Cefaclor: summary of clinical experience

Chromatographic studies of unusual on-column degradation of cefaclor observed in the impurity separation by HPLC

An unpredictable ghost peak was intermittently observed during the impurity separation of cefaclor and formulation by high performance liquid chromatography (HPLC) with a content from below the reported threshold to approximately 0.3% in different laboratories. Through a series of investigations, the ghost peak was identified as an unusual on-column degradant of cefaclor formed under elevated column temperature but was not an actual sample impurity. The chemical structure of the degradant was determined by spectroscopic methods, including high resolution mass spectrometry (HRMS) and ¹H-NMR. Consequently, the unknown peak was identified as a C-4 oxidative decarboxylation analog of cefaclor. The formation mechanism of the analog is proposed, and it is suggested that elevated column temperature during HPLC analysis has a profound effect on the degradation. Dissolved oxygen in the mobile phase may promote the formation of the ghost peak. The degradation can be suppressed by using a column temperature below 30 °C. Moreover, several other prevention measures are suggested based upon the results of the investigation.

Cefaclor versus amoxicillin in the treatment of bacterial pneumonia: a comparative double-blind study

A randomized double-blind controlled trial was carried out to compare the effectiveness and side-effects of cefaclor with those of amoxicillin in the treatment of 34 patients hospitalized because of acute bacterial pulmonary infection. Cefaclor and amoxicillin were given three times daily before meals in a dosage of 500 and 750 mg respectively for seven days. The cure rate was 94% in the group of patients treated with cefaclor and 89% in the group treated with amoxicillin. According to all the parameters used to assess outcome, no significant difference was found between the two antibiotics tested. In this study, cefaclor and amoxicillin appeared to be of equal value in the treatment of bacterial pneumonia or bronchopneumonia.

Comparative study of cefaclor and amoxycillin in the treatment of respiratory tract infections in general practice

A single-blind, randomized study was carried out in 101 general practice patients with respiratory infection to compare the effectiveness of 250 mg cefaclor 3-times daily with that of 250 mg amoxycillin 3-times daily. Assessment of 5 specific symptoms was carried out by the doctor before treatment and again 1 week later, and patients recorded their own opinion of any change in their condition. The results suggest that cefaclor was at least as effective as amoxycillin in producing resolution or improvement in symptoms and the median time to maximum response was somewhat shorter. Only 1 patient (on cefaclor) had a side-effect sufficiently severe to warrant cessation of therapy.

A comparison of cefaclor and ampicillin in the treatment of respiratory infection in elderly in-patients

Fifty patients admitted to a geriatric ward with respiratory tract infection were randomly allocated to treatment with 250 mg cefaclor 8-hourly or 250 mg ampicillin 6-hourly. Assessment of response was performed by nursing and medical staff independently and it was found that the nurses tended to record changes in overall condition earlier than did the doctors. The failure rate was 15%, with no difference between the two treatments. The significance of this in relation to the different pharmacokinetic properties of these antibiotics is discussed.

[Hypersensitivity to antibiotics: Frequency, risks, cross-allergies (author's transl)]

The present paper gives a systematic review of the clinical manifestations of allergic reactions and the underlying immunological mechanisms. Attention is drawn to the relatively high proportion of cases of anaphylactic shock and serum disease related to the total number of cases of allergic reaction, and to the diagnostic techniques available for detection of sensitization towards antibiotics. Structural allergenicity is mentioned, using penicillin allergy as an example. The frequency of allergy to several antibiotics and the frequency of cross-reaction between penicillins and cephalosporins reported in the literature are discussed critically.