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Pharmacologic class: Second-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
Interferes with bacterial cell-wall synthesis, causing cell to rupture and die
Capsules: 250 mg, 500 mg
Oral suspension: 125 mg/5 ml, 187 mg/5 ml, 250 mg/5 ml, 375 mg/5 ml
Tablets (extended-release): 500 mg
Indications and dosages
➣ Uncomplicated skin infections caused by Staphylococcus aureus
Adults and children ages 16 and older: 375 mg P.O. (extended-release tablet) q 12 hours for 7 to 10 days
➣ Pharyngitis and tonsillitis not caused by Haemophilus influenzae
Adults and children ages 16 and older: 375 mg P.O. (extended-release tablet) q 12 hours for 10 days
➣ Chronic bronchitis and acute bronchitis not caused by H. influenzae
Adults and children ages 16 and older: 500 mg P.O. (extended-release tablet) q 12 hours for 7 days
➣ Otitis media caused by staphylococci; lower respiratory tract infections caused by H. influenzae, S. pyogenes, and S. pneumoniae; pharyngitis and tonsillitis caused by S. pyogenes; urinary tract infections caused by Klebsiella species, Escherichia coli, Proteus mirabilis, and coagulase-negative staphylococci
Adults and children ages 13 to 17: 250 mg P.O. q 8 hours. For severe infections, 500 mg P.O. q 8 hours.
Children: 20 mg/kg/day P.O. in divided doses q 8 hours. For serious infections, 40 mg/kg/day P.O. in divided doses q 8 hours. Maximum dosage is 1 g/day.
• Renal insufficiency
• Elderly patients
• Hypersensitivity to cephalosporins or penicillins
Use cautiously in:
• renal impairment, phenylketonuria
• history of GI disease (especially colitis)
• emaciated patients
• elderly patients
• pregnant or breastfeeding patients
• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Be aware that cross-sensitivity to penicillins may occur.
• Give extended-release tablets with food to enhance absorption.
• Don't give antacids within 2 hours of extended-release form.
CNS: headache, lethargy, paresthesia, syncope, seizures
CV: hypotension, palpitations, chest pain, vasodilation
EENT: hearing loss
GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis
GU: vaginal candidiasis, nephrotoxicity
Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression
Hepatic: hepatic failure, hepatomegaly
Skin: urticaria, maculopapular or erythematous rash
Other: chills, fever, superinfection, anaphylaxis, serum sickness
Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity
Antacids: decreased absorption of extended-release cefaclor tablets
Chloramphenicol: antagonistic effect
Probenecid: decreased excretion and increased blood level of cefaclor
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results
Hemoglobin, platelets, white blood cells: decreased values
• Assess CBC and kidney and liver function test results.
• With long-term therapy, obtain monthly Coombs' test.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.
• Instruct patient to take drug with food or milk to reduce GI upset.
• Advise patient to complete entire course of therapy even if he feels better.
• Tell patient to report signs and symptoms of allergic response and other adverse reactions, such as rash, easy bruising, bleeding, severe GI problems, or difficulty breathing.
• Instruct patient to avoid taking antacids within 2 hours of extended-release cefaclor.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.