Second-Generation Cephalosporin (true 2nd generation cephalosporin)
Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp. Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae
Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to play a role in the activation of bacterical cell autolysins which may contribute to bacterial cell lysis.
Cephalosporins exhibit time-dependent killing (T > MIC)
Dose of 500mg: Cmax: 17.3 mcg/L; Tmax: 0.7 hours; Half-life: 0.6 hours; Table 10
Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia
Hematologic: Neutropenia, Leukopenia, Thrombocytopenia
GI: Diarrhea, C. difficile disease
Renal: Interstitial nephritis
PO: 250mg, 500mg capsules
Powder for Suspension: 125mg/5mL, 187mg/5mL, 250 mg/5mL, 375mg/5mL
Chewable tablets: 125mg, 187mg, 250mg, 375mg
Extended release tablets: 375mg, 500mg
Dosing in adults:
Acute exacerbation of chronic bronchitis: 500 mg extendedrelease tablets PO q12h x 7 days
Acute otitis media: 250mg to 500mg tablets PO q8h
Lower respiratory tract infection: 250mg to 500mg tablets PO q8h
Urinary tract infection: 250mg to 500mg tablets PO q8h
Dosing in pediatrics:
20-40mg/kg divided PO q8h
Disease state based dosing:
Renal failure: Caution with markedly impaired renal function; dose adjustment for moderate to severe renal impairment not usually recommended
Hepatic failure: No dosing changes recommended at this time.
Contraindications/Warnings/Precautions:
Precautions: Hypersensitivity to penicillins, renal impairment
Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine
Pregnancy:
Category B: No evidence of risk in humans but studies inadequate.
Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count
Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia, Prothrombin time in patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy.
Brand names/Manufacturer: CeclorÒ/Eli Lilly; Ceclor CDÒ/Dura Pharmaceuticals; Cefaclor Extended ReleaseÒ/Ivax Pharmaceuticals