Medical term:

Ceclor

[se´klor]

trademark for a preparation of cefaclor, a broad-spectrum cephalosporinantibiotic.

cefaclor

(sef-a-klor) ,

Raniclor

(trade name),

Ceclor

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: second generation cephalosporins

Pregnancy Category: B

Indications

Treatment of the following infections caused by susceptible organisms:

Respiratory tract infections,

Skin and skin structure infections,

Urinary tract infections,

Otitis media.

Action

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria.

Similar to that of first-generation cephalosporins but has increased activity against several other gram-negative pathogens including:

Haemophilus influenzae,

Escherichia coli,

Klebsiella pneumoniae,

Proteus mirabilis.

Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Widely distributed. Penetration into CSF is poor. Crosses the placenta and enters breast milk in low concentrations.

Metabolism and Excretion: Excreted primarily unchanged by the kidneys.

Half-life: 30–60 min (increased in renal impairment).

Time/action profile

ROUTE	ONSET	PEAK	DURATION
PO	rapid	30–60 min	6–12 hr
PO-CD	unknown	unknown	12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins.

Use Cautiously in: Renal impairment ; History of GI disease, especially colitis; Pregnancy and lactation (has been used safely).

Adverse Reactions/Side Effects

Central nervous system

seizures (very high doses) (life-threatening)

Gastrointestinal

pseudomembranous colitis (life-threatening)
diarrhea
nausea
vomiting

Dermatologic

rashes
urticaria

Hematologic

agranulocytosis
bleeding
eosinophilia
hemolytic anemia
neutropenia

Miscellaneous

allergic reactions including anaphylaxis and serum sickness (life-threatening)
superinfection

Interactions

Drug-Drug interaction

Probenecid decreases excretion and increases blood levels.Antacids decrease absorption.

Route/Dosage

Oral (Adults) 250–500 mg q 8 hr or 375–500 mg q 12 hr as extended-release tablets.

Oral (Children >1 mo) 6.7–13.4 mg/kg q 8 hr or 10–20 mg/kg q 12 hr (up to 1 g/day).

Availability (generic available)

Capsules: 250 mg, 500 mg

Extended-release tablets (CD): 375 mg, 500 mg

Chewable tabletfruity: 125 mg, 187 mg, 250 mg, 375 mg

Oral suspensionstrawberry: 125 mg/5 mL, 187 mg/5 mL, 250 mg/5 mL, 375 mg/5 mL

Nursing implications

Nursing assessment

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
Lab Test Considerations: May cause positive results for Coombs' test.
- May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
- May rarely cause neutropenia, agranulocytosis, and eosinophilia.

Potential Nursing Diagnoses

Risk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

Oral: Administer around the clock. Chewable tablets, capsules, or suspension may be administered on full or empty stomach. Administration with food may minimize GI irritation. Extended-release tablets should be taken with food. Shake oral suspension well before administering. Suspension is stable for 14 days after reconstitution if refrigerated.
- Do not administer within 1 hr of taking antacids.
- Do not crush, break, or chew extended-release tablets.

Patient/Family Teaching

Instruct patient to take medication around the clock at evenly spaced times and to finish the medication completely, even if feeling better. Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses. Instruct patient to use calibrated measuring device with suspension. Advise patient that sharing of this medication may be dangerous.
Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.

Evaluation/Desired Outcomes

Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

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