Classifications: antibiotic; beta-lactam; second-generation cephalosporin;
Therapeutic: antibiotic
; cephalosporin
Prototype: Cefonicid
Pregnancy Category: B


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


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.


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


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


  • 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.


Drug: May have prolonged bleeding time with warfarin.


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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