Usual Adult Dose for Skin or Soft Tissue Infection

1 gram orally once a day OR in divided doses given 2 times a day

Comments:

• The duration of therapy in beta-hemolytic streptococcal infections is at least 10 days.
• Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Use: Treatment of skin and structure infections caused by staphylococci and/or streptococci

Usual Adult Dose for Tonsillitis/Pharyngitis

1 gram orally once a day OR in divided doses given 2 times a day

• Duration of therapy: 10 days

Comments:

• This drug is generally effective in eradicating nasopharynx Streptococcus pyogenes infections; there are no data that establish efficacy in the prevention of rheumatic fever.
• Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Use: Treatment of pharyngitis and/or tonsillitis caused by S pyogenes (Group A beta-hemolytic streptococci)

Infectious Diseases Society of America (IDSA) Recommendations:
30 mg/kg orally once a day

• Maximum dose: 1 gram/day
• Duration of therapy: 10 days

Comment: This drug should be avoided in patients with immediate hypersensitivity to penicillin.

Use: Treatment of group A streptococcal pharyngitis in patients with penicillin allergies

Usual Adult Dose for Cystitis

Uncomplicated lower urinary tract infections (e.g., cystitis): 1 to 2 grams orally once a day OR in divided doses given 2 times a day
Complicated urinary tract infections: 1 gram orally 2 times a day

Comment: Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Use: Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, and Proteus mirabilis

Usual Adult Dose for Pyelonephritis

Uncomplicated lower urinary tract infections (e.g., cystitis): 1 to 2 grams orally once a day OR in divided doses given 2 times a day
Complicated urinary tract infections: 1 gram orally 2 times a day

Comment: Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Use: Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, and Proteus mirabilis

Usual Adult Dose for Urinary Tract Infection

Uncomplicated lower urinary tract infections (e.g., cystitis): 1 to 2 grams orally once a day OR in divided doses given 2 times a day
Complicated urinary tract infections: 1 gram orally 2 times a day

Comment: Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Use: Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, and Proteus mirabilis

Usual Adult Dose for Osteomyelitis

Uncomplicated lower urinary tract infections (e.g., cystitis): 1 to 2 grams orally once a day OR in divided doses given 2 times a day
Complicated urinary tract infections: 1 gram orally 2 times a day

Comment: Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Use: Treatment of urinary tract infections caused by Escherichia coli, Klebsiella species, and Proteus mirabilis

Usual Pediatric Dose for Urinary Tract Infection

Children: 15 mg/kg orally every 12 hours

Comments:

• The duration of therapy in beta-hemolytic streptococcal infections is at least 10 days.
• Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Uses:

• Treatment of skin and structure infections caused by staphylococci and/or streptococci
• Treatment of urinary tract infections caused by E coli, Klebsiella species, and P mirabilis

Usual Pediatric Dose for Skin and Structure Infection

Children: 15 mg/kg orally every 12 hours

Comments:

• The duration of therapy in beta-hemolytic streptococcal infections is at least 10 days.
• Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Uses:

• Treatment of skin and structure infections caused by staphylococci and/or streptococci
• Treatment of urinary tract infections caused by E coli, Klebsiella species, and P mirabilis

Usual Pediatric Dose for Tonsillitis/Pharyngitis

Children: 30 mg/kg orally per day, given once a day OR in divided doses 2 times a day

Comments:

• The duration of therapy in beta-hemolytic streptococcal infections is at least 10 days.
• This drug is generally effective in eradicating nasopharynx S pyogenes infections; there are no data that establish efficacy in the prevention of rheumatic fever.
• Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Uses:

• Treatment of impetigo caused by staphylococci and/or streptococci
• Treatment of pharyngitis and/or tonsillitis caused by S pyogenes (Group A beta-hemolytic streptococci)

IDSA Recommendations:
30 mg/kg orally once a day

• Maximum dose: 1 gram/day
• Duration of therapy: 10 days

Comment: This drug should be avoided in patients with immediate hypersensitivity to penicillin.

Use: Treatment of group A streptococcal pharyngitis in patients with penicillin-allergies

Usual Pediatric Dose for Impetigo

Children: 30 mg/kg orally per day, given once a day OR in divided doses 2 times a day

Comments:

• The duration of therapy in beta-hemolytic streptococcal infections is at least 10 days.
• This drug is generally effective in eradicating nasopharynx S pyogenes infections; there are no data that establish efficacy in the prevention of rheumatic fever.
• Treatment may be started empirically but should be adjusted once the causative organism is identified and susceptibility results are available.

Uses:

• Treatment of impetigo caused by staphylococci and/or streptococci
• Treatment of pharyngitis and/or tonsillitis caused by S pyogenes (Group A beta-hemolytic streptococci)

IDSA Recommendations:
30 mg/kg orally once a day

• Maximum dose: 1 gram/day
• Duration of therapy: 10 days

Comment: This drug should be avoided in patients with immediate hypersensitivity to penicillin.

Use: Treatment of group A streptococcal pharyngitis in patients with penicillin-allergies

Usual Pediatric Dose for Bacterial Infection

American Academy of Pediatrics (AAP) Recommendations:
15 mg/kg orally 2 times a day

• Maximum dose: 2 grams/day

Renal Dose Adjustments

CrCl 25 to 50 mL/min: 1 g orally followed by 500 mg orally every 12 hours
CrCl 10 to 25 mL/min: 1 g orally followed by 500 mg orally every 24 hours
CrCl 0 to 10 mL/min: 1 g orally followed by 500 mg orally every 36 hours

Liver Dose Adjustments

Data not available

Precautions

CONTRAINDICATIONS:

• Patients with a known allergy to the cephalosporin group of antibiotics

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:

• This drug may be taken without regard to meals; however, food consumed concomitantly during administration may decrease gastrointestinal side effects.

Storage requirements:

• Capsules and tablets: Protect from moisture.

General:

• Local epidemiological and susceptibility patterns should be used to guide treatment selection in the absence of patient-specific culture and susceptibility information.

Monitoring:

• HEPATIC: Hepatic function tests when necessary
• IMMUNOLOGIC: Culture and susceptibility tests prior to and during treatment
• RENAL: Renal function tests when necessary
• Inform patients that this drug may cause dizziness, fatigue, headache, nervousness, and sleeplessness, and they should avoid driving or operating machinery if these side effects occur.

Patient advice:

• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
• Patients should be directed to take the full course of treatment, even if they feel better.
• Patients should be instructed to report signs/symptoms of Clostridium difficile (e.g., watery/bloody stools, stomach cramps, fever), for up to 2 months after stopping treatment.

Frequently asked questions

• What is the best antibiotic to treat strep throat?