Cefaclor

cefaclor

(sef' a klor)

Apo-Cefaclor (CAN), Ceclor, Ceclor Pulvules, PMS-Cefaclor (CAN), Raniclor

Pregnancy Category B

Drug classes

Antibiotic

Cephalosporin (second generation)

Therapeutic actions

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Indications

·        Lower respiratory infections caused by Streptococcus pneumoniae, Haemophilus influenzae, S. pyogenes

·        URIs caused by S. pyogenes

·        Dermatologic infections caused by Staphylococcus aureus, S. pyogenes

·        UTIs caused by E. coli, P. mirabilis, Klebsiella, coagulase-negative staphylococci

·        Otitis media caused by S. pneumoniae, H. influenzae, S. pyogenes, staphylococci

·        ER tablets: Acute exacerbations of chronic bronchitis, secondary infections of acute bronchitis, pharyngitis, and tonsilitis due to S. pyogenes; uncomplicated skin infections

·        Unlabeled use: Acute uncomplicated UTI in select patients, single 2-g dose

Contraindications and cautions

·        Contraindicated with allergy to cephalosporins or penicillins.

·        Use cautiously with renal failure, lactation, pregnancy.

Available forms

Capsules—250, 500 mg; chewable tablets—125, 187, 250, 375 mg; powder for suspension—125 mg/5 mL, 187 mg/5 mL, 250 mg/5 mL, 375 mg/5 mL

Dosages

ADULTS

250 mg PO q 8 hr; dosage may be doubled in severe cases. Do not exceed 4 g/day.

PEDIATRIC PATIENTS

20 mg/kg per day PO in divided doses q 8 hr; in severe cases 40 mg/kg/day may be given. Do not exceed 1 g/day.

·        Otitis media and pharyngitis: Total daily dosage may be divided and administered q 12 hr.

Pharmacokinetics

Route	Peak	Duration
Oral	30–60 min	8–10 hr

Metabolism: T_1/2: 30–60 min

Distribution: Crosses the placenta; enters breast milk

Excretion: Urine, unchanged

Adverse effects

·        CNS: Headache, dizziness, lethargy, paresthesias

·        GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, liver toxicity

·        GU: Nephrotoxicity

·        Hematologic: Bone marrow depression

·        Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction

·        Other: Superinfections

Interactions

Drug-drug

·        Increased nephrotoxicity with aminoglycosides

·        Increased bleeding effects with oral anticoagulants

Drug-lab test

·        Possibility of false results on tests of urine glucose using Benedict's solution, Fehling's solution, Clinitest tablets; urinary 17-ketosteroids; direct Coombs' test

Nursing considerations

Assessment

·        History: Penicillin or cephalosporin allergy, pregnancy or lactation

·        Physical: Renal function tests, respiratory status, skin status, culture and sensitivity tests of infected area

Interventions

·        Culture infection before drug therapy.

·        Give drug with meals or food to decrease GI discomfort.

·        Refrigerate suspension after reconstitution, and discard after 14 days.

·        Discontinue drug if hypersensitivity reaction occurs.

·        Give patient yogurt or buttermilk in case of diarrhea.

·        Arrange for oral vancomycin for serious colitis that fails to respond to discontinuation of drug.

Teaching points

·        Take this drug with meals or food.

·        Complete the full course of this drug, even if you feel better.

·        This drug is prescribed for this particular infection; do not self-treat any other infection.

·        You may experience these side effects: Stomach upset, loss of appetite, nausea (take drug with food); diarrhea; headache, dizziness.

·        Report severe diarrhea with blood, pus, or mucus; rash or hives; difficulty breathing; unusual tiredness or fatigue; unusual bleeding or bruising.

Adverse effects in Italic are most common; those in Bold are life-threatening.