No

Antibiotic, Carbacephem

Infections caused by susceptible organisms involving the respiratory tract, acute otitis media, sinusitis, skin and skin structure, bone and joint, and urinary tract and gynecologic

B

Patients with a history of hypersensitivity to loracarbef or cephalosporins

Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; use with caution in patients with a previous history of hypersensitivity to other beta-lactam antibiotics (eg, penicillins, cephalosporins)

>1%: Gastrointestinal: Diarrhea

<1%: Seizures (with high doses and renal dysfunction), headache, nervousness, rash, urticaria, pruritus, Stevens-Johnson syndrome, nausea, vomiting, pseudomembranous colitis, eosinophilia, hemolytic anemia, neutropenia, positive Coombs' test, thrombocytopenia, cholestatic jaundice, slightly increased AST/ALT, arthralgia, nephrotoxicity with transient elevations of BUN/creatinine, interstitial nephritis, serum sickness, candidiasis

Symptoms of overdose include abdominal discomfort, diarrhea

Supportive care only

Increased effect: Probenecid may decrease cephalosporin elimination

Increased toxicity: Furosemide, aminoglycosides may be a possible additive to nephrotoxicity

Suspension may be kept at room temperature for 14 days

Inhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. It is thought that beta-lactam antibiotics inactivate transpeptidase via acylation of the enzyme with cleavage of the CO-N bond of the beta-lactam ring. Upon exposure to beta-lactam antibiotics, bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.

Absorption: Oral: Rapid

Half-life, elimination: ~1 hour

Time to peak serum concentration: Oral: Within 1 hour

Elimination: Plasma clearance: ~200-300 mL/minute

Oral:

Acute otitis media: 15 mg/kg twice daily for 10 days

Pharyngitis and impetigo: 7.5-15 mg/kg twice daily for 10 days

Adults:

Uncomplicated urinary tract infections: 200 mg once daily for 7 days

Skin and soft tissue: 200-400 mg every 12-24 hours

Uncomplicated pyelonephritis: 400 mg every 12 hours for 14 days

Upper/lower respiratory tract infection: 200-400 mg every 12-24 hours for 7-14 days

Dosing comments in renal impairment:

Cl_cr 10-49 mL/minute: 50% of usual dose at usual interval or usual dose given half as often

Cl_cr <10 mL/minute: Administer usual dose every 3-5 days

Hemodialysis: Doses should be administered after dialysis sessions

Should be administered on an empty stomach at least 1 hour before or 2 hours after meals; administration with food decreases and delays the peak plasma concentration

May cause nervousness; cephalosporins reported to cause illusions, delusion, depersonalization, and euphoria

May cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

Take as directed, preferably on an empty stomach (30 minutes before or 2 hours after meals). Take entire prescription even if feeling better. Maintain adequate hydration (2-3 L/day of fluids unless instructed to restrict fluid intake). You may experience nausea, vomiting, or anorexia (small frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help). Report immediately any signs of skin rash, joint or back pain, or difficulty breathing. Report unusual fever, chills, vaginal itching or foul-smelling vaginal discharge, or easy bruising or bleeding. Breast-feeding precautions: Consult prescriber if breast-feeding.

Finish all medication

Capsule: 200 mg, 400 mg

Suspension, oral: 100 mg/5 mL (50 mL, 100 mL); 200 mg/5 mL (50 mL, 100 mL)

DeSante KA and Zeckel ML, "Pharmacokinetic Profile of Loracarbef," Am J Med, 1992, 92(6A):16S-9S.

Force RW and Nahata MC, "Loracarbef: A New Orally Administered Carbacephem Antibiotic," Ann Pharmacother, 1993, 27(3):321-9.

Foshee WS, "Loracarbef (LY163892) Versus Amoxicillin-Clavulanate in the Treatment of Acute Otitis Media With Effusion," J Pediatr, 1992, 120(6):980-6.

Nelson JD, Shelton S, and Kusmiesz H, "Pharmacokinetics of LY163892 in Infants and Children," Antimicrob Agents Chemother, 1988, 32(11):1738-9.

Schatz BS, Karavokiros KT, Taeubel MA, et al, "Comparison of Cefprozil, Cefpodoxime Proxetil, Loracarbef, Cefixime, and Ceftibuten," Ann Pharmacother, 1996, 30(3):258-68.