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[Absorption and excretion studies of S6472 (sustained release preparations of cefaclor)].

In order to see absorption and excretion of S6472 (sustained release preparations of cefaclor (CCL], 3 studies regarding, 1) influence of meals (single dose of 375 mg in capsule form), 2) dose response (single dose of 375 mg vs. 750 mg in granule form) and 3) continuous administration (twice-a-day administration of 750 mg in granule form for 8 days) were conducted in 15 healthy adult male volunteers using capsule and granule forms of S6472. The following is the summary of the results from the above studies: Tolerance. In the above 3 studies, none of the 15 volunteers complained of subjective abnormalities. In the clinical laboratory tests performed before the administration of S6472 and at the next day of the completion of the studies, the values from the laboratory tests were within normal range. Influence of meals. The average time for peak plasma level of CCL and decrease in the plasma level following the administration of S6472 were the fastest in the fasted volunteers, followed by the volunteers with light meals and usual meals. From this, it was confirmed that plasma levels of CCL were maintained for longer period of time in the non-fasted volunteers than in the fasted volunteers. In the volunteers who had light and usual meals, the peak plasma levels, AUC of the plasma levels and urinary recovery rate were almost the same. Influence by amount of meals was scarcely observed. Dose response. Mean serum levels and their AUC in the volunteers receiving 750 mg of S6472 were approximately twice as much as those in the volunteers receiving 375 mg of S6472, and dose response between the 2 doses was confirmed. Continuous administration. Mean serum levels and their AUC at the first dose and the 15th dose (final dose) were almost the same. In the continuous administration of S6472 for 8 days (15 doses), no accumulation of CCL in the body was observed.

Adult↗

[Cefaclor dosage change with renal dysfunction].

Serum and/or urine levels of cefaclor (CCL) were studied in 4 patients during the therapy with CCL. In patients with severely impaired renal function, moderately higher serum and urine levels of CCL persisted, serum half-lives of CCL were moderately prolonged and urinary excretion of CCL slightly decreased. Although dosage modification of CCL is necessary in patients with renal dysfunction, multiple doses of 250 mg every 8 hours may be safe and effective even in patients with impaired renal function.

Administration, Oral↗

Comparative in vitro microbiological activity and stability of cefaclor.

The in vitro activity of cefaclor was compared with that of cephalexin and cephradine. This new antibiotic was the most active of the oral agents against Haemophilus influenzae (especially non-beta-lactamase producing strains). It was also significantly more active against N. gonorrhoeae and the Enterobacteriaceae. The instability in agar raises some issues that need further study.

Bacteria↗

Cefaclor therapy in acute exacerbations of chronic bronchitis.

Twenty-four patients with acute exacerbations of chronic bronchitis were treated with cefaclor at a dose of 500 mg every 8 hours for 10 days. Studies included volume, appearance and bacteriological examination of sputum, and haematological and virus serology tests. The response to therapy was judged on the reduction in sputum volume or the conversion of its character from purulent to mucoid. Nineteen of 24 patients improved and in 4 of 5 failures, positive serology for influenza virus was found. Growth of Pseudomonas occurred in one sputum. Minor side effects were seen in 3 patients, and no haematological or biochemical abnormalities were found.

Acute Disease↗

Cefaclor--summary of clinical experience.

Cefaclor, a new semisynthetic cephalosporin antibiotic for oral use, was studied by 62 clinical investigators in 6 countries in 1493 adult and paediatric patients. The pooled data reveal that satisfactory clinical responses were obtained in 80% of urinary tract infections, 87% of upper respiratory infections, 90% of cases of otitis media, 99% of lower respiratory tract infections, and 96% of skin and skin structure infections. Administration of this antibiotic was associated with a low incidence of adverse reactions including gastrointestinal (2.6%) and hypersensitivity reactions (1.5%). Of particular clinical interest were the outstanding results obtained in the treatment of otitis media and lower respiratory tract infections.

Adult↗

A comparison of the activity in vitro of different cephalosporins: cephalothin, cephradine, cephacetrile, cefaclor, cefuroxime and cefotaxime.

6-cephalosporins (cephalothin, cephradine, cephacetrile, cefaclor, cefuroxime, cefotaxime) has been tested in vitro against 212 gram negative bacteria and 60 Staphylococci. Cefuroxime and especially Cefotaxime showed the highest activity against the gram negative bacteria, with a very low MIC. Cefotaxime also acted fairly well against several strains of Pseudomonas. Of the six cephalosporins tested, cephalothin gave the best results against the Staphylococci.

Cefaclor↗

Influence of cefaclor on immune response parameters.

The effect of cefaclor (CCl) and other orally applied antibiotics were examined on different parameters of the immune response. It could be shown that CCl enhances specific IgM response in a dose dependent profile. This is dependent on the application time relative to immunization because it reduces the reaction if given thereafter. IgG response is inhibited in low but not in higher doses. Cellular immune reaction in CCl treated animals evaluated with the footpad swelling test shows also a dose dependent profile but it is always enhanced compared with controls. The cortisone or cyclophosphamide induced immunosuppression is largely abrogated. Prostaglandin E2 (PGE2) production by macrophages and PGE2-sensitivity of lymphocytes are rather reduced if cell donors were treated with CCl. Interleukin 1 production is clearly stimulated. The enhanced survival rate of CCl treated animals observed in experimental infections with the primary resistant Candida species is explained by the concomitant inhibition of PGE2-production as an inhibitor of immune reactions and reduction of PGE2-sensitivity together with a stimulation of cellular immunity.

Animals↗

[A study of the disc sensitivity test for cefaclor].

Susceptibilities of 169 strains of 30 bacterial species to cefaclor (CCL) were determined by the 2-fold agar dilution method in parallel with the diameter of inhibition zones by the single-disc method, under the experimental condition established by Kanazawa. The experiments demonstrated significant correlation between MIC by the dilution method and diameter of inhibition zone in each of conventional assay of the over-night (about 16 hours) incubation, delayed assay (about 24 hours incubation), and rapid assay (after 3-4 or 5-6 hours incubation), thus confirming applicability of the single-disc assay for CCL. Analysis of the data obtained by using CCL disc containing 30 micrograms revealed the primary regression equation to be: D (diameter, mm) = 28.2--10.2 log MIC (micrograms/ml) in conventional assay, D = 33.8--13.0 log MIC (micrograms/ml) in delayed assay, D = 17.9--5.1 log MIC (micrograms/ml) in 3-4 hours rapid assay and D = 22.6--7.4 log MIC (micrograms/ml) in 5-6 hours rapid assay, respectively. The range of variations in MICs estimated from the diameter of inhibition zone by the disc test was then calculated in comparison with that in MIC determined by the 2-fold agar dilution assays, as reference for the experimental errors which may be involved in the estimation of MIC of CCL by the single-disc assay.

Bacteria↗

[A double-blind comparison between cefaclor and cephalexin in the treatment of dental infections].

A comparative clinical study of cefaclor (CCL) with cephalexin (CEX) was carried out by randomized double-blind techniques in order to contemplate the clinical efficacy, side effects and usefulness in treatment of 243 patients with dental infections. In the CEX group, CEX was orally administered 4 times a day at a daily dosage of 1,000 mg for 3 to 5 days. In the CCL group, CCL was orally administered 3 times a day at a daily dosage of 750 mg for 3 to 5 days and 1 capsule of placebo was also given every evening in order to keep the blindness of the administration. Evaluable cases for efficacy of athe drugs were 213 consisting of 108 for CCL and 105 for CEX. There were no significant differences in background of the patients and severity of the disease between 2 treatment groups. Clinical effectiveness on the 3rd day was 89.7% in CCL group and 78.6% in CEX group, showing significant difference between 2 treatment groups. Clinical effectiveness on the final day of administration was 94.4% in CCL group and 92.4% in CEX group, showing no significant difference between 2 treatment groups. Side effects were found in 10.5% of 114 patients receiving CCL and in 4.5% of 112 patients with CEX, and there was no significant difference between 2 treatment groups. The side effects were mostly gastrointestinal origin. According to the judgement by physicians in charge, no significant difference was seen in clinical usefulness between the 2 drugs.

Adult↗

[Fundamental and clinical studies of cefaclor in oral surgery].

Fundamental and clinical studies on cefaclor (CCL) have been performed and the following results were obtained. CCL was orally administered to NZW rabbits at the dose of 20 mg/kg, and its concentrations in blood and various tissues of oral organs were determined. Pattern of change in its blood concentration after the administration was similar to that of change in its concentration in the tissues of oral organs. Its concentration in blood was the highest followed by gingiva, parotid gland, submandibular gland, cervical lymph node and tongue in descending order. Comparative studies of CCL against cephalexin (CEX) were conducted in 5 healthy volunteers with cross over method. The 5 volunteers were orally given 500 mg of CCL or CEX at 1 dose after meal. Peak blood levels of CCL and CEX were 14.8 micrograms/ml at 2 hours and 11.5 micrograms/ml at 3 hours, respectively. The dose of 750 or 1,500 mg/day of CCL in 3 divided doses was orally administered to 71 patients with acute purulent infections in oral tissues for 3 to 13 days. Evaluation of effect was determined by the criteria for evaluation of antimicrobial agents in oral surgery. Out of the 70 patients, excellent clinical response was observed in 18 patients, good in 40, and poor in 12. Effective rate was 83%. In vitro antibacterial activities (MIC) of CCL and CEX were studied in 74 out of 81 strains (41 from aerobes and 40 from anaerobes) isolated from 47 patients. CCL showed stronger antibacterial activities than CEX. MICs of CCL against 30 strains of Gram-positive anaerobes were distributed from 0.10 to 3.13 micrograms/ml with a peak of 0.78 micrograms/ml. As adverse reaction due to CCL, eruption was observed in only 1 patient. Laboratory tests in 61 patients who received CCL showed elevation of GOT in 1 patient and elevation of GOT and GPT in 1 patient. From the above fundamental and clinical results, CCL was considered to be a useful antibiotic for the treatment of acute purulent infections caused by aerobes and anaerobes in oral surgery field.

Adolescent↗

[Clinical studies of cefaclor for respiratory tract infections].

Cefaclor (CCL) was administered to 27 patients with acute pneumonia and the following results were obtained. CCL was given 500 mg t. i. d. for 6 to 23 days. The clinical effects of CCL were excellent in 2 cases, good in 14 cases, fair in 6 cases and poor in 5 cases, the efficacy rate was 59.3%. No adverse reaction was observed. We conclude that CCL is considerably useful in the treatment of acute pneumonia of outpatients.

Acute Disease↗

[Effect of cefaclor in urinary tract infections (2)].

A second part of our continuous investigation on the clinical effect of cefaclor (CCL) against urinary tract infections was reported herein. CCL, a daily dose of 0.75 g t.i.d., has been applied for the treatment of (I) 76 cases with the uncomplicated acute cystitis in the women, and (II) 55 cases with the complicated. Rates of effectiveness were obtained 98.7% in (I) and 60% in (II). Side effects were noted in 13 cases out of total 150 cases.

Administration, Oral↗

[Effect of cefaclor and tobramycin on the phagocytic activity of peritoneal macrophages in mice].

The influence of Cefaclor and of Tobramycin on phagocytosis of sheep erythrocytes by murine peritoneal macrophages was investigated. The antibiotics in various concentrations were either added to the cells directly during the phagocytosis period or injected i.v. into cell donor mice at different times before cell harvest and the cells subsequently assayed for phagocytic activity in vitro. When antibiotic was added during the phagocytosis a dose-dependent inhibition of phagocytosis was observed which, however, became significant only at extremely high concentrations of the antibiotic. In all other experimental set-ups, phagocytosis was not influenced by antibiotics. Restrictive usage of either antibiotic in clinical situation does not appear mandatory on the basis of the reported observations.

Animals↗

[Clinical results of cefaclor treatment of infections of oral regions].

Cefaclor (CCL) is a cephem antibiotic for oral use. Thirty cases of infection of oral regions, in the First Department of Oral and Maxillofacial Surgery, School of Dentistry, the University of Tokushima, were treated with CCL at 750 mg/day. The results were as follows: The efficacy rate for all kinds of diseases was 80.0% in 3 days and 96.7% in 5 days and 86.7% as an overall assessment by the patients' doctors. With regard to the degree of symptoms, the efficacy rate for cases with moderate symptoms was less than that for mild cases in 3 days and according to the assessment by the patients' doctors. Some moderate cases required increased medication because no beneficial effect was observed. In sensitivity tests, CCL was shown to be effective on all 27 isolated clones of bacteria tested. CCL caused no detectable changes in laboratory data. No side effects were observed in any case. From these results, it is concluded that CCL is a highly effective antibiotic for use on infections of the oral regions.

Administration, Oral↗

High-pressure liquid chromatography and microbiological assay in the determination of serum levels using cefradine and cefaclor.

A method for the identification of cefradine and cefaclor by high-pressure liquid chromatography is described in detail. The antibacterial activity in the serum of ten subjects was determined by microbiological methods and by the HPLC method. No statistically significant difference exists between the values obtained by the two procedures. No decomposition of antibiotic occurs in the preparation of the serum sample for HPLC. The recovery rate was 94-105%. With the HPLC method 10 samples can be analysed within 70 min. The advantages and disadvantages of the method are discussed.

Adult↗

[Comparative pharmacokinetics of oral cephalosporins: cephalexin, cefaclor and cefadroxil (author's transl)].

In a randomized crossover study, the pharmacokinetics of two new cephalosporin antibiotics, cefaclor (CCL), and cefadroxil (CDX), were determined after oral administration of 1000 mg (capsules) on an empty stomach in 12 normal subjects in comparison to cephalexin (CEX). Serum concentrations were measured during a period of 8 h and urine recovery during 24 h. The significant parameters of bioavailability of an orally administered substance were determined. The maximum serum concentrations (ymax) were 38.8 +/- 8.1 mg/l (CEX), 34.6 +/0 7.8 mg/l (CCL), 33.0 +/- 5.4 mg/l (CDX); the areas under the curve were 93.0 +/- 14.8 h . mg/l (CEX), 74.5 +/- 9.9 h . mg/l (CCL), and 108.5 +/- 18.4 h . mg/l (CDX). In a further crossover study with 6 subjects, 1000 mg CEX and CDX were given during a standard breakfast. The ymax of CEX decreased to 23.1 +/- 6.6 mg/l in contrast to CDX with an unchanged ymax of 32.7 +/- 3.4 mg/l.

Adult↗

[Stability of various cephalosporins in solutions. Cefazolin, cefazedone, cefaclor].

The kinetics of splitting out the substitute at C3 in the molecule of beta-lactam antibiotics such as cefazolin, cefaclor, cefazedone and others as well as that of splitting out the chlorine atom in the side radical of the cefazedone molecule was studied within wide ranges of pH and temperature. The destruction processes for all the investigated compounds were shown to be described by the 1st order equations. The values of the activation energy, pre-exponential factors and reaction order by the hydrogen ions were measured. This provided the mathematical description of the destruction processes within wide ranges of pH and temperature. An unusual mechanism of synchronous splitting out the substitute at C3 and one of the chlorine atoms in the side radical of the cefazedone molecule was observed.

Anti-Infective Agents, Urinary↗

Efficacy and tolerability of brodimoprim in bacterial otitis media in children. Controlled study versus cefaclor.

78 pediatric patients affected by acute otitis media were selected and randomized into two balanced groups of treatment: brodimoprim, at the dosage of 200 mg once-a-day on the first day and of 100 mg once-a-day on the following days, and cefaclor at a dosage of 40 mg/Kg/day in three doses. Brodimoprim resulted more efficacious in the reduction of symptoms, especially hypoacusis and tinnitus (p < 0.05 between treatments); tympanometry showed a higher number of normalizations in the brodimoprim group, without significant differences between treatments. Both drugs resulted active against most of isolated bacterial strains. Side effects were reported in 4 patients treated with brodimoprim and in 6 patients in the control group.

Acute Disease↗