ORAL · TABLET, EXTENDED RELEASE
CLINICAL PHARMACOLOGY Cefaclor is well absorbed after oral administration to fasting subjects. Total absorption is the same whether the drug is given with or without food; however, when it is taken with food, the peak concentration achieved is 50% to 75% of that observed when the drug is administered to fasting subjects and generally appears from three fourths to 1 hour later. Following administration of 250-mg, 500-mg, and 1-g doses to fasting subjects, average peak serum levels of approximately 7, 13, and 23 mcg/mL respectively were obtained within 30 to 60 minutes. Approximately 60% to 85% of the drug is excreted unchanged in the urine within 8 hours, the greater portion being excreted within the first 2 hours. During this 8-hour period, peak urine concentrations following the 250-mg, 500-mg and 1-g doses were approximately 600, 900 and 1,900 mc g/mL, respectively. The serum half-life in normal subjects is 0.6 to 0.9 hour. In patients with reduced renal function, the serum half-life of cefaclor is slightly prolonged. In those with complete absence of renal function, the plasma half-life of the intact molecule is 2.3 to 2.8 hours. Excretion pathways in patients with markedly impaired renal function have not been determined. Hemodialysis shortens the half-life by 25% to 30%. Microbiology Mechanism of Action As with other cephalosporins, the bactericidal action of cefaclor results from inhibition of cell-wall synthesis. Mechanism of Resistance Resistance to cefaclor is primarily through hydrolysis of beta-lactamases, alteration of penicillin-binding proteins (PBPs) and decreased permeability. Pseudomonas spp ., Acinetobacter calcoaceticus and most strains of Enterococi ( Enterococcus faecalis, group D streptococci), Enterobacter spp ., indole-positive Proteus, Morganella morganii (formerly Proteus morganii ), Providencia rettgeri (formerly Proteus rettgeri ) and Serratia spp. are resistant to cefaclor. Cefaclor is inactive against methicillin-resistant staphylococci. β-lactamase-negative, ampicillin-resistant strains of H. influenzae should be considered resistant to cefaclor despite apparent in vitro susceptibility to this agent. Antibacterial Activity Cefaclor has been shown to be active against most strains of the following microorganisms both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section. Gram-positive Bacteria Staphylococcus aureus (methicillin susceptible only) Coagulase negative staphylococci (methicillin susceptible only) Streptococcus pneumoniae Streptococcus pyogenes (group A β-hemolytic streptococci) Gram-negative Bacteria Escherichia coli Haemophilus influenzae (excluding β-lactamase-negative, ampicillin-resistant strains) Klebsiella spp. Proteus mirabilis The following in vitro data are available, but their clinical significance is unknown . At least 90 percent of the following bacteria exhibit an in vitro minimum inhibitory concentrations (MICs) less than or equal to the susceptible breakpoint the treatment of the following infectionsHaemophilus influenzaestaphylococci+2 more