II. Indications

  1. See Second Generation Broad-spectrum Cephalosporin
  2. Conditions
    1. Respiratory tract infections
    2. Community Acquired Pneumonia
    3. Urinary Tract Infection
    4. Skin and Soft Tissue Infection
    5. Otitis Media (second-line)
    6. Acute Sinusitis (second-line)
    7. Streptococcal Pharyngitis (second-line)
    8. No significant CSF penetration
      1. Cefuroxime as an exception does penetrate CSF, but less than Third Generation Cephalosporins
  3. Antibiotic Coverage Spectrum
    1. Gram Positive Cocci
    2. EKP Gram Negative Bacteria
    3. Gram Negative Coccobacilli
    4. No significant anaerobic coverage

III. Medications: Available in U.S.

  1. Cefprozil (Cefzil)
    1. Adult: 250 to 500 mg orally divided daily to twice daily
    2. Child
      1. Otitis Media: 15 mg/kg/dose orally twice daily
      2. Pharyngitis: 7.5 mg/kg/dose orally twice daily for 10 days
  2. Cefuroxime (Ceftin, Zinacef)
    1. Adult
      1. Parenteral: 750 to 1500 mg IM or IV every 8 hours
      2. Oral: 250 to 500 mg orally twice daily
    2. Child
      1. Parenteral: 50-100 mg/kg/day IV divided every 6-8 hours
      2. Oral: 20-30 mg/kg/day orally divided twice daily
        1. Reported to have unpleasant taste
    3. Directions
      1. Take with food

IV. Medications: Discontinued in U.S. (or avoided)

  1. Loracarbef (Lorabid)
    1. Listed for historical reasons
    2. Discontinued in U.S. in 2006
    3. Adult: 200 to 400 mg orally twice daily
    4. Child
      1. Otitis Media: 30 mg/kg/day divided bid
      2. Other infections: 15 mg/kg/day divided bid
    5. Directions
      1. Take more than 1 hour before or 2 hours after food
  2. Cefaclor (Ceclor)
    1. Listed for historical reference only
    2. Risk of significant serum-sickness type reaction
    3. Adult: 250 to 500 mg orally three times daily
    4. Child: 20 to 30 mg/kg/day (maximum 1 g/day) orally divided three times daily

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Cost: Medications

cefaclor (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
CEFACLOR 250 MG CAPSULE Generic $1.00 each
CEFACLOR 500 MG CAPSULE Generic $0.89 each

Ontology: Cefaclor (C0007537)

Definition (NCI) A beta-lactam, second-generation cephalosporin antibiotic with bactericidal activity. Cefaclor binds to and inactivates penicillin-binding proteins (PBP) located in bacterial cytoplasmic membranes. PBPs are enzymes involved in the terminal stages of assembling the bacterial cell wall and in reshaping the cell wall during growth and division. Inactivation of PBPs interferes with the cross-linkage of peptidoglycan chains necessary for bacterial cell wall strength and rigidity. This results in the weakening of the bacterial cell wall and causes cell lysis.
Definition (MSH) Semisynthetic, broad-spectrum antibiotic derivative of CEPHALEXIN.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D002433
SnomedCT 387270009, 4937008
LNC LP14176-9, MTHU005577
English Cefaclor, 5-Thia-1-azabicyclo(4.2.0)oct-2-ene-2-carboxylic acid, 7-((aminophenylacetyl)amino)-3-chloro-8-oxo-, (6R-(6alpha,7beta(R*)))-, cefaclor, cefaclor (medication), CEFACLOR, Cefaclor [Chemical/Ingredient], Cefaclor product, Cefaclor (product), Cefaclor (substance)
Swedish Cefaklor
Czech cefaklor
Finnish Kefakloori
Russian TSEFAKLOR, ЦЕФАКЛОР
Japanese セファクロル
Polish Cefaklor
Spanish cefaclor (producto), cefaclor (sustancia), cefaclor, Cefaclor
French Céfaclor
German Cefaclor
Italian Cefacloro
Portuguese Cefaclor

Ontology: loracarbef (C0065295)

Definition (NCI) A semi-synthetic, broad-spectrum, beta-lactamase resistant, second-generation cephalosporin antibiotic derived from cephasporium. The bactericidal activity of loracarbef results from the inhibition of bacterial cell wall synthesis through interference with the cross-linking of peptidoglycan units. This results in a reduction of cell wall stability and causes cell lysis. Loracarbef is more active against a variety of gram-negative organisms but less active against gram-positive pathogens compared to first-generation agents.
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C054920
SnomedCT 96061006, 370362008
LNC LP15927-4, MTHU008099
English 1-Azabicyclo(4.2.0)oct-2-ene-2-carboxylic acid, 7-((aminophenylacetyl)amino)-3-chloro-8-oxo-, (6R-(6alpha,7beta(R*)))-, loracarbef, (6R, 7S)-7-[(R)-2-Amino-2-phenylacetamido]-3-chloro-8-oxo-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic Acid, Monohydrate, loracarbef (medication), loracarbef [Chemical/Ingredient], Carbacefaclor, Loracarbef, Loracarbef (substance), Loracarbef product (product), Loracarbef product, LORACARBEF
Spanish loracarbef, producto con loracarbef (producto), loracarbef (producto), producto con loracarbef, carbacefaclor (sustancia), carbacefaclor

Ontology: Second generation cephalosporin (C0304319)

Concepts Organic Chemical (T109) , Antibiotic (T195)
SnomedCT 372814002, 67891001
English Second gen. cephalosporin, second generation cephalosporins (medication), antibacterial cephalosporins second generation, second generation cephalosporins, Second-generation cephalosporins, Second generation cephalosporin, Second generation cephalosporin (product), Second generation cephalosporin (substance), Second generation cephalosporin, NOS, Cephalosporin Antibacterials, 2nd Generation
Spanish cefalosporina de segunda generación (producto), cefalosporina de segunda generación (sustancia), cefalosporina de segunda generación

Ontology: Lorabid (C0721422)

Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH C054920
English lorabid, Lilly Brand of Loracarbef Monohydrate, Monarch Brand of Loracarbef Monohydrate, Lorabid