Cloracef® Forte is indicated for the treatment of infections caused by sensitive microorganisms. These are infections of the respiratory tract which include pneumonia, bronchitis (including deteriorations in chronic bronchitis), tonsillitis, pharyngitis and the management of sinusitis. Cefaclor is also effective in otitis media. It is active in acute and chronic urinary tract infections including cystitis and pyelonephritis and also in infections of the skin and soft tissues. Cefaclor may also be used in the eradication of nasopharyngeal streptococci but resulting prevention of rheumatic fever and/or bacterial endocarditis has not been proven.
The following microorganisms are susceptible in vitro to cefaclor:
− Alpha and beta-haemolytic streptococci
− Staphylococci (including coagulase-negative, coagulase-positive and penicillinase- producing strains)
− Strep. pneumoniae
− Strep. pyogenes (group A beta-haemolytic streptococci)
− Branhamella catarrhalis
− E. ccli
− Proteus mirabilis
− Klebsiella spp.
− Haemophilus influenzae (including ampicillin-resistant strains)
Cefaclor is inactive against Pseudomonas and Acinetobacter spp., most strains of Enterobacter and Serratia spp., Morganella morganii, Proteus vulgaris and
Providencia rettgeri. Methicillin-resistant staphylococci and most strains of enterococci including Strep. faecalis are resistant to cefaclor.
 

The route of administration is oral.
Adults:
250mg every eight hours, may be doubled to 500mg every eight hours for more severe infections. Total daily dosage should not exceed 4g.
Children:
20mg/kg/day in divided doses every eight hours. This may be increased to 40mg/kg/day in divided doses in otitis media, sinusitis, more serious infections and those caused by less susceptible bacteria. In otitis media and pharyngitis the total daily dosage may be divided and given every twelve hours.
Bronchitis and pneumonia: 20mg/kg/day in divided doses three times daily.
Total daily dosage should not exceed 1g.
Doses may generally be administered three times daily as follows: 

In infections caused by beta-haemolytic streptococci, treatment should be continued

for at least 10 days.
The safe use of cefaclor in babies aged below one month has not been proven.
Elderly:
The normal adult dose is appropriate.
Patients Undergoing Haemodialysis:
Due to a 25-30% decrease in plasma half-life, a loading dose of 250mg - 1g before dialysis is recommended with a maintenance dose between dialysis sessions of 250mg - 500mg every six to eight hours

Warnings:
Prolonged use of cefaclor may result in the overgrowth of non-susceptible organisms. If superinfection occurs during therapy, appropriate measures should be taken.
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.
Cephalosporin antibiotics may cause a positive result in Coombs’ testing.
When Coombs’ testing is performed on neonates whose mothers received cephalosporins prior to labour, it should be noted that a positive result may bedue to the drug. This should also be borne in mind during anti-globulin testing for haematological or cross- matching procedures. Cefaclor may also cause a false positive urine glucose result when Benedict’s or Fehling’s solutions or copper sulphate tablets are used in the testing.
Precautions:
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 - 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 be made.
Broad spectrum antibiotics should be prescribed with caution in individuals with a history of gastrointestinal disease.

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.
The renal excretion of cefaclor is inhibited by Probenecid.

Pregnancy
Pregnancy category: category B.
Animal studies have shown no evidence of impaired female fertility or teratogenicity. However, since there are no adequate or well controlled studies in pregnant women, caution should be exercised when prescribing for the pregnant patient.
Breastfeeding
Small amounts of cefaclor have been detected in breast milk following administration of single 500mg doses. Average levels of about 0.2 micrograms/ml or less were detected up to 5 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 woman. 

Cefaclor does not affect the ability to drive or operate machinery.

Very common (≥1/10); common (≥1/100 to <1/10); uncommon (≥1/1,000 to ≤1/100); rare (≥1/10,000 to ≤1/1,000); very rare (≤1/10,000), not known (cannot be estimated form the available data).
Infections and infestations
Frequency not known; Genital pruritus, vaginitis and vaginal moniliasis.
Blood and the lymphatic system disorders
Rare: Thrombocytopenia, transient lymphocytosis and leucopenia. Other haematological reactions include haemolytic anaemia, aplastic anaemia, agranulocytosis and reversible neutropenia.
Frequency not known: eosinophilia, positive Coomb’s test
Immune system disorders
Rare: Allergic reactions, such as morbilliform eruptions, pruritus and urticaria have been observed. These reactions usually subside upon discontinuation of therapy
Frequency not known: 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 protenuria are infrequent; there are no circulating immue complexes and no evidence of sequelae. Occasionally, solitary symptoms may occur, but do not represent a serum-sickness –like 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 not been reported.
Rarely, hypersensitivity symptoms may last for months.
Psychiatric disorders
Frequency not known: nervousness, confusion, insomnia, hypertonia, reversible hyperactivity and hallucinations
Nervous system disorders
Common: Headache
Frequency not known: Dizziness, drowsiness, somnolence, agitation
Class effect of beta lactam antibiotics: beta lactam antibiotics may trigger seizures.
Gastrointestinal disorders
Rare: pseudomembraneous colitis
Common: Diarrhoea (not usually severe enough to discontinue treatment),
Colitis, Nausea, Vomiting, Abdominal discomfort
Hepato-biliary disorders
Rare: Transient hepatitis and cholestatic jaundice
Investigations
Frequency not known: Slight elevations in AST, ALT or alkaline phosphatase valules.
Skin and subcutaneous tissue disorders
Rare: Stevens-Johnson syndrome (erythema multiforme major), toxic epidermal necrolysis and anaphylaxis (which may be more common in patients allergic to penicillins). Anaphylactoid events may present as solitary symptoms, including angioedma, asthenia, oedema (including face and limbs), dyspnoea, paraesthesias, syncope or vasodilatation.
Renal and urinary disorders
Rare: reversible interstitial nephritis, slight elevations in blood urea or serum creatinine and abnormal urine test results.
It should be noted that there is a lack of modern frequency data for cefaclor adverse events.
To report any side effects:
• Saudi Arabia 

The symptoms of cefaclor overdose are non-specific and are generally nausea, vomiting, diarrhoea and epigastric distress.
Treatment
Unless 5 times the normal total daily dose has been ingested, gastrointestinal decontamination will not be necessary.
General management may consist of supportive therapy.

Pharmacotherapeutic group: second generation cephalosporin. ATC code: J01DC04
Cefaclor is active against the following organisms in vitro:
Alpha- and beta-haemolytic streptococci
Staphylococci; including coagulase-positive, coagulase-negative and penicillinase-producing strains
Streptococcus pneumoniae
Streptococcus pyogenes (group A beta-haemolytic streptococci)
Branhamella catarrhalis
Escherichia coli
Proteus mirabilis
Klebsiella species
Haemophilus influenzae, including ampicillin-resistant strains.
Cefaclor has no activity against Pseudomonas species or Acinetobacter species.
Methicillin-resistant staphylococci and most strains of enterococci (eg, Str. faecalis) are resistant to cefaclor. Cefaclor is not active against most strains of Enterobacterspp, Serratia spp, Morganella morganii, Proteus vulgaris and Providencia rettgeri. 

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-
75% of that observed when the drug is administered to fasting subjects and generally appears from ¾ to one hour later. Following administration of 500mg, 500mg and 1G doses to fasting subjects, average peak serum levels of approximately 7, 13 and 23 mg/L respectively were obtained within 30 -
60 minutes. Approximately 60 - 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 500mg, 500mg and 1G doses were approximately 600, 900 and 1,900 mg/L respectively. The serum half-life in normal subjects is 0.6 - 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 half-life of the intact molecule is 2.3 - 2.8 hours. Excretion pathways in patients with markedly impaired renal function have not been determined. Haemodialysis shortens the half-life by 25 - 30%.

No further preclinical safety data

Sodium starch glycolate, sodium laurilsulphate, magnesium stearate.

Cefaclor has no major incompatibilities.

Protect form light, store in a dry place.
Do not store above 30° C.

Primary packaging: Aluminum foil / PVC - PVDC
Secondary packaging: Carton and insert
Cloracef® 500 Forte capsules are available in packs of 16 (2 blisters per pack each containing 8 capsules) and packs of 500 (50 blisters of 10) and 504 (63 blisters of 8).
Not all pack sizes may be marketed.

Any unused product or waste material should be disposed of in accordance with local requirements.