Carbacephem

General

• Type: 2nd generation Carbacephem
• Dosage Forms: Capsule, Powder for oral suspension
• Dosage Strengths: 200mg, 400mg; 100mg/5mL, 200mg/5mL
• Routes of Administration: PO
• Common Trade Names: Lorabid

Adult Dosing

General

• See specific indications below
• Take on an empty stomach (1 hour before or 2 hours after food)
• Max: Not established, typically 800mg/day

UTI, Uncomplicated (Cystitis)

• 200mg PO q24h x 7 days

Pyelonephritis, Uncomplicated

• 400mg PO q12h x 14 days

Acute Bacterial Exacerbation of Chronic Bronchitis

• 400mg PO q12h x 7 days

Community Acquired Pneumonia

• 400mg PO q12h x 14 days

Sinusitis, Acute

• 400mg PO q12h x 10 days

Pediatric Dosing

General (6 months - 12 years)

• Acute Otitis Media: 30mg/kg/day PO divided q12h x 10 days
• Acute Maxillary Sinusitis: 30mg/kg/day PO divided q12h x 10 days
• Pharyngitis/Tonsillitis: 15mg/kg/day PO divided q12h x 10 days (Strep. pyogenes)
• Impetigo: 15mg/kg/day PO divided q12h x 7 days
• Do not use in infants < 6 months

Special Populations

• Pregnancy: B
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl >= 50: Standard dose
    • CrCl 10-49: 50% of recommended dose at usual interval
    • CrCl <10: Recommended dose given every 3 to 5 days
    • Hemodialysis: Give supplemental dose following dialysis
  • Pediatric
    • Clinical data limited; follow adult adjustments based on GFR
• Hepatic
  • No adjustment necessary

Contraindications

• Allergy to class/drug (Carbacephem or Cephalosporin)
• Documented anaphylaxis to Penicillin (cross-reactivity exists)

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile associated diarrhea
• Seizures
• Renal dysfunction

Common

• Diarrhea
• Nausea and Vomiting
• Headache
• Abdominal Pain
• Rash (Higher incidence in pediatric patients)
• Rhinitis
• Vaginitis

Pharmacology

• Half-life: ~1 hour
• Metabolism: Not metabolized
• Excretion: Urine (unchanged drug)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis. Chemically a carbacephem (carbon replaces sulfur in dihydrothiazine ring) but biologically acts as a second-generation cephalosporin.

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	I
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	X1
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	R
	Serratia marcescens	R
	Salmonella sp	X1
	Shigella sp	X1
	Proteus mirabilis	S
	Proteus vulgaris	R
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	R
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	X1
	Francisella tularensis	R
	Brucella sp.	R
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	I
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)