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First-generation cephalosporin Pregnancy: Fertility: although animal studies have shown no teratogenic effects, safety in pregnancy has not been established. Pregnancy: as with all medicines, use should be avoided in pregnancy especially in the first trimester, unless considered essential by the physician. Breast-feeding: cefradine is excreted in breast milk and therefore should be used with caution in lactating mothers. (UK SPC §4.6)

Cefradine

Brand names: Velosef (legacy)

Cefradine is a first-generation cephalosporin antibacterial used for susceptible infections of the skin and soft tissue, respiratory tract and urinary tract.

Adult dose

Dose: Respiratory tract infections and skin and soft tissue infections: 250 mg or 500 mg four times daily, or 500 mg or 1 g twice daily, depending on the severity and site of infection. Urinary tract infections: 500 mg four times daily or 1 g twice daily (may need to be increased for severe or chronic infections). Severe or chronic infection (all patients irrespective of age and weight): larger doses of up to 1 g four times daily may be given.
Route: Oral
Frequency: Four times daily or twice daily (per regimen above)
Max: Up to 1 g four times daily in severe or chronic infection (SPC: 'larger doses of up to 1g four times daily may be given')
SPC §4.2 Adults (verbatim): 'Respiratory tract infections and skin and soft tissue infections - the usual dose is 250mg or 500mg four times daily or 500mg or 1g twice daily depending on the severity and site of infection. Urinary tract infections - the usual dose is 500mg four times daily or 1g twice daily. This may need to be increased for severe or chronic infections. Prolonged intensive therapy is needed for complications such as prostatitis and epididymitis.' Elderly: 'As for adults.' All patients irrespective of age and weight: 'In the case of severe or chronic infection larger doses of up to 1g four times daily may be given.' DURATION (verbatim): administration should be continued for a minimum of 48-72 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained; for infections caused by haemolytic strains of streptococci a minimum of 10 days treatment is recommended to guard against the risk of rheumatic fever or glomerulo-nephritis; for 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.' Cefradine may be taken without regard to meals. 'As cefradine is available in both injectable and oral forms, patients may be changed from injection to capsules at the same dosage level.' SCOPE: the source product is Cefradine 500mg Capsules (§2: each capsule contains cefradine monohydrate equivalent to 500mg cefradine) - ORAL ONLY. The page's other route (IV) is NOT covered by this SPC and no IV dose is given. §4.1 also lists prophylaxis of postoperative infections (administer immediately prior to surgery and continue during the post-operative period) but the §4.2 text prints no prophylaxis dose, so none is stated.

Paediatric dose

Dose: 25 to 50 mg/kg/day total; for otitis media 75 to 100 mg/kg/day
Route: Oral
Frequency: Usual dose: two or four equally divided doses. Otitis media: divided doses every 6 to 12 hours
Max: 4 g per day
SPC §4.2 Paediatric population (verbatim): 'The usual dose is 25 to 50 mg/kg/day total, given in two or four equally divided doses. For otitis media daily doses from 75 to 100mg/kg in divided doses every 6 to 12 hours are recommended. Maximum dose 4g per day.' These are per-DAY totals, not per-dose figures. The '4g per day' maximum is printed inside the paediatric paragraph. 'Doses for children should not exceed those recommended for adults.' 'Further modification of the dosage schedule may be required in children' with renal impairment. The source product is a 500mg capsule; the SPC gives no paediatric formulation or age/weight bands. Verify against a children's formulary before use.

Dose adjustments

Renal

SPC §4.2 'Patients with impaired renal or hepatic function should be monitored as modifications of the dosage schedule may be required.' §4.4: 'Dosage should be reduced in renal failure.' Dosage in renal impairment, patients not on dialysis (guideline based on a dosage of 500mg 6 hourly and on creatinine clearance): more than 20 ml/min - 500 mg every 6 hours; 5-20 ml/min - 250 mg every 6 hours; less than 5 ml/min - 250 mg every 50-70 hours. 'Adjustments to the dosage schedule provided may be necessary because of the dosage selected and individual variation.' Patients on chronic, intermittent haemodialysis: 250 mg at start of haemodialysis; 250 mg 6-12 hours after start; 250 mg 36-48 hours after start; 250 mg at start of next haemodialysis if more than 30 hours after the previous dose. 'Further modification of the dosage schedule may be required in children.'

Hepatic

SPC §4.2: patients with impaired hepatic function should be monitored as modifications of the dosage schedule may be required. No numeric hepatic dose adjustment is printed.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substance or to any of the excipients listed in section 6.1 (§4.3)

Side effects

  • Undesirable effects are uncommon and mainly mild; limited essentially to gastrointestinal disturbances and, on occasion, hypersensitivity phenomena (§4.8)
  • Rarely: antibiotic-associated colitis; headache; vomiting; abdominal discomfort (§4.8)
  • Frequency unknown: diarrhoea, nausea, glossitis, heartburn; vaginitis, candidal overgrowth, candidiasis (§4.8)
  • Frequency unknown: rashes, pruritus, urticaria, oedema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis (§4.8)
  • Frequency unknown: anaphylaxis, serum sickness-like reactions, fever, arthralgia (§4.8)
  • Frequency unknown: eosinophilia and blood disorders including thrombocytopenia, leucopenia, agranulocytosis, aplastic anaemia and haemolytic anaemia; positive direct Coombs' test (§4.8)
  • Frequency unknown: reversible interstitial nephritis; transient hepatitis, cholestatic jaundice, liver enzyme disturbances; elevated blood urea nitrogen, serum creatinine, ALT, AST, total bilirubin, alkaline phosphatase (§4.8)
  • Frequency unknown: dizziness, nervousness, confusion, sleep disturbances, hyperactivity, hypertonia, tightness in the chest, joint pain (§4.8)

Interactions

  • Loop diuretics may increase the nephrotoxicity of cephalosporins (§4.5)
  • Probenecid raises serum concentrations of cefradine by reducing renal clearance (§4.5)
  • Partial allergenicity between penicillins and cephalosporins - use with caution in patients with known penicillin hypersensitivity; reactions to both drug classes (including anaphylaxis) have occurred (§4.5)
  • False positive urinary glucose reaction with Benedict's or Fehling's solution or Clinitest tablets; does not occur with enzyme-based tests such as Clinistix or Diastix (§4.4)

Monitoring

  • Monitor patients with impaired renal or hepatic function; the dosage schedule may need modification (§4.2); dosage should be reduced in renal failure (§4.4)
  • Laboratory testing should be carried out to determine the causative agents and their sensitivity to cefradine; therapy may commence before sensitivity results are received (§4.1)
  • Chronic urinary tract infections: frequent bacteriological and clinical appraisal during therapy and possibly for several months afterwards (§4.2)
  • Prolonged use of antibiotics may result in overgrowth of non-susceptible organisms (§4.4)
  • Use enzyme-based urine glucose tests rather than Benedict's/Fehling's/Clinitest, which can give false positives (§4.4)

Clinical monograph

How it works

It is a beta-lactam that binds penicillin-binding proteins to inhibit bacterial cell-wall synthesis, giving a bactericidal effect with good activity against many Gram-positive organisms.

Prescribing in practice

  • Avoid in patients with a history of immediate hypersensitivity to penicillins or other beta-lactams because of the risk of cross-reactivity.
  • As a first-generation agent it has limited Gram-negative cover, so it is not suitable for many resistant or hospital-acquired infections.
  • Dose adjustment is required in significant renal impairment, in line with the SPC.

Monitoring

Routine monitoring is not generally needed for short courses, but renal function should guide dosing and clinical response should be reviewed.

Counselling the patient

  • Complete the full prescribed course even if you feel better.
  • Report any rash, swelling, breathing difficulty, or severe or persistent diarrhoea.

Evidence & guidelines

Use is supported by standard UK prescribing references for susceptible infections rather than by a specific landmark trial.

Reference: BSAC; UKHSA; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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