- Undesirable Upper respiratory tract infections: sinusitis, pharyngitis, tonsillitis, laryngo-tracheo bronchitis and otitis media, and also
- Lower respiratory tract infections: bronchitis (acute and chronic), lobar pneumonia and bronchopneumonia.
- Urinary tract infections: cystitis, urethritis and pyelonephritis.
- Skin and soft tissue infections: abscess, cellulitis, furunculosis and impetigo.
The following microorganisms are susceptible, in vitro to Cephradine:
- Gram-positive: Staphylococci (both penicillin sensitive and resistant strains and penicillinase-producing species), Streptococci, Streptococci pyogenes (beta haemolytic), Streptococcus pneumonia.
- Gram-negative: Escherichia coli, Klebsiella spp, Proteus mirabilis, Haemophilus influenza, Shigella spp, Salmonella spp (including Salmonella typhi), Neisseria spp Many strains of E.coli and Staphylococcus aureus that produce the enzyme penicillinase and thus are ampicillin resistant, are susceptible to Cephradine which is unaffected by this enzyme.
Dosage & Administration
- Urinary tract infections: 500mg four times daily or 1g twice daily. Infections which are severe or chronic may necessitate the administration of higher doses. Where complications arise including prostatitis and epididymitis continued intensive treatment is required.
- Respiratory tract infections: 250 to 500mg four times daily or 500mg to 1g twice daily, dependent on the site and severity of the infection.
- Skin and soft tissue infections: 250 to 500mg four times daily or 500mg to 1g twice daily, again dependent on the site and severity of the infection.
- Total daily dose of 25 to 50mg/kg given in two or four equally divided doses.
- Otitis media: Total daily dose of 75 to 100mg/kg given in divided doses 6 to 12 hourly.
- Maximum daily dosage: 4 gm
Elderly: The normal adult dose is appropriate. Patients with impaired renal or hepatic function should be monitored during treatment.
For injectable administration–
- Adult: The usual dose is 2-4 gm daily in four equally divided doses up to 8 gm daily. For prophylaxis a single preoperative dose of 1-2 gm intramuscularly or intravenously is given.
- Children: The dose is 50-100 mg/kg daily in four equally divided doses, up to 300 mg/kg daily in severe infection.
- Blood and lymphatic system disorders- Unknown: blood disorders (including thrombocytopenia, leucopenia, agranulocytosis, aplastic anaemia and haemolytic anaemia)
- Immune system disorders- Unknown: Fever, serum sickness like reactions, anaphylaxis
- Psychiatric disorders- Unknown: Confusion, sleep disturbances
- Nervous system disorders- Unknown: hyperactivity, hypertonia, dizziness, nervousness; Rarely: Headache
- Hepatobiliary disorders- Frequency unknown: Liver, enzyme disturbances, transient hepatitis, cholestatic jaundice
- Renal and urinary disorders- Unknown: Reversible interstitial nephritis
- Investigations- Unknown: Elevation of blood urea nitrogen, serum creatinine, alanine aminotransferase, aspartate aminotransferase, total bilirubin, alkaline phosphatase.
Pregnancy & Lactation
Precautions & Warnings
- Prolonged use of an anti-infective may result in the development of superinfection due to the emergence of resistant organisms.
- Cephradine should be administered with care to patients hypersensitive to penicillins because of the risk of cross-sensitivity between beta-lactam antibiotics.
- Cephalosporin antibiotics may cause a positive result in Coombs’ testing. When Coombs testing is performed on neonates whose mothers received cephalosporins prior to labour, it should be noted that a positive result may be due to the drug.
- Cephradine may cause a false positive urine glucose result when Benedict’s or Fehling’s solutions or tablets such as Clinitest are used in the testing. This does not occur with enzyme-based tests (e.g. Clinistix, Diastix).
- Dosage adjustment is necessary in renal impairment.
- This product contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Use in Special Populations
- CrCl: >20 ml/min: 500 mg every 6 hours
- CrCl: 5-20 ml/min: 250 mg every 6 hours
- CrCl: <5 ml/min: 250 mg every 50-70 hours.
Recommendations for patients on chronic, intermittent haemodialysis:
- 250 mg at the start of haemodialysis
- 250 mg 6 to 12 hours after the start
- 250 mg 36 to 48 hours after the start
- 250 mg at the start of the next haemodialysis session if more than 30 hours have elapsed since the last dose.
Additional Information for all patients Regardless of patient age or weight, higher doses of up to 1 gm four times daily may be required for infections which are chronic or severe. Treatment should continue for at least 2 to 3 days after symptoms have resolved or bacteria have been eradicated. To reduce the possibility of rheumatic fever or glomerulonephritis resulting from infections with haemolytic streptococci, treatment should be continued for at least 10 days. Throughout treatment of chronic urinary tract infections and for several months thereafter, regular bacteriological and clinical monitoring is required.
Doses below those recommended above should not be prescribed. Paediatric dosages should not exceed those specified for adults, regardless of severity of infection. It may be necessary to continue Cephradine therapy for several weeks in persistent infections. Patients may be transferred from intramuscular/intravenous Cephradine therapy to oral treatment at the same dosage level.