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Action/Kinetics:
Related chemically to cephalosporins. Acts by inhibiting cell wall synthesis. Stable in the presence of certain bacterial beta-lactamases.
Average peak plasma levels: 8 mcg/mL following a single 200-mg dose in a fasting subject after 90 min and 14 mcg/mL following a single 400-mg dose in a fasting subject after 90 min. Following doses of 7.5 mg/kg and 15 mg/kg of the oral suspension to children, average peak plasma levels were 13 and 19 mcg/mL, respectively, within 40-60 min.
Elimination t
1/2: 1 hr (increased to 5.6 hr in clients with a C
CR from 10 to 50 mL/min/1.73 m
2 and to 32 hr in clients with a C
CR of less than 10 mL/min/1.73 m
2). Over 90% excreted unchanged in the urine.
Uses:
(1) Secondary bacterial infections of acute bronchitis and acute bacterial exacerbations of chronic bronchitis caused by
Streptococcus pneumoniae, Haemophilus influenzae or
Morazella catarrhalis (including beta-lactamase-producing strains of both organisms). (2) Pneumonia caused by
S. pneumoniae or
H. influenzae (only non-beta-lactamase-producing strains). (3) Otitis media caused by
S. pneumoniae, Streptococcus pyogenes, H. influenzae or
M. catarrhalis (including beta-lactamase-producing strains of both organisms). (4) Acute maxillary sinusitis caused by
S. pneumoniae, H. influenzae (only non-beta-lactamase-producing strains), or
M. catarrhalis (including beta-lactamase-producing strains). (5) Pharyngitis and tonsillitis caused by
S. pyogenes. (6) Uncomplicated skin and skin structure infections caused by
Staphylococcus aureus (including penicillinase-producing strains) or
S. pyogenes. (7) Uncomplicated UTIs caused by
Escherichia coli or
Staphylococcus saprophyticus. Uncomplicated pyelonephritis caused by
E. coli.
Contraindications:
Hypersensitivity to loracarbef or cephalosporin-class antibiotics.
Special Concerns:
Use during labor and delivery only if clearly needed. Pseudomembranous colitis is possible with most antibacterial agents. Use with caution and at reduced dosage in clients with impaired renal function, in those with a history of colitis, in clients receiving concurrent treatment with potent diuretics, during lactation, and in clients with known penicillin allergies. Safety and efficacy in children less than 6 months of age have not been determined.
Side Effects:
The incidence of certain side effects is different in the pediatric population compared with the adult population.
GI: Diarrhea, N&V;, abdominal pain, anorexia, pseudomembranous colitis.
Hypersensitivity: Skin rashes, urticaria, pruritus, erythema multiforme.
CNS: Headache, somnolence, nervousness, insomnia, dizziness.
Hematologic: Transient thrombocytopenia, leukopenia, eosinophilia.
Miscellaneous: Vasodilation, vaginitis, vaginal moniliasis, rhinitis.
Overdose Management:
Symptoms: N&V;, epigastric distress, diarrhea.
Treatment: Hemodialysis may be effective in increasing the elimination of loracarbef from plasma from clients with chronic renal failure.
Drug Interactions:
-
Diuretics, potent /
Risk of renal dysfunction
-
Probenecid /
Renal excretion
plasma loracarbef levels
How Supplied:
Capsule: 200 mg, 400 mg;
Powder for reconstitution: 100 mg/5 mL, 200 mg/5 mL
Dosage
?Capsules, Oral Suspension
Secondary bacterial infection of acute bronchitis.
Adults 13 years of age and older: 200-400 mg q 12 hr for 7 days.
Acute bacterial exacerbation of chronic bronchitis.
Adults 13 years of age and older: 400 mg q 12 hr for 7 days.
Pneumonia.
Adults 13 years of age and older: 400 q 12 hr for 14 days.
Pharyngitis, tonsillitis.
Adults 13 years of age and older: 200 mg q 12 hr for 10 days (longer for
S.
pyogenes infections).
Infants and children, 6 months-12 years: 15 mg/kg/day in divided doses q 12 hr for 10 days (longer for
S.
pyogenes infections).
Sinusitis.
Adults 13 years of age and older: 400 mg q 12 hr for 10 days.
Acute otitis media, Acute maxillary sinusitis.
Infants and children, 6 months-12 years: 30 mg/kg/day in divided doses q 12 hr for 10 days. Use the suspension as it is more rapidly absorbed than the capsules, resulting in higher peak plasma levels when given at the same dose.
Skin and skin structure infections (impetigo).
Adults: 200 mg q 12 hr for 7 days.
Infants and children, 6 months-12 years: 15 mg/kg/day in divided doses q 12 hr for 7 days.
Uncomplicated cystitis.
Adults 13 years of age and older: 200 mg q 24 hr for 7 days.
Uncomplicated pyelonephritis.
Adults 13 years of age and older: 400 mg q 12 hr for 14 days.
