillin.
* Not indicated for the treatment of MRSA or *Enterococcus* species.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies; always consult local institutional protocols, the current product monograph, or a standard drug information resource (such as Lexicomp or Micromedex) before prescribing or administering medication.
