Ceclor CD

Cefaclor-CD (Cefaclor Extended-Release Tablets): A Comprehensive Overview

Cefaclor-CD, also known as Cefaclor Extended-Release (ER), is a second-generation cephalosporin antibiotic used to treat a variety of bacterial infections. It is an extended-release formulation of cefaclor, designed to provide a prolonged therapeutic effect, allowing for less frequent dosing compared to the immediate-release version. This medication is particularly effective against a wide range of Gram-positive and Gram-negative bacteria, making it a versatile option for treating respiratory, urinary, skin, and soft tissue infections.

Mechanism of Action

Cefaclor-CD belongs to the cephalosporin class of antibiotics, which are bactericidal agents. It works by inhibiting bacterial cell wall synthesis, leading to the weakening and eventual destruction of the bacterial cell. Specifically, cefaclor binds to penicillin-binding proteins (PBPs) located on the bacterial cell wall, disrupting the cross-linking process necessary for cell wall integrity. This mechanism is particularly effective against rapidly dividing bacteria.

Spectrum of Activity

Cefaclor-CD exhibits a broad spectrum of activity, including:

• Gram-positive bacteria: Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus (methicillin-susceptible strains).

• Gram-negative bacteria: Haemophilus influenzae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Moraxella catarrhalis.

It is important to note that cefaclor is not effective against methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, or Enterococcus species.

Indications

Cefaclor-CD is prescribed for the treatment of mild to moderate infections caused by susceptible organisms. Common indications include:

1. Respiratory Tract Infections:

   • Acute bacterial exacerbations of chronic bronchitis.

   • Community-acquired pneumonia.

   • Pharyngitis and tonsillitis.

   • Sinusitis (acute bacterial).

2. Urinary Tract Infections (UTIs):

   • Uncomplicated lower UTIs (e.g., cystitis).

3. Skin and Soft Tissue Infections:

   • Cellulitis.

   • Impetigo.

4. Otitis Media:

   • Acute otitis media in pediatric patients.

Dosage and Administration

Cefaclor-CD is available in extended-release tablet form, typically in strengths of 375 mg and 500 mg. The extended-release formulation allows for twice-daily dosing, improving patient compliance compared to the immediate-release version, which requires more frequent administration.

• Adults and Adolescents (12 years and older):

  • The usual dose is 500 mg every 12 hours for 7–10 days, depending on the severity and type of infection.

• Pediatric Patients (under 12 years):

  • The safety and efficacy of Cefaclor-CD have not been established in children under 12 years. Immediate-release cefaclor is preferred for pediatric patients.

Cefaclor-CD should be taken with food to enhance absorption and reduce gastrointestinal side effects. The tablets must be swallowed whole and not crushed, chewed, or split, as this would compromise the extended-release mechanism.

Pharmacokinetics

• Absorption: Cefaclor is well-absorbed from the gastrointestinal tract, with bioavailability ranging from 90–95%. Food intake does not significantly affect the absorption of the extended-release formulation.

• Distribution: Cefaclor is widely distributed in body tissues and fluids, including the respiratory tract, kidneys, and skin. It has limited penetration into the cerebrospinal fluid (CSF).

• Metabolism: Cefaclor is minimally metabolized in the liver.

• Excretion: The drug is primarily excreted unchanged in the urine, with a half-life of approximately 0.6–0.9 hours. Renal impairment may necessitate dosage adjustments.

Side Effects

Like all medications, Cefaclor-CD may cause side effects, although not everyone experiences them. Common side effects include:

• Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain, and dyspepsia.

• Hypersensitivity Reactions: Rash, itching, and urticaria. Severe allergic reactions (e.g., anaphylaxis) are rare but possible.

• Central Nervous System: Headache, dizziness.

• Hematologic: Transient eosinophilia, leukopenia, and thrombocytopenia.

• Hepatic: Elevated liver enzymes (ALT, AST).

Contraindications

Cefaclor-CD is contraindicated in patients with:

• A known hypersensitivity to cefaclor, other cephalosporins, or penicillins (due to the risk of cross-reactivity).

• A history of severe allergic reactions (e.g., anaphylaxis) to beta-lactam antibiotics.

Precautions and Warnings

• Renal Impairment: Dosage adjustments may be necessary in patients with severe renal impairment (creatinine clearance < 30 mL/min).

• Clostridium difficile-Associated Diarrhea (CDAD): Prolonged use of antibiotics, including cefaclor, may lead to the overgrowth of Clostridium difficile, resulting in severe diarrhea and colitis.

• Drug Interactions: Cefaclor may interact with probenecid (increases cefaclor levels) and oral anticoagulants (increases the risk of bleeding).

Pregnancy and Lactation

• Pregnancy: Cefaclor is classified as a Pregnancy Category B drug, meaning it is generally considered safe during pregnancy. However, it should only be used if clearly needed.

• Lactation: Cefaclor is excreted in breast milk in small amounts. Caution is advised when administering to nursing mothers.

Resistance and Antibiotic Stewardship

The widespread use of antibiotics has led to the emergence of resistant bacterial strains. To minimize resistance, Cefaclor-CD should be used only for bacterial infections confirmed or strongly suspected to be caused by susceptible organisms. Unnecessary or prolonged use should be avoided.

Conclusion

Cefaclor-CD is a valuable antibiotic in the treatment of various bacterial infections, offering the convenience of extended-release dosing. Its broad spectrum of activity, combined with a favorable safety profile, makes it a reliable choice for clinicians. However, like all antibiotics, it should be used judiciously to prevent the development of resistance and ensure its continued efficacy. Patients should be advised to complete the full course of therapy, even if symptoms improve, to eradicate the infection completely.

Always consult a healthcare professional for personalized medical advice and treatment recommendations.