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# Forcef (cephradine)
## Overview
Cephradine is a first-generation cephalosporin antibiotic. It is bactericidal and works by inhibiting bacterial cell wall synthesis.
## Primary Indications
* **Respiratory tract infections:** Pneumonia, bronchitis.
* **Urinary tract infections:** Pyelonephritis, cystitis.
* **Skin and soft tissue infections:** Cellulitis, abscesses, impetigo.
* **Bone and joint infections:** Osteomyelitis.
* **Septicemia** due to susceptible organisms.
* **Prophylaxis** during certain surgical procedures.
## Adult Dosing
* **General infections:** 250 mg to 500 mg orally every 6 hours, or 500 mg to 1 g intravenously/intramuscularly every 6 to 12 hours.
* **Severe infections:** May require higher doses, up to 1 g orally every 6 hours or 4 g intravenously/intramuscularly per day.
* **Surgical prophylaxis:** 1 g intravenously 30-60 minutes before incision, with subsequent doses of 500 mg to 1 g every 4 to 6 hours for up to 24 hours post-operatively.
* **Maximum dose:** Generally 4 grams per day.
## Pediatric Dosing
* **Oral:** 25 mg/kg/day to 50 mg/kg/day divided into 4 doses every 6 hours.
* **Severe infections:** May require up to 100 mg/kg/day divided into 4 doses.
* **Intravenous/Intramuscular:** 25 mg/kg/day to 50 mg/kg/day divided into 4 doses every 6 hours.
* **Severe infections IV/IM:** May require up to 100 mg/kg/day divided into 4 doses, not to exceed adult maximum.
## Dose Adjustments
* **Renal impairment:** Adjust dose based on creatinine clearance. Dosing guides vary; consult specific renal dose adjustment guidelines.
## Contraindications
* Known hypersensitivity to cephradine or other cephalosporins.
* History of immediate or severe allergic reaction to penicillin.
## Adverse Effects
* **Common:** Diarrhea, nausea, vomiting, rash, pruritus.
* **Serious:** Anaphylaxis, Clostridioides difficile-associated diarrhea, Stevens-Johnson syndrome, toxic epidermal necrolysis, hepatic dysfunction, hematologic changes (eosinophilia, leukopenia, thrombocytopenia).
## Key Drug Interactions
* **Probenecid:** May increase and prolong cephradine plasma concentrations.
* **Aminoglycosides:** Increased risk of nephrotoxicity when used concurrently.
* **Oral contraceptives:** Cephalosporins may reduce the efficacy of oral contraceptives.
## Monitoring
* Monitor for signs and symptoms of hypersensitivity reactions.
* Monitor for signs and symptoms of C. difficile infection (e.g., diarrhea).
* Assess renal function, especially in patients with pre-existing renal disease or those receiving nephrotoxic agents.
* Monitor for potential electrolyte imbalances if large volumes of IV fluids are administered.
## Clinical Pearls
* Cephradine is generally well-tolerated but can cause gastrointestinal upset.
* Considered a first-generation cephalosporin, with good activity against Gram-positive organisms and some Gram-negative coverage.
* Ensure adequate hydration when administering intravenously to prevent crystalluria.
* For patients with a penicillin allergy, cross-reactivity with cephalosporins is possible, though less common with first-generation agents.
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**Disclaimer:** This information is intended for clinical professionals and does not replace the need to consult the most current official prescribing information, institutional protocols, or a pharmacist. Dosing and recommendations may vary.
