Cefaclor revisited

Objective: This paper describes the rationale for choosing cefaclor for the management of respiratory tract infections.

Background: Since 1979, cefaclor has established a record of efficacy in the management of respiratory tract infections. Factors contributing to the efficacy and tolerability of this drug include its molecular stability, activity against the most prevalent gram-positive and gram-negative respiratory tract pathogens, rapid absorption, >90% bioavailability, and good penetration into respiratory mucosa. After 2 decades of widespread use, this agent remains clinically effective in patients with respiratory tract infections, making it competitive with other cephalosporins and with macrolides and fluoroquinolones, including many newer agents used for respiratory tract infections. Cefaclor extended-release tablets, the newest formulation, retain the positive efficacy and tolerability attributes of immediate-release cefaclor, varying mainly in the rate of dissolution. The approved indications for extended-release cefaclor include Bacterial bronchitis, pharyngitis, and skin infections.

Methods: A MEDLINE search showed that the few adverse effects related to therapy with cefaclor are usually minor and transient and that drug-drug interactions involving cefaclor are rare.

Conclusions: Multiple clinical trials have shown that extended-release cefaclor in 375-mg and 500-mg doses BID demonstrates tolerability and efficacy comparable to those of immediate-release cefaclor 250 mg TID. Extended-release cefaclor is indicated for BID dosing, which should encourage greater compliance.