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Isolation and structure elucidation of the major degradation products of cefaclor in the solid state.

Cefaclor is a beta-lactam antibiotic that degrades slowly under normal storage conditions to several minor products. To obtain samples large enough to permit structure elucidation, cefaclor was allowed to degrade at 40 degrees C (75% relative humidity) and at 85 degrees C. The profile of degradation products formed under these conditions is qualitatively similar to the profile of degradation products observed in samples of cefaclor aged for 14 years at room temperature, although some products found in the sample degraded at 85 degrees C are not formed at the lower temperatures. Using preparative reversed-phase high-performance liquid chromatography (rp-HPLC) and a combination of spectroscopic methods, we have isolated and characterized 17 of these degradation products. Some of these products were also isolated from studies of aqueous degradations. The major products appear to have arisen from five distinct pathways: (1) isomerization of the double bond in the dihydrothiazine ring; (2) decarboxylation; (3) ring contraction of the cephem nucleus to thiazole structures; (4) oxidative attack at carbon 4 of the dihydrothiazine ring; and (5) intramolecular attack of the primary amine of the side chain on either the beta-lactam carbonyl to form 3-phenyl-2,5-diketopiperazines or the "masked aldehyde" at carbon 6 to form 2-hydroxy-3-phenylpyrazine derivatives. The pathway involving oxidation at carbon 4 is particularly important at ambient temperatures and is unique to the solid-state degradation.

Cefaclor↗

Safety and efficacy of cefixime versus cefaclor in respiratory tract infections.

A randomized controlled study design was used to compare the efficacy of cefixime versus cefaclor in 30 patients suffering from lower respiratory tract infections. Patients were treated with a 10 to 11 day course of cefixime 200 mg b.i.d. or cefaclor 500 mg t.i.d. The overall clinical response (cured and improved) in the 13 evaluable patients of the cefixime group was 100%. 12 of the 14 patients of the cefaclor group were cured or improved. In the two other patients the symptoms remained unchanged. The bacteriological efficacy in both groups was comparable. Adverse effects were not reported during the study.

Adult↗

Pharmacokinetic study of cefaclor in chronic maxillary sinusitis.

The pharmacokinetics of the maxillary sinus fluid were studied in 42 patients (26 males and 16 females), suffering from chronic maxillary sinusitis, after oral administration of 0.5g or 1g cefaclor. A thin plastic catheter, for sinus secretion sampling, was inserted in the sinus cavity and remained in place throughout the study. Sinus fluid levels of cefaclor (0.5g), measured by agar and well-diffusion microbiological method, ranged between 0.17-0.19, 0.28-0.42, 0.18-0.22 and 0.12-0.16 microgram/ml at 2, 4, 6 and 8 hour intervals respectively. Levels ranging between 0.15-0.26, 0.37-0.90, 0.23-0.27 and 0.16-0.19 microgram/ml were found after the administration of 1g cefaclor at the same time intervals respectively. Higher levels were found in purulent nasal material than in cystic fluid aspirates.

Administration, Oral↗

Influence of cefaclor, phenethicillin, co-trimoxazole and doxycycline on colonization resistance in healthy volunteers.

The influence of oral administration of cefaclor, phenethicillin, co-trimoxazole and doxycycline on colonization resistance (CR) of the oropharynx and colon in healthy volunteers was studied. Antimicrobial agents were administered in a randomized cross-over design. No effect on CR of the oropharynx could be demonstrated. Phenethicillin decreased CR of the colon against Enterobacteriaceae (P = 0.001). Co-trimoxazole significantly decreased the concentration of Enterobacteriaceae in faeces (P = 0.03) but the decrease caused by cefaclor and doxycycline did not reach statistical significance. Administration of antimicrobial agents increased the appearance of secondary colonization by Enterobacteriaceae in faeces, especially when Escherichia coli was eliminated. During administration of phenethicillin, secondary colonization occurred at a concentration exceeding 10(7)/g in some volunteers. Following administration of cefaclor, co-trimoxazole and doxycycline, elimination of E. coli may result in the substitution by resistant Gram-negative bacilli in low concentrations.

Adult↗

Presence of ROB-1 beta-lactamase correlates with cefaclor resistance among recent isolates of Haemophilus influenzae.

beta-Lactamase production in Canadian isolates of Haemophilus influenzae has remained relatively constant (25-35%) over the last decade despite increasing cefaclor resistance (MIC >/= 32 mg/L). TEM (294/324, 90.7%) and ROB-1 (30/324, 9.3%) prevalence rates among 324 isolates of H. influenzae obtained from across Canada in 1997-1998 were similar (P > 0.05) to previously published reports. However, 66. 7% (26/39) of cefaclor-resistant isolates were ROB-1-positive (P < 0. 001) and the remaining four ROB-1-positive isolates were cefaclor-intermediate (MIC 16 mg/L). Susceptibilities to loracarbef (P < 0.001) and cefprozil were also reduced in the presence of ROB-1 while the activities of cefuroxime, cefotaxime, cefixime and imipenem were similar in both TEM- and ROB-1-positive solates.

Canada↗

Concentration of cefaclor in human prostatic tissue.

Concentration of cefaclor, a new oral cephalosporin, was measured in prostatic tissue of ten patients undergoing suprapubic prostatectomy. The average prostatic tissue concentrations were 0.51 +/- 0.22 microgram and 0.74 +/- 0.67 microgram per gram of tissue following the oral administration of 250-milligram and 500-milligram doses, respectively. The prostate/plasma ratios of cefaclor were approximately 0.7 indicating no evidence of accumulation of the drug in prostatic tissue. Levels of cefaclor achieved in human prostatic disease are equal to or less than the minimum inhibitory concentration of strains of known facultative bacterial pathogens associated with prostatitis.

Aged↗

Cefaclor treatment of upper and lower respiratory tract infections caused by Moraxella catarrhalis.

A retrospective analysis of data from 18 clinical studies was performed to examine the effectiveness and safety of cefaclor in the treatment of upper and lower respiratory tract infections caused by Moraxella catarrhalis (previously called Branhamella catarrhalis). Eighty-six percent of 56 evaluable patients had improvement in their symptoms of infections following therapy with cefaclor. There were no serious or life-threatening adverse drug experiences reported by any patient. Cefaclor appears to be an appropriate antibiotic for the safe and effective treatment of respiratory tract infections caused by M. catarrhalis.

Adolescent↗

Interactions of cephradine and cefaclor with the intestinal absorption of D-galactose.

Oral cephalosporins are frequently prescribed beta-lactam antibiotics. Although it has been well established that cephalosporins compete with dipeptides for absorption in the intestine, using the same transport mechanism, little is known about the action of the drugs on the absorption of other nutrients. In this work the effect of cephradine and cefaclor on the absorption of D-galactose has been studied. Intestinal sugar uptake was measured in-vitro in pieces of intestine (50 mg) and brush-border membrane vesicles, and in-vivo in intestinal loops. Galactose uptake was inhibited by cephalosporins in a dose-related, time-dependent manner. In-vivo the inhibition appeared when the antibiotics were on the luminal side of the enterocyte and when they reached the gut from the basolateral side. Only the active transport of the sugar was modified; passive transfer did not change in the presence of cephalosporins. In brush-border membrane vesicles, cephradine and cefaclor did not alter sugar uptake in either sodium or potassium gradients. Both antibiotics non-competitively inhibited basolateral Na+,K(+)-ATPase activity. These findings show that cephradine and cefaclor inhibit the active-transport component of galactose absorption because they reduce the activity of the basolateral Na+,K(+)-ATPase.

Animals↗

In vitro activities of LY163892, cefaclor, and cefuroxime.

The in vitro activity of LY163892, a synthetic oral cephalosporin, was compared with those of cefaclor and cefuroxime against 1,193 clinical isolates. MIC ranges and MICs for 50 and 90% of isolates of the three cephalosporins were comparable. The activities of LY163892 and cefaclor were, however, highly inoculum dependent against beta-lactamase-positive Haemophilus influenzae and Staphylococcus aureus; that of cefuroxime was not. LY163892 and cefuroxime appeared stable in microdilution trays stored at 5 and -20 degrees C for 5 weeks, in contrast to cefaclor which remained stable for more than a week only at -5 degrees C.

Anti-Bacterial Agents↗

Single-dose cefuroxime axetil versus multiple-dose cefaclor in the treatment of acute urinary tract infections.

Eighty-nine college women with acute urinary tract infections were treated orally with either 1,000 mg of cefuroxime axetil in a single dose (n = 59) or 250 mg of cefaclor three times a day for 7 days (n = 30). At 1 week posttherapy, 88% of the patients in the cefuroxime axetil group and 97% in the cefaclor group were clinically and bacteriologically cured (P greater than 0.10). There was no statistically significant difference between the cure rates of the two treatment groups. However, this study has only a 50% power to detect a 10% difference. Therefore, there is a substantial possibility of a type II error, i.e., failing to find a difference that is actually present. At 4 weeks posttherapy, 78% of the patients in the cefuroxime group and 80% in the cefaclor group remained cured. By 36 weeks posttherapy, the cumulative rate of recurrence in both treatment groups was 60%. Of the patients with a positive antibody-coated bacteria test, fewer achieved a short-term cure after single-dose treatment with cefuroxime axetil than those with a negative antibody-coated bacteria test (67 versus 96%; P less than 0.01).

Acute Disease↗

Loracarbef versus cefaclor in the treatment of urinary tract infections in women.

In a double-blind, prospective, randomized study, 108 college women with acute urinary tract infections were treated for 7 days with either loracarbef (LY163892) at 200 mg once daily (n = 53) or cefaclor at 250 mg three times daily (n = 55). The cure rates at 5 to 9 days after treatment in the loracarbef and cefaclor groups were 96 and 90%, respectively. Both loracarbef and cefaclor are safe, well tolerated, and effective in the treatment of urinary tract infections in women.

Cefaclor↗

Comparison of cefprozil and cefaclor for treatment of acute urinary tract infections in women.

A total of 108 college women with acute urinary tract infections were treated for 10 days with either 500 mg of cefprozil (BMY-28100-03-800) once a day (n = 72) or 250 mg of cefaclor three times a day (n = 36). Clinical and bacterial cure rates at 1 week posttherapy were 94 and 93%, respectively, for the cefprozil group and 94 and 94%, respectively, for the cefaclor group (P, not significant). Both cefprozil and cefaclor were safe and effective.

Acute Disease↗

Bacteriologic efficacies of oral azithromycin and oral cefaclor in treatment of acute otitis media in infants and young children.

A prospective, open-label, randomized study was conducted in order to determine the bacteriologic efficacies of cefaclor and azithromycin in acute otitis media (AOM). Tympanocentesis was performed on entry into the study and 3 to 4 days after initiation of treatment. Bacteriologic failure after 3 to 4 days of treatment with both drugs occurred in a high proportion of culture-positive patients, especially in those in whom AOM was caused by Haemophilus influenzae (16 of 33 [53%] of those treated with azithromycin and 13 of 34 [52%] of those treated with cefaclor). Although a clear correlation of the persistence of the pathogen with increased MICs of the respective drugs could be demonstrated for Streptococcus pneumoniae, no such correlation was found for H. influenzae. It is proposed that susceptibility breakpoints for H. influenzae should be considerably lower than the current ones for both cefaclor and azithromycin for AOM caused by H. influenzae.

Acute Disease↗

Autobac I procedure to assess susceptibility to Cefaclor.

Agar dilution and Autobac I tests were performed to compare the susceptibility of 1,000 bacterial isolates to cefaclor and cephalothin. The standard Autobac methodology will correctly predict resistance to cefaclor. The test methodology seems to influence in vitro results, since more strains of gram-negative bacteria were susceptible to cefaclor by the Autobac I method than by the agar dilution test.

Cefaclor↗

Single oral dose of cefaclor for the treatment of infections with penicillinase-producing strains of Neisseria gonorrhoeae.

A single oral dose of 3 g cefaclor was effective in the treatment of uncomplicated gonococcal infection in women due to penicillinase-producing strains of Neisseria gonorrhoeae (PPNG). Cefaclor was equally active in vitro against both PPNG (MIC range, 0.01-1.0 microgram/ml) and non-PPNG strains (MIC range, 0.005-2.0 micrograms/ml). As empirical treatment cefaclor was effective in 53 of 57 (93%) patients compared with ampicillin, to which only 37 of 53 (69.8%) patients responded. This difference was attributed to the 40% incidence of PPNG in the patients studied; as expected, such patients responded poorly to ampicillin.

Adolescent↗

Cefaclor and cefamandole as alternatives to spectinomycin in the treatment of men with uncomplicated gonorrhoea.

Between 25 December 1981 and 11 March 1982, 400 men with uncomplicated gonococcal urethritis were randomly assigned to one of four treatment regimens: spectinomycin 2 g intramuscularly (group A); cefamandole 1 g intramuscularly after probenecid 1 g orally (group B); cefaclor 3 g orally with probenecid 1 g orally (group C); and cefaclor 3 g orally (group D). The cure rates were 91 of 92 (98.9%) in group A, 68 of 96 (70.8%) in group B, 88 of 92 (95.8%) in group C, and 86 of 96 (89.6%) in group D. Cefaclor at a dose of 3 g given orally with 1 g probenecid appears to be an effective alternative to spectinomycin 2 g in the treatment of gonorrhoea in areas where strains of penicillinase producing Neisseria gonorrhoeae (PPNG) are prevalent.

Cefaclor↗

Penetration of cefaclor into bronchial mucosa.

Bronchial mucosal biopsy specimens were obtained during fibreoptic bronchoscopy in 30 patients receiving a new oral cephalosporin antibiotic, cefaclor (10 had 250 mg, 10 had 500 mg, and 10 had 1000 mg every eight hours). In 10 patients (from all dosage groups) cefaclor was undetectable in the bronchial mucosa but in every case the serum concentration was low, suggesting incomplete absorption. The mean (SD) bronchial mucosal concentration after 250 mg was 3.78 (1.77) micrograms/g (range 2.1-5.8 micrograms/g, n = 4), after 500 mg 4.43 (2.04) micrograms/g (range 2.0-7.1 micrograms/g, n = 8), and after 1000 mg 7.73 (2.76) micrograms/g (range 5.0-12.7 micrograms/g, n = 6). A significantly higher concentration in the bronchial mucosa was achieved with 1000 mg than with 250 mg (p less than 0.05) or 500 mg (p less than 0.025). These concentrations should be effective against Streptococcus pneumoniae, most strains being inhibited below 1.0 microgram/ml. The concentrations were within one dilution of the minimal inhibitory concentration for Haemophilus influenzae, most strains being inhibited below 4.0 micrograms/ml. Some strains of H influenzae will not be inhibited by the concentrations of cefaclor found in the bronchial mucosa, particularly those that are ampicillin resistant.

Adult↗

Clinical comparison of once-daily cefadroxil and thrice-daily cefaclor in the treatment of streptococcal pharyngitis.

The efficacy of cefadroxil once daily and cefaclor given 3 times daily was compared in 250 pediatric patients with group A beta-hemolytic streptococcal pharyngitis. The duration of the therapy was 10 days. Therapeutic response was based on clinical responses at 24 h and 10 days and throat cultures on days 14, and 21 or 28. Five (5%) cefadroxil-treated patients and 12 (12%) cefaclor-treated patients were still culture-positive on day 14. When the patients were stratified according to major differences between treatment groups observed at baseline, a significant difference between the treatment groups in favor of cefadroxil was found on day 14 (p = 0.020) and days 21-28 (p = 0.043). These data were confirmed by the clinical findings; failure or clinical recurrence occurred in 4.6% of cefadroxil-treated patients versus 22.1% of cefaclor-treated patients. The patients complied with the recommended drug regimen, and none experienced any significant drug-related adverse reactions. The results of this study indicate that cefadroxil given once daily for streptococcal pharyngitis is an effective and well-tolerated antimicrobial agent, and suggest that the desirable pharmacokinetic properties of cefadroxil contribute to this efficacy.

Administration, Oral↗