• Type: First generation cephalosporin
  • Dosage Forms: capsule, oral suspension, tablet
  • Dosage Strengths: capsule: 500mg; oral suspension: 250mg/5mL, 500mg/5mL; tablet: 1g
  • Routes of Administration: PO
  • Common Trade Names: Duricef, Ultracef

Adult Dosing

Infections, bacteria

  • 1-2g/day PO divided q12-24h

Pharyngitis/tonsillitis, streptococcal

  • 1g PO divided q12-24h x 10days

Pediatric Dosing

  • infections, bacterial
    • 30mg/kg/day PO divided q12-24h max 2g/day
  • paryngitis/tonsillitis, streptococcal
    • 30mg/kg/day PO divided q12-24h x 10days, max 1g/day

Special Populations

  • Pregnancy Rating: B (no evidence of harm)
  • Lactation: safe (no risk/minimal risk)
  • Renal Dosing
    • Adult
      • GFR 25-50: 1g x1, then 500mg q12h
      • GFR 10-25: 1g x1 then 500mg q24h
      • GFR < 10: 1g x1, then 500mg q36h
      • HD: give 0.5-1g supplement
      • PD: 500mg q24h
    • Pediatric
      • GFR 10-25: give q24h
      • GFR < 10: give q36h
      • HD: give supplement
      • PD: no supplement
  • Hepatic Dosing
    • Adult: not defined
    • Pediatric: not defined


  • Allergy to class/drug

Adverse Reactions


  • anaphylaxis
  • Stevens-Johnson syndrome
  • toxic epidermal necrolysis
  • angioedema
  • neutropenia
  • thrombocytopenia
  • pancytopenia
  • anemia, hemolytic
  • aplastic anemia
  • hemorrhage
  • seizures
  • superinfection
  • C.difficile-associated diarrhea


  • diarrhea
  • nausea
  • dyspepsia
  • urticaria
  • pruritus
  • rash
  • vomiting
  • ALT, AST elevation


  • Half-life:
    • 78-96 min, 20-25hr (ESRD)
  • Metabolism:
    • minimal, site unknown
  • Excretion:
    • urine primarily (>90% unchanged)
  • Mechanism of Action:
    • bacteriacidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeS
Viridans strepS
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumX1
Staph. EpidermidisI
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeR
N. meningitidisR
Moraxella catarrhalisR
H. influenzaeX1
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negR
Enterobacter sp, AmpC posR
Serratia spR
Serratia marcescensX1
Salmonella spR
Shigella spR
Proteus mirabilisS
Proteus vulgarisR
Providencia sp.R
Morganella sp.R
Citrobacter freundiiR
Citrobacter diversusR
Citrobacter sp.X1
Aeromonas spX1
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaX1
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaX1
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
Bacteroides fragilisX1
Prevotella melaninogenicaX1
Clostridium difficileX1
Clostridium (not difficile)X1
Fusobacterium necrophorumX1
Peptostreptococcus sp.X1


  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also


  1. Sanford Guide to Antimicrobial Therapy 2014
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