LORACARBEF

LORACARBEF
(lor-a-car'bef)
Lorabid
Classifications: antibiotic; beta-lactam; second-generation cephalosporin;
Therapeutic: antibiotic
; cephalosporin
Prototype: Cefonicid
Pregnancy Category: B

Availability

200 mg, 400 mg capsules; 100 mg/5 mL, 200 mg/5 mL suspension

Action

Second-generation cephalosporin antibiotic with drug structure characterized by a beta-lactam ring that inhibits cell wall synthesis of bacteria. By preferentially binding to penicillin-binding proteins (PBPs) located inside the bacterial cell wall, loracarbef inhibits the third and final stage of bacterial cell wall synthesis. Penicillin-binding proteins (PBPs) are responsible for several steps in the synthesis of the bacterial cell wall. This interference results in cell death of these bacteria.

Therapeutic Effect

Effective against gram-positive and gram-negative bacteria.

Uses

Upper and lower respiratory tract infections, skin and skin structure infections, urinary tract infections.

Contraindications

Hypersensitivity to cephalosporins and related antibiotics.

Cautious Use

Renal impairment, renal failure or Clcr <49 mL/min; seizures; history of GI disease, colitis, diarrhea; older adults; PKU; pregnancy (category B).

Route & Dosage

Upper & Lower Respiratory Tract Infections
Adult: PO 200–400 mg q12h taken 1 h a.c. or 2 h p.c.
Child: PO 15–30 mg/kg/d divided q12h taken 1 h a.c. or 2 h p.c.

Skin & Skin Structure Infections
Adult: PO 200 mg q12h taken 1 h a.c. or 2 h p.c.
Child: PO 15 mg/kg/d divided q12h taken 1 h a.c. or 2 h p.c.

Urinary Tract Infections
Adult: PO 200 mg q24h or 400 mg q12h taken 1 h a.c. or 2 h p.c.

Otitis Media
Child: PO 30 mg/kg/d divided q12h taken 1 h a.c. or 2 h p.c.

Renal Impairment
Clcr 10–49 mL/min: reduce recommended dose by 50% or give standard dose q24h; <10 mL/min: extend dosing interval to every 3–5 d

Administration

Oral
  • Reconstitute suspension by adding 30 or 60 mL of water to the 50- or 100-mL bottles, respectively, of dry mixture. Add the water in 2 portions and shake bottle after each portion.
  • Give at least 1 h before or 2 h after meals.
  • Give half of the normal dose if Clcr lies between 10 and 49 mL/min.
  • Store suspension in a tightly closed container. Discard after 14 d.

Adverse Effects (≥1%)

CNS: Headache. GI: Nausea, vomiting, diarrhea, diaper rash, abdominal pain. Other: Rash, candidiasis.

Interactions

Drug: May have prolonged bleeding time with warfarin.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Peak: 45–60 min. Distribution: Distributes into middle ear fluid. Elimination: In urine. Half-Life: 0.78–0.85 h.

Nursing Implications

Assessment & Drug Effects

  • Take a careful history to determine previous hypersensitivity reaction to beta-lactam antibiotics (penicillins and cephalosporins) or to other allergens.
  • Discontinue drug and notify the physician immediately if allergic reaction occurs (e.g., hives, wheezing, rash, pruritus).
  • Inspect patient's mouth on a regular basis to detect superinfection (see Appendix F).
  • Rule out pseudomembranous enterocolitis (see Appendix F) if severe diarrhea accompanied by abdominal pain and fever occurs. Notify physician immediately.
  • Monitor kidney function throughout therapy with concurrent diuretic use.

Patient & Family Education

  • Notify physician immediately of rash or any other allergic reaction.
  • Report loose stools or diarrhea promptly.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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