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Cefadroxil as Oral Transitional Therapy for Gram-Positive Bacteremia With or Without Non-Vertebral Osteomyelitis: A
Devin C Clark1,2, Rachel Baden1,2, Josh Banerjee1,2
1Department of Medicine, Los Angeles General Medical Center, Los Angeles, California, USA.
Open Forum Infectious Diseases
|August 11, 2026
Summary
Cefadroxil demonstrates comparable effectiveness and safety to intravenous or other oral therapies for Gram-positive cocci bloodstream infections. This oral antibiotic is a viable option for treating BSI and osteomyelitis, excluding specific complex cases.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- Limited clinical data exist for oral cefadroxil in treating Gram-positive cocci (GPC) bloodstream infections (BSI) and osteomyelitis.
- Cefadroxil possesses favorable pharmacokinetic properties for these indications.
Purpose of the Study:
- To evaluate the efficacy and safety of oral cefadroxil as a transitional therapy for GPC BSI, with or without osteomyelitis.
- To compare cefadroxil outcomes against intravenous-only or other oral antibiotic regimens.
Main Methods:
- Multicenter, retrospective cohort study of adult patients with susceptible GPC BSI.
- Compared cefadroxil to IV-only or other oral transitional therapies.
- Primary outcome: 90-day survival without infection progression or relapse. Secondary outcomes: mortality, recurrent bacteremia, readmission.
Main Results:
- Treatment success rates were similar across cefadroxil (91%), IV-only (94%), and other oral (93%) groups.
- Cefadroxil was associated with a higher proportion of skin and soft-tissue infection sources.
- Mortality, readmission, and adverse events were comparable between treatment groups.
Conclusions:
- Cefadroxil is an effective and safe oral transitional therapy for GPC BSI, with or without nonvertebral osteomyelitis.
- Outcomes were similar to IV or other oral alternatives in patients without endocarditis, vertebral osteomyelitis, or CNS/prosthetic infections.
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