Loracarbef

A to Z Drug Facts

 Action Binds to proteins in bacterial cell wall, which inhibits cell wall synthesis.

 Indications Treatment of infections of lower respiratory tract, otitis media, acute maxillary sinusitis, pharyngitis, tonsillitis, skin and skin structures, and urinary tract due to susceptible strains of specific microorganisms.

 Contraindications Hypersensitivity to cephalosporins or related antibiotics.

 Route/Dosage

Lower Respiratory Tract Infections:

ADULTS and CHILDREN (³ 13 yr): PO Secondary bacterial infection of acute bronchitis: 200 to 400 mg q 12 hr for 7 days. Acute bacterial exacerbation of chronic bronchitis: 400 mg q 12 hr for 7 days. Pneumonia: 400 mg q 12 hr for 14 days.

Upper Respiratory Tract Infections ADULTS and CHILDREN (³ 13 yr): PO Pharyngitis/tonsillitis: 200 mg q 12 hr for 10 days. Sinusitis: 400 mg q 12 hr for 10 days.

CHILDREN (6 mo to 12 yr): PO Acute otitis media/acute maxillary sinusitis: 30 mg/kg/day in divided doses q 12 hr for 10 days. Pharyngitis/tonsillitis: 15 mg/kg/day in divided doses q 12 hr for 10 days.

Skin and Skin Structures ADULTS and CHILDREN (³ 13 yr): PO Uncomplicated skin and skin structure infections: 200 mg q 12 hr for 7 days.

CHILDREN (³ 6 mo to 12 yr): PO Impetigo: 15 mg/kg/day in divided doses q 12 hr for 7 days.

Urinary Tract Infections ADULTS and CHILDREN (³ 13 yr): PO Uncomplicated cystitis: 200 mg q 24 hr for 7 days. Uncomplicated pyelonephritis: 400 mg q 12 hr for 14 days.

Renal Impairment Ccr 10 to 49 mL/min: PO 50% recommended dose at usual dosage interval or normal recommended dose at twice the usual dosage interval.

Ccr < 10 mL/min: PO Recommended dose q 3 to 5 days.

Hemodialysis: PO Administer another dose after dialysis.

 Interactions

Probenecid: Inhibition of renal excretion of loracarbef.

 Lab Test Interferences Increased prothrombin time; positive direct Coombs' test ; elevated LDH; pancytopenia; neutropenia.

 Adverse Reactions

CNS: Headache; somnolence. DERMATOLOGIC: Skin rash. EENT: Rhinitis. GI: Diarrhea; abdominal pain; nausea; vomiting; anorexia. GU: Vaginitis; vaginal moniliasis. OTHER: Hypersensitivity.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Children: Safety and efficacy not established in children < 6 mo. Elderly: Evaluate renal function before use. Hypersensitivity: Reactions may range from mild to life-threatening. Administer with caution to penicillin-sensitive patients because of possible cross-reactivity. Pseudomembranous colitis: Pseudomembranous colitis should be considered in patients who develop diarrhea. Renal impairment: Use drug with caution. Dosage adjustment based on renal function may be necessary. Superinfection: May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

 Administration/Storage

• Otitis media should be treated with the suspension only. Do not substitute the capsule for the suspension when treating otitis media.
• Administer each dose on an empty stomach, ³ 1 hr before or 2 hr after a meal.
• Shake suspension well before measuring dose.
• Use a medicine dropper or dosing spoon to administer suspension to children.
• Use suspension for adults who have difficulty swallowing.
• Administer reduced dose to patient with renal impairment.
• Store suspension and capsules at room temperature. Keep tightly closed. Discard any unused suspension after 14 days.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note history of renal impairment and allergy to penicillins or cephalosporins.
• Review results of culture and sensitivity testing as available.
• Monitor for signs of infection, especially fever, and for positive response to antibiotic therapy.
• Monitor patient for signs of allergic reaction. Discontinue therapy and immediately notify health care provider if noted.
• Monitor patient for GI side effects. Report to health care provider if noted and significant.

 Patient/Family Education

• Explain name, dose, action, and potential side effects of drug.
• Review dosing schedule and prescribed length of therapy with patient.
• Instruct patient to take each dose on an empty stomach, ³ 1 hr before or 2 hr after a meal.
• Remind patient, family, or caregiver that patient should complete entire course of therapy, even if symptoms of infection have disappeared.
• Advise patient, family, or caregiver to have patient discontinue therapy and contact health care provider immediately if skin rash, hives, itching, or shortness of breath occurs.
• Advise patient, family, or caregiver to report signs of superinfection to health care provider: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
• Warn patient, family, or caregiver that diarrhea containing blood or pus may be a sign of a serious disorder and to seek medical care if noted and not to treat at home.
• Instruct patient not to take any prescription or otc medications or dietary supplements unless advised to do so by health care provider.
• Advise patient, family, or caregiver that follow-up examinations and lab tests may be required to monitor therapy and to be sure and keep appointments.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts