- Drugs List
- Therapeutic Indications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
Capsules containing 250mg cefradine
Capsules containing 500mg cefradine
Treatment of infections of the urinary and respiratory tracts and of the skin and soft tissues including:
Upper respiratory tract infections - pharyngitis, sinusitis, otitis media, tonsillitis, laryngo-tracheo bronchitis.
Lower respiratory tract infections- acute and chronic bronchitis, lobar and bronchopneumonia.
Urinary tract infections - cystitis, urethritis, pyelonephritis.
Skin and soft tissue infections - abscess, cellulitis, furunculosis, impetigo.
Cefradine has been shown to be effective in reducing the incidence of postoperative infections in patients undergoing surgical procedures associated with a high risk of infection. It is also of value where postoperative infections would be disastrous and where patients have a reduced host resistance to bacterial infection.
Bacteriology studies to determine the causative organisms and their sensitivity to cefradine should be performed. Therapy may be instituted prior to receiving the results of the sensitivity test.
Consideration should be given to official local guidance on the appropriate use of antibacterial agents.
Urinary tract infections
500mg four times a day
1g twice a day.
Severe or chronic infections may require larger doses. Prolonged intensive therapy is needed for complications such as prostatitis and epididymitis.
Respiratory tract infections and skin and soft tissue infections
250mg or 500mg four times a day
500mg or 1g twice daily depending on the severity and site of infections.
The following alternative dosing schedule may be suitable:
Surgical prophylaxis; Susceptible infections due to sensitive Gram-positive and Gram-negative bacteria
250mg to 500mg four times a day
500mg to 1g twice a day
Maximum dose: 1g four times a day in severe infections.
25mg/kg to 50mg/kg a day, given in two or four divided doses.
75mg/kg to 100mg/kg a day, given in divided doses every 6 to 12 hours. Maximum dose 4g per day.
Prevention of Staphylococcus aureus lung infection in cystic fibrosis
Children aged 7 to 18 years: 2g twice a day.
Surgical prophylaxis; Infections due to Gram-positive and Gram-negative bacteria
Children aged 12 to 18 years: 500mg to 1g twice daily or 250 to 500mg four times daily. Maximum dose is 1g four times daily in severe infections.
Children aged 7 to 12 years: 25mg/kg to 50mg/kg, given in two to four divided doses.
Patients with Renal Impairment
Patients not on dialysis
The following dosage schedule is suggested as a guideline based on a dosage of 500mg every six hours and on creatinine clearance.
Creatinine Clearance greater than 20ml/minute: 500mg every 6 hours.
Creatinine Clearance 5 to 20ml/minute: 250mg every 6 hours.
Creatinine Clearance less than 5ml/minute: 250mg every 50 to 70 hours
Patients on chronic, intermittent haemodialysis
250mg at the start of haemodialysis.
250mg 6 to 12 hours after the start.
250mg 36 to 48 hours after the start.
250mg at the start of the next haemodialysis session if greater than 30 hours have elapsed since the last dose.
Further modification of the dosage schedule may be required in children.
The Renal Drug Handbook suggests the following doses in renal impairment
Glomerular Filtration Rate 20 to 50ml/minute: Dose as in normal renal function.
Glomerular Filtration Rate 10 to 20ml/minute: Dose as in normal renal function.
Glomerular Filtration Rate less than 10ml/minute: 250mg to 500mg every six hours.
Additional Dosage Information
To reduce the incidence of postoperative infections
Protection is best ensured by achieving adequate local tissue concentrations at the time of contamination is likely to occur. Thus, cefradine should be administered immediately prior to surgery and continued during the post operative period.
Chronic infections in all patients, irrespective of age and weight
Larger doses (up to 1g four times a day) may be given for severe or chronic infections. Therapy should be continued for a minimum of 48 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. In infections caused by haemolytic strains of streptococci, a minimum of 10 days' treatment is recommended to guard against the risk of rheumatic fever or glomerulonephritis. In the treatment of chronic urinary tract infections, frequent bacteriological and clinical appraisal is necessary during therapy and may be necessary for several months afterwards. Persistent infections may require treatment for several weeks. Smaller doses than those indicated above should not be used. Doses for children should not exceed doses recommended for adults.
For oral administration. Cefradine may be given without regard to meals.
Precautions and Warnings
There are no specific precautions for use in the elderly except to monitor those patients with impaired renal or hepatic function.
Renal impairment - see Dosage; Renal Impairment
There is evidence of partial cross-allergenicity between the penicillins and the cephalosporins. Cefradine should therefore be used with caution in those patients with known hypersensitivity to penicillins. There have been instances of patients who have had reactions to both drug classes (including anaphylaxis).
Discontinue if drug-related rash or other hypersensitivity reaction occur.
Pregnancy - see Pregnancy section
Breastfeeding - see Lactation section
There is a possibility of development of pseudomembranous colitis and it is therefore important to consider its diagnosis in patients who develop diarrhoea whilst taking cefradine. The condition may range in severity from mild to life threatening with mild cases usually responding to cessation of therapy. Appropriate measures should be taken in moderate to severe cases.
Prolonged use may result in the overgrowth of non-susceptible organisms. The patient should therefore be observed carefully and if superinfection occurs, appropriate measures should be taken.
False positive Coombs' test and false positive urinary glucose tests (if tested for reducing substances) are possible - see Laboratory Tests.
Some formulations may contain lactose and should not be used in patients with galactosaemia, lactose intolerance and glucose-galactose malabsorption syndrome.
Use in Porphyria
Cephalosporins as a group are considered safe however, there is conflicting evidence regarding the safety of cefradine in porphyrias.
Pregnancy and Lactation
Although animal studies have not demonstrated any teratogenicity, safety in pregnancy has not been established.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Use with caution as cefradine is excreted in breast milk. Limited information indicates that maternal doses of oral cefradine produce low levels in milk that are not expected to cause adverse effects the nursing infant. Disruption of the infants gastrointestinal flora, resulting in diarrhoea or thrush has been reported.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Effects on Ability to Drive and Operate Machinery
Cefradine may cause dizziness. Patients should be aware that this can occur and that their ability to drive and operate machinery may be affected.
Hypersensitivity reactions. This is more likely to occur in individuals who have previously demonstrated hypersensitivity and those with a history of allergy, asthma, hay fever or urticaria.
Feeling of tightness in chest
Toxic epidermal necrolysis
Interstitial nephritis (reversible)
Serum sickness-like reactions
Alterations in hepatic enzymes
Effects on Laboratory Tests
After treatment with cefradine, a false positive reaction for glucose in the urine may occur with Benedict's or Fehling's solution or with reagent tablets such as Clinitest, but not with the enzyme based tests such as Clinistix or Diastix.
A false positive result for Coombs' test may occur.
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Shelf Life and Storage
Store below 25 degrees C
Last Full Review Date: November 2011
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 8th edition (2008) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.
Summary of Product Characteristics: Nicef Capsules 250mg/Cephradine Capsules 250mg. Galen Ltd. Revised September 1998
Summary of Product Characteristics: Nicef Capsules 500mg/Cephradine Capsules 500mg. Galen Ltd. Revised September 1998
The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 29 August 2017
UK Drugs in Lactation Advisory Service.
Available at: https://www.ukmicentral.nhs.uk/drugpreg/qrg_p1.asp
Last accessed: November 16, 2011
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Cephradine Last revised: February 12, 2010
Last accessed: November 16, 2011
Already a member? Log in
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.