Second-generation Cephalosporins

The advantage of the second-generation cephalosporins over the first-generation cephalosporins is that they are more effective against some of the anaerobes, however, they are more effective in treating early infections rather than late infections.

Contraindications: Hypersensitivity to cefaclor, any component of the formulation, or other cephalosporins.

Warnings/Precautions: Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection. Use with caution in patients with a history of penicillin allergy. Extended release tablets are not approved for use in children < 16 years of age.

The oral dosage forms of these drugs, cefaclor (Ceclor®) and cefuroxine (Ceftin®), have the advantage of twice-a-day dosing

The usual daily oral dose for treating odontogenic infections is:

Children under 12 years: 20-40 mg/kg/day divided every 8-12 hours with a maximum dose of 2 g/day.
Children over 12 years and adults: 250-500 mg divided every 8-12 hours.
Cefaclor and cefuroxine are supplied as 125, 187, 250, 375 mg/5 ml suspensions and 250 and 500 mg capsules.

Sample cefaclor/cefuroxine prescription for a 3-year-old patient weighing 12 kg (25 lb) with facial swelling:

Rx: Ceflacor 125 mg/5 ml
Disp: 150 cc
Sig: 1 teaspoon every 8 hours for 10 days