CEFACLOR 125MG/5ML ORAL SUSPENSION
Active substance(s): CEFACLOR ANHYDROUS / CEFACLOR ANHYDROUS
NAME OF THE MEDICINAL PRODUCT
Cefaclor 125mg/5ml Oral Suspension
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each 5 ml of the constituted suspension contains Cefaclor monohydrate 131.1mg
equivalent to anhydrous Cefaclor 125 mg.
Excipient(s) with known effect:
Each 5 ml of the constituted suspension contains 2291.20mg sucrose. The suspension
also contains allura red.
For the full list of excipients, see 6.1.
Granules for oral suspension.
White to off-white granular powder forming a red suspension on constitution
with water having a strawberry flavour.
Cefaclor is used in the treatment of the following mild or moderately-severe
infections caused by susceptible microorganisms.
Respiratory tract infections, including pneumonia, bronchitis, exacerbations of
chronic bronchitis, pharyngitis and tonsillitis, and as part of the management
Skin and soft tissue infections
Urinary tract infections, including pyelonephritis and cystitis
Cefaclor has been found to be effective in both acute and chronic urinary tract
Cefaclor is generally effective in the eradication of streptococci from the
nasopharynx, however, data establishing efficacy in the subsequent prevention
of either rheumatic fever or bacterial endocarditis are not available. Penicillin
is the usual drug of choice for the treatment of streptococcal infections.
Cefaclor should not be used in the treatment of meningitis.
Consideration should be given to local guidance regarding the appropriate use
of antibacterial agents.
Posology and method of administration
Adults (including the elderly): The usual adult dosage is 250mg every eight
hours. A dosage of 250mg, administered 3 times daily for 10 days, is
recommended for sinusitis. For more severe infections or those caused by less
susceptible organisms, doses may be doubled to 500mg every eight hours.
Doses of 4g per day have been administered safely to normal subjects for 28
days but the total daily dosage should not exceed this amount.
Paediatric population: The usual recommended daily dosage for mild to
moderately-severe infections in children is 20 mg/kg/day in divided doses
every eight hours. For bronchitis and pneumonia, the dosage is 20 mg/kg/day
in divided doses administered three times daily. For otitis media and
pharyngitis, the total daily dosage may be divided and administered every 12
hours. Safety and efficacy have not been established for use in infants aged
less than one month. Suggested doses for children are:
Cefaclor for oral
< 1 year (9 kg)
1-5 years (9-18 kg)
Over 5 years
125 mg/5 ml
250 mg/5 ml
2.5 ml tid
5.0 ml tid
5.0 ml tid
In more serious infections, otitis media and infections caused by less
susceptible organisms, 40 mg/kg/day in divided doses is recommended, up to
a daily maximum of 1 g.
In the treatment of beta-haemolytic streptococcal infections, therapy should be
continued for at least 10 days.
Patients with impaired renal function: Cefaclor may be administered in the
presence of impaired renal function. Under such conditions dosage is
unchanged. Cefaclor should be administered with caution in the presence of
markedly impaired renal function. Since the half-life of cefaclor in anuric
patients is 2.3 to 2.8 hours (compared to 0.6 to 0.9 hours in normal subjects),
dosage adjustments for patients with moderate or severe renal impairment are
not usually required. Clinical experience with cefaclor under such conditions
is limited; therefore, careful clinical observation and laboratory studies should
Patients undergoing haemodialysis: Haemodialysis shortens serum half-life by
25-30%. In patients undergoing regular haemodialysis, a loading dose of
250mg-1g administered prior to dialysis and a therapeutic dose of 250-500mg
every six to eight hours maintained during interdialytic periods is
Method of administration
Cefaclor is administered orally. The spoon provided with the package
dispenses a volume of 5 mL.
Cefaclor is contra-indicated in patients with hypersensitivity to the
cephalosporin group of antibiotics or any of its excipients (as listed in section
Special warnings and precautions for use
Warnings: Before instituting therapy with cefaclor, every effort should be made to
determine whether the patient has had previous hypersensitivity reactions to cefaclor,
cephalosporins, penicillins or other drugs. Cefaclor should be given cautiously to
penicillin-sensitive patients because cross-hypersensitivity, including anaphylaxis,
among beta-lactam antibiotics has been clearly documented.
If an allergic reaction to cefaclor occurs, the drug should be discontinued and the
patient treated with the appropriate agents.
Pseudomembranous colitis has been reported with virtually all broad-spectrum
antibiotics including macrolides, semi-synthetic penicillins and cephalosporins. It is
important, therefore, to consider its diagnosis in patients who develop diarrhoea in
association with the use of antibiotics. Such colitis may range in severity from mild
to life-threatening. Mild cases usually respond to drug discontinuance alone. In
moderate to severe cases, appropriate measures should be taken. Use of peristalsisinhibiting preparations are contra-indicated in such situations.
The suspension contains sucrose “May be harmful to the teeth if the therapy exceeds
2 weeks or more”.
Broad-spectrum antibiotics should be prescribed with caution in individuals with a
history of gastro-intestinal disease, particularly colitis.
Prolonged use of cefaclor may result in the overgrowth of non-susceptible organisms.
If superinfection occurs during therapy, appropriate measures should be taken.
Positive direct Coombs' tests have been reported during treatment with the
cephalosporin antibiotics. In haematological studies or in transfusion cross-matching
procedures when anti-globulin tests are performed on the minor side, or in Coombs'
testing of newborns whose mothers have received cephalosporin antibiotics before
parturition, it should be recognised that a positive Coombs' test may be due to the
A false-positive reaction for glucose in the urine may occur with Benedict's or
Fehling's solutions or with Copper sulphate test tablets.
Cross-resistance may exist between penicillins and cephalosporins.
This medicinal product contains sucrose. Patients with rare hereditary problems of
fructose intolerance, glucose-galactose malabsorption or sucrase – isomaltase
insufficiency should not take this medicine.
This medicinal product also contains allura red which is a colouring agent and can
cause allergic reactions.
Interaction with other medicinal products and other forms of interaction
There have been rare reports of increased prothrombin time, with or without
clinical bleeding, in patients receiving cefaclor and warfarin concomitantly. It
is recommended that in such patients, regular monitoring of prothrombin time
should be considered with adjustment of dosage if necessary.
A combination with oral contraceptives may require dose adjustment.
The absorption of cefaclor may be reduced by antacids.
The renal excretion of Cefaclor is inhibited by probenecid.
Fertility, pregnancy and lactation
Cefaclor should not be administered during pregnancy unless considered
essential by the physician. Animal studies have shown no evidence of
impaired fertility or teratogenicity. However, there are no adequate or wellcontrolled studies in pregnant women.
Small amounts of cefaclor have been detected in breast milk following
administration of single 500 mg doses. Average levels of about 0.2
micrograms/ml or less were detected up to five hours later. Trace amounts
were detected at one hour. As the effect on nursing infants is not known,
caution should be exercised when cefaclor is administered to a nursing
Effects on ability to drive and use machines
Blood and lymphatic system disorders: Eosinophilia, positive Coombs' tests and,
rarely, thrombocytopenia. Transient lymphocytosis, leucopenia and, rarely,
haemolytic anaemia, aplastic anaemia, agranulocytosis and reversible neutropenia of
possible clinical significance have also been reported (see section 4.5).
Immune system disorders Allergic reactions such as morbiliform eruptions, pruritus
and urticaria have been observed. These reactions usually subside upon
discontinuation of therapy. Serum sickness-like reactions (erythema multiforme
minor, rashes or other skin manifestations accompanied by arthritis/arthralgia, with or
without fever) have been reported. Lymphadenopathy and proteinuria are infrequent,
there are no circulating immune complexes and no evidence of sequelae.
Occasionally, solitary symptoms may occur, but do not represent a serum sicknesslike reaction. Serum sickness-like reactions are apparently due to hypersensitivity and
have usually occurred during or following a second (or subsequent) course of therapy
with cefaclor. Such reactions have been reported more frequently in children than in
adults. Signs and symptoms usually occur a few days after initiation of therapy and
usually subside within a few days of cessation of therapy. Antihistamines and
corticosteroids appear to enhance resolution of the syndrome. No serious sequelae
have been reported.
There are rare reports of erythema multiforme major (Stevens-Johnson syndrome),
toxic epidermal necrolysis and anaphylaxis. Anaphylaxis may be more common in
patients with a history of penicillin allergy. Anaphylactoid events may be solitary
symptoms, including angioedema, asthenia, oedema (including face and limbs),
dyspnea, paresthesia, syncope, hypotension or vasodilation.
Rarely, hypersensitivity symptoms may persist for several months.
Nervous System disorders: Reversible hyperactivity, agitation, nervousness,
insomnia, confusion, hypertonia, dizziness, hallucinations and somnolence have been
Beta lactam antibiotics may trigger seizures.
Gastro-intestinal disorders: The most frequent side-effect has been diarrhoea. It is
rarely severe enough to warrant cessation of therapy. Colitis, including rare instances
of pseudomembranous colitis, has been reported. Nausea and vomiting have also
Hepato-biliary disorders: Transient hepatitis and cholestatic jaundice have been
reported rarely, slight elevations in AST, ALT or alkaline phosphatase values.
Renal and urinary disorders: Reversible interstitial nephritis has occurred rarely,
also slight elevations in blood urea or serum creatinine or abnormal urinalysis.
Toxic nephropathy has been observed with other beta-lactam antibiotics.
Reproductive system and breast disorders: Genital pruritus, vaginitis andvaginal
Reporting of suspected adverse reactions
Reporting suspected adverse reactions after authorisation of the medicinal product is
important. It allows continued monitoring of the benefit/risk balance of the medicinal
product. Healthcare professionals are asked to report any suspected adverse reactions
via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard.
Symptoms of nausea, vomiting, epigastric distress and diarrhoea would be
Treatment: Unless five times the normal total daily dose has been ingested,
gastro-intestinal decontamination will be not necessary.
General management may consist of supportive therapy.
Cefaclor is a semi-synthetic, orally active, 2nd generation cephalosporin
antibiotic. Like other β-lactam antibiotics cefaclor owes its antibacterial
activity to its ability to bind to and inhibit the action of certain bacterial cell
wall synthetic enzymes, namely the penicillin binding proteins. The results of
inhibition of one or more of essential penicillin binding proteins is the
interruption of cell wall (peptidoglycan) biosynthesis which leads, through the
activity of the cell’s autolytic enzymes, to lysis and death.
The preliminary MIC breakpoints for sensitive, intermediately sensitive or
resistant organisms are as follows:
Sensitive: this category includes bacterial species which are fully sensitive to
cefaclor i.e. they are inhibited by usually achievable concentrations of cefaclor
Intermediate sensitive: this category includes bacterial species which have
natural intermediate sensitivity to cefaclor as demonstrated by moderate in
vitro activity. This category implies possible clinical applicability in body
sites where the drug is physiologically concentrated or in situations where high
doses of the drug can be used.
Resistant: this category includes bacterial species which are naturally resistant
to the antibiotic or with acquired resistance precluding antibiotic treatment
with this medicinal product.
The following table gives the antibacterial spectrum of cefaclor. The
prevalence of resistance may vary geographically and with time for selected
species and local information on resistance is desirable, particularly when
treating severe infections. This information gives only an approximate
guidance on probabilities whether microorganisms will be susceptible to
cefaclor or not.
Sensitive (anaerobes are generally
Methicillin resistant S. aureus
European range of
* consideration should be given to local guidance regarding information on
Mechanisms of bacterial resistance to Cefaclor:
Bacteria may be resistant to cefaclor due to production of those beta
lactamases which can hydrolyse cephalosporins due to alterations in penicillin
binding proteins, due to impermeability to the drug or due to drug efflux
pumps. One or more of these mechanisms may coexist in the same organism,
leading to variable and unpredictable cross-resistance to other beta-lactams
and to antibacterial drugs of other classes.
Cefaclor is well absorbed after oral administration to fasting subjects. Total
absorption is the same whether the drug is given with or without food.
However, when it is taken with food, the peak concentration achieved is 50%
to 75% of that observed when the drug is administered to fasting subjects and
generally appears from 45 to 60 minutes later. Following administration of
250 mg, 500 mg and 1 g doses to fasting subjects, average peak serum levels
of approximately 7, 13 and 23 μg/l, respectively, were obtained within 30 to
60 minutes. Approximately 60% to 85% of the drug is excreted unchanged in
the urine within eight hours, the greater portion being excreted within the first
two hours. During the eight hour period, peak urine concentrations following
the 250 mg, 500 mg and 1 g doses were approximately 600, 900 and 1900 μg/l
respectively. The serum half-life in normal subjects is 0.6 to 0.9 hours. In
patients with reduced renal function, the serum half-life of cefaclor is slightly
prolonged. In those with complete absence of renal function, the plasma halflife of the intact molecules is 2.3 to 2.8 hours. Excretion pathways in patients
with markedly impaired renal function have not been determined.
Haemodialysis shortens the half-life by 25% to 30%.
The Cefaclor plasma concentrations for various doses are shown in the table
Cefaclor plasma concentrations for doses of 250 mg, 500 mg and 1000
4.38 ± 1.32
1.94 ± 0.47
0.20 ± 0.18
Protein binding of cefaclor is 25%.
6.99 ± 1.49
1.83 ± 0.90
25.44 ± 3.70
12.74 ± 4.50
1.94 ± 0.28
Pre-clinical Safety Data
Cefaclor is well established for its pharmacological and toxicological
properties. There are no preclinical data of clinical concern.
List of Excipients
Colloidal anhydrous silica
Allura Red (FD & C Red No 40,E129)
Citric acid (anhydrous)
Simethicone emulsion 30% w/w
Shelf life as packaged for sale: two years
Shelf life following constitution: 14 days
Special Precautions for Storage
Store in well closed containers at a temperature not exceeding 25°C protected
from light and moisture.
After constitution the suspension should be stored in a refrigerator (2-8°C) and
used within 14 days.
Nature and contents of container
HDPE bottle with polypropylene child resistant closure containing 60 or 100
ml of suspension when constituted.
Not all pack sizes may be marketed
Special precautions for disposal and other handling
Directions for mixing:
Measure 70 mL of water using a measuring cup. Add this volume of water in two
portions to the dry mixture in the bottle. Shake well after each addition.
Measure 42 mL of water using a measuring cup. Add this volume of water in two
portions to the dry mixture in the bottle. Shake well after each addition.
The spoon provided with the package dispenses a volume of 5 mL.
MARKETING AUTHORISATION HOLDER
Ranbaxy (UK) Limited
Building 4, Chiswick Park
566 Chiswick High Road
London, W4 5YE
MARKETING AUTHORISATION NUMBER
Cefaclor Oral Suspension 125mg/5mL 14894/0003
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
DATE OF REVISION OF THE TEXT
Source: Medicines and Healthcare Products Regulatory Agency
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