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# Cephradine
## Overview
Cephradine is a first-generation cephalosporin antibiotic effective against many Gram-positive and some Gram-negative bacteria. It is available in oral and intravenous formulations.
## Primary Indications
* **Respiratory tract infections:** Pneumonia, bronchitis, pharyngitis.
* **Urinary tract infections:** Cystitis, pyelonephritis.
* **Skin and soft tissue infections:** Cellulitis, impetigo, furunculosis.
* **Bone and joint infections:** Osteomyelitis, septic arthritis.
* **Bacteremia:** Secondary to other infections.
## Adult Dosing
* **Oral:** 250 mg to 500 mg every 6 hours. Maximum dose is typically 4 grams per day.
* **Intravenous (IV):** 500 mg to 1 gram every 6 hours. Maximum dose is typically 4 grams per day.
* Specific dosing may vary depending on the severity and site of infection and local protocols.
## Pediatric Dosing
* **Oral:** 25 mg/kg/day divided into 4 doses (every 6 hours). Maximum 3 grams per day.
* **IV:** 50 mg/kg/day divided into 4 doses (every 6 hours). For severe infections, up to 100 mg/kg/day divided into 4 doses may be used. Maximum 4 grams per day.
* Dosing should be adjusted based on weight and clinical response.
## Dose Adjustments
* **Renal Impairment:** Dosage reduction is necessary in patients with impaired renal function. Consult specific guidelines for dose and frequency adjustments based on creatinine clearance (CrCl).
## Contraindications
* Hypersensitivity to cephradine or other cephalosporins.
* Hypersensitivity to penicillins may indicate cross-reactivity.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, abdominal pain, rash, pruritus.
* **Serious (Rare):** Anaphylaxis, Stevens-Johnson syndrome, Clostridioides difficile-associated diarrhea, neutropenia, eosinophilia, hepatitis, interstitial nephritis.
## Key Drug Interactions
* **Probenecid:** May decrease renal excretion of cephradine, leading to increased serum levels.
* **Oral anticoagulants (e.g., warfarin):** Cephradine may rarely affect prothrombin time. Monitor INR closely.
* **Aminoglycosides:** Concurrent use may increase risk of nephrotoxicity.
## Monitoring
* Assess for signs and symptoms of infection before and during treatment.
* Monitor for allergic reactions.
* Monitor renal function, especially in patients with pre-existing renal disease or those receiving other nephrotoxic drugs.
* Monitor for diarrhea or signs of C. difficile infection.
## Clinical Pearls
* Cephradine can be administered orally or intravenously; intravenous administration should be used for more severe infections or when oral administration is not feasible.
* Ensure adequate hydration to prevent crystalluria, especially with IV administration.
* Culture
