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First-generation oral cephalosporin Pregnancy: Considered safe — extensive use in pregnancy without teratogenic signal.

Cefadroxil

Brand names: Baxan (UK historical), Duricef

Adult dose

Dose: 500 mg–1 g BD for skin/soft tissue infection or UTI; 500 mg BD for streptococcal pharyngitis (10 days).
Route: Oral
Frequency: Twice daily
Max: 2 g/day
Take with food if GI upset; otherwise no food restrictions. Long half-life (90 min) allows BD dosing — useful adherence advantage over cefalexin (QDS).

Paediatric dose

Dose: 25 mg/kg
Route: Oral
Frequency: BD
Max: 2 g/day
25–50 mg/kg/day in 2 divided doses. Group A strep pharyngitis: 30 mg/kg OD or 15 mg/kg BD for 10 days.

Dose adjustments

Renal

CrCl 25–50: 1 g loading then 500 mg BD. CrCl 10–25: 1 g loading then 500 mg OD. CrCl <10: 1 g loading then 500 mg every 36 hours. Dialysis: dose after dialysis.

Paediatric weight-based calculator

25–50 mg/kg/day in 2 divided doses. Group A strep pharyngitis: 30 mg/kg OD or 15 mg/kg BD for 10 days.

Clinical pearls

  • First-generation oral cephalosporin — covers Gram-positive (Staph aureus including MSSA, Streptococci) and limited Gram-negative (E. coli, Proteus, Klebsiella).
  • Cefalexin is the more common UK choice (more available); cefadroxil's BD dosing is advantageous when adherence is a concern.
  • Useful for: streptococcal pharyngitis (alternative to penicillin), MSSA cellulitis, uncomplicated UTI in pregnancy.
  • NOT effective against MRSA, Pseudomonas, anaerobes, or atypicals.
  • Cross-reactivity with penicillin is highest in those with anaphylaxis to penicillin — avoid; use macrolide or clindamycin instead.
  • UK availability of Baxan is limited — may need import or specialist supply.

Contraindications

  • Hypersensitivity to cephalosporins
  • History of severe immediate reaction (anaphylaxis) to penicillins (cross-reactivity ~1–10%)

Side effects

  • GI upset: nausea, diarrhoea, vomiting
  • Rash, urticaria, pruritus
  • Hypersensitivity reactions (rare — anaphylaxis, Stevens-Johnson, TEN)
  • Vaginal candidiasis
  • Eosinophilia, transient neutropenia
  • Raised LFTs (transient)
  • Clostridioides difficile colitis (less than broad-spectrum agents)

Interactions

  • Probenecid: ↑ cefadroxil levels (used clinically in some indications)
  • Aminoglycosides: additive nephrotoxicity
  • Oral contraceptives: theoretical ↓ efficacy via gut flora disruption (limited evidence)
  • Warfarin: rare ↑ INR via vitamin K-producing flora suppression

Monitoring

  • Symptom resolution at 48–72 hours; switch to narrower agent guided by sensitivities

Reference: BNFc; BNF 90; SmPC Duricef; NICE CKS Sore Throat; UKHSA UTI Guidelines 2024. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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