Pregnancy Risk Category B
How supplied
Pulvules: 200 mg, 400 mg
Powder for oral suspension: 100 mg/
5 ml, 200 mg/5 ml in 50-ml, 75-ml and 100-ml bottles
Action
A synthetic beta-lactam antibiotic of the carbacephem class with actions similar to second-generation cephalosporins. Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.
Indications & dosage
Secondary bacterial infections of acute bronchitis-
Adults: 200 to 400 mg P.O. q 12 hours for 7 days.
Acute bacterial exacerbations of chronic bronchitis-
Adults: 400 mg P.O. q 12 hours for 7 days.
Pneumonia-
Adults: 400 mg P.O. q 12 hours for 14 days.
Pharyngitis, sinusitis, tonsillitis-
Adults: 200 to 400 mg P.O. q 12 hours for 10 days.
Children ages 6 months to 12 years: 15 mg/kg P.O. daily in divided doses q 12 hours for 10 days.
Acute otitis media-
Children ages 6 months to 12 years: 30 mg/kg (oral suspension) P.O. daily in divided doses q 12 hours for 10 days.
Uncomplicated skin and skin-structure infections-
Adults: 200 mg P.O. q 12 hours for 7 days.
Impetigo-
Children ages 6 months to 12 years: 15 mg/kg P.O. daily in divided doses q 12 hours for 7 days.
Uncomplicated cystitis-
Adults: 200 mg P.O. daily for 7 days.
Uncomplicated pyelonephritis-
Adults: 400 mg P.O. q 12 hours for 14 days.
Adjust-a-dose: Patients with creatinine clearance of 50 ml/minute or more don't require dose and interval changes. If creatinine clearance is 10 to 49 ml/minute, give half of usual dose at same interval; if it is below 10 ml/minute, give usual dose q 3 to 5 days. Hemodialysis patients require an additional dose after dialysis.
Adverse reactions
CNS: headache, somnolence, nervousness, insomnia, dizziness.
CV: vasodilation.
GI: diarrhea, nausea, vomiting, abdominal pain, anorexia, pseudomembranous colitis.
GU: vaginal candidiasis, transient increases in BUN and creatinine levels.
Hematologic: transient thrombocytopenia, leukopenia, eosinophilia, increased PT and INR, pancytopenia, neutropenia.
Hepatic: transient elevations in AST, ALT, and alkaline phosphatase levels.
Skin: rash, urticaria, pruritus, erythema multiforme.
Other: hypersensitivity reactions, anaphylaxis.
Interactions
Drug-drug. Probenecid: decreased excretion of loracarbef, causing increased plasma levels. Monitor for toxicity.
Drug-food. Any food: decreased absorption. Have patent take drug on empty stomach at least 1 hour before or 2 hours after a meal.
Effects on diagnostic tests
Drug can cause positive direct Coombs' test results.
Contraindications
Contraindicated in patients with hypersensitivity to drug or other cephalosporins and in patients with diarrhea due to pseudomembranous colitis.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING