Cefaclor

General

• Type: Second generation cephalosporin
• Dosage Forms: capsule, tablet, oral suspension
• Dosage Strengths: capsule: 250mg, 500mg; tablet 500mg; oral suspension: 125mg/5mL, 250mg/5mL, 375mg/5mL
• Routes of Administration: PO
• Common Trade Names: Ceclor, Raniclor

Adult Dosing

Infection, bacterial

• Immediate-release:
  • 250-500 mg PO q8h
    • Max: 2 g/day
• Extended-release:
  • 500 mg ER PO q12h
    • Max 2 g/day

Pediatric Dosing

Infection, bacterial

• 1+ mo
  • 20-40 mg/kg/day PO divided 18-12h
    • Max: 1 g/day

Special Populations

• Pregnancy Rating: B
• Lactation: May use while breastfeeding

• Renal Dosing
  • Adult:
    • No adjustment
    • HD: Give dose after dialysis
    • PD: No supplement
  • Pediatric
    • CrCl <10: Decrease dose 50%
    • HD: Give dose after dialysis
  • PD: No supplement
• Hepatic Dosing
  • Adult:
    • Not defined
  • Pediatric
    • Not defined

Contraindications

• Allergy to class/drug
• Caution:
  • Hypersensitivity to penicillin
  • Renal impairment
  • Concurrent nephrotoxic agent
  • Seizure disorder
  • Recent abx-associated colitis history

Adverse Reactions

Serious

• Anaphylaxis
• Thrombocytopenia
• Serum-sickness like reaction
• Seizure
• Nephrotoxicity
• Neutropenia
• Anemia, hemolytic
• Exfoliative dermatitis
• Stevens-Johnson Syndrome
• Superinfection
• C. difficile associated diarrhea
• Cholestatic jaundice

Common

• Diarrhea, nausea, vomiting
• Vaginitis
• Pruritus, rash, urticaria
• LFT elevation
• Eosinophilia

Pharmacology

• Half-life: 35-54 min; 2-3hr in ERSD
• Metabolism: Partial, hepatic
• Excretion: Urine primarily (60-85% unchanged)
• Mechanism of Action: Inhibits cell wall mucopeptide synthesis; bactericidal

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	X1
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	I
	Moraxella catarrhalis	I
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	X1
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	S
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	I
	Aeromonas sp	X1
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	X1
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)

References

• Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
• American Thoracic Society, “Guidelines for the Initial Management of Adults With Community-Acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy,” Am Rev Respir Dis, 1993, 148(5):1418-26. [PubMed 8239186]
• Aronoff GR, Bennett WM, Berns JS, et al, Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children, 5th ed. Philadelphia, PA: American College of Physicians; 2007, p 61, 153.
• Boguniewicz M and Leung DYM, “Hypersensitivity Reactions to Antibiotics Commonly Used in Children,” Pediatr Infect Dis J, 1995, 14(3):221-31. [PubMed 7761188]
• Campagna JD, Bond MC, Schabelman E, Hayes BD. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med. 2012; 42(5):612-620. [PubMed 21742459]
• Cefaclor Capsules [prescribing information]. Eatontown, NJ: West-Ward Pharmaceuticals; July 2015.
• Cefaclor Extended-Release Tablets [prescribing information]. North Wales, PA: Teva Pharmaceuticals; December 2014.