Cefaclor

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[edit] STRUCTURE

Cefaclor.jpg

[edit] MECHANISM OF ACTION

Cefaclor is a second-generation cephalosporin antibiotic. By binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall, Cefaclor inhibits the third and last stage of bacterial cell wall synthesis. Cell lysis is then mediated by bacterial cell wall autolytic enzymes such as autolysins

[edit] INDICATIONS

Cefaclor is indicated for the treatment of the following types of infections caused by susceptible organisms:

  • Acute bronchitis and acute exacerbations of chronic bronchitis.
  • Upper respiratory infections, including pharyngitis, tonsillitis and acute bacterial sinusitis.
  • Community-acquired pneumonia of mild to moderate severity (excluding atypical pneumonia).
  • Symptomatic lower urinary tract infections, including cystitis.
  • Skin and skin structure infections.

[edit] DOSAGE

Adults The usual adult dosage is 250 mg every 8 to 12 hours.

For bronchitis and pneumonia, the dosage is 250 mg administered 3 times daily. A dosage of 250 mg administered 3 times daily for 10 days is recommended for sinusitis.

For more severe infections, such as pneumonia, or those caused by less susceptible organisms doses may be doubled.

For mild to moderate infections of the urinary tract, skin and soft tissues, and upper respiratory tract, a dosage of 250 mg administered 2 times daily may be sufficient. Doses of 4 g/day have been administered safely to normal subjects for 28 days, but the total daily dosage should not exceed this amount.


Children

The usual recommended daily dosage for children with mild to moderate infections is 20 mg/kg/day in divided doses every 8 to 12 hours. For bronchitis and pneumonia, the dosage is 20 mg/kg/day in divided doses administered 3 times daily.


In more serious infections, otitis media and infections caused by less susceptible organisms, the recommended dosage is 40 mg/kg/day in divided doses every 8 to 12 hours, with a maximum dosage of 1 g/day.


Twice daily treatment option For the treatment of otitis media and pharyngitis, the total daily dosage may be divided and administered every 12 hours.

[edit] CONTRAINDICATIONS

  • Patients with known allergy to the cephalosporin group of antibiotics or who have previously experienced a major allergy to penicillin

[edit] PRECAUTIONS

  • Cefaclor should not ordinarily be given to those allergic to cephalosporins or to penicillins
  • Antibiotic associated pseudomembranous colitis has been reported with many antibiotics including cefaclor. It is important to consider this diagnosis in patients who develop diarrhea or colitis in association with antibiotic use (this may occur up to several weeks after cessation of antibiotic therapy). Mild cases usually respond to drug discontinuation alone. However, in moderate to severe cases appropriate therapy with a suitable oral antibacterial agent effective against Cl. difficile should be considered. Fluids, electrolytes and protein replacement should be provided when indicated. Drugs that delay peristalsis, e.g. opiates and diphenoxylate with atropine, may prolong and/or worsen the condition and should not be used.

[edit] INTERACTIONS

Plasma concentrations of cefaclor extended-release tablets may be reduced by coadministration with antacids.

[edit] PREGNANCY AND LACTATION

  • Pregnancy category B (US). Cefaclor should be used during pregnancy only if clearly needed.
  • Use in lactation: Cephalosporins are considered to be compatible with breastfeeding although there are theoretical risks of alterations to infant bowel flora and allergic sensitisation.

[edit] SIDE EFFECTS

  • Gastrointestinal: Diarrhoea (3.4%), nausea (2.5%), vomiting and dyspepsia.
  • Hypersensitivity: Rash, urticaria or pruritus occurred in approximately 1.7% of patients.
  • Haematologic and Lymphatic Systems: Eosinophilia ( less than 1%).
  • Genitourinary: Vaginal moniliasis (2.5%) and vaginitis (1.7%).

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[edit] REFERENCES

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