What is the recommended dose of cefaclor (Cephalosporin) for pediatric patients?

Cefaclor Dosing and Uses in Pediatric Patients

The recommended dosage of cefaclor for pediatric patients is 20-40 mg/kg/day divided into three doses every 8 hours, with a maximum dosage of 1 g/day. 1

Standard Dosing Regimens

Standard Dosing

• Mild to moderate infections: 20 mg/kg/day divided into three doses every 8 hours 1
• Severe infections or less susceptible organisms: 40 mg/kg/day divided into three doses every 8 hours 1
• Maximum daily dose: 1 g/day 1

Alternative B.I.D. (Twice Daily) Dosing Option

For specific conditions, cefaclor can be administered every 12 hours:

• Pharyngitis: 20 mg/kg/day divided into two doses 1
• Otitis media: 40 mg/kg/day divided into two doses 1

Weight-Based Dosing Guide

Weight	20 mg/kg/day (125 mg/5 mL)	20 mg/kg/day (250 mg/5 mL)	40 mg/kg/day (125 mg/5 mL)	40 mg/kg/day (250 mg/5 mL)
9 kg	1/2 tsp t.i.d.	-	1 tsp t.i.d.	1/2 tsp t.i.d.
18 kg	1 tsp t.i.d.	1/2 tsp t.i.d.	-	1 tsp t.i.d.

Clinical Uses

Cefaclor is effective for treating various pediatric infections:

1. Respiratory tract infections (upper and lower) 2
2. Otitis media - particularly effective with 97% bacteriologic cure rate in clinical studies 3
3. Pharyngitis - shown to be more effective than penicillin V with lower bacteriologic failure rates (3.4% vs 19.6%) 4
4. Skin and soft tissue infections 2
5. Urinary tract infections 2

Advantages and Special Considerations

• Spectrum of activity: Effective against a wide range of gram-positive and gram-negative bacteria, including beta-lactamase-producing H. influenzae resistant to ampicillin 2
• Administration: Should be given on an empty stomach; food delays absorption 2
• Twice-daily dosing option: For otitis media and pharyngitis, twice-daily dosing has been shown to be effective, which may improve adherence 1, 5
• Renal impairment: Generally no dosage adjustment required in impaired renal function 1
• Duration: For beta-hemolytic streptococcal infections, treatment should continue for at least 10 days 1

Adverse Effects

Cefaclor is generally well-tolerated with few adverse effects:

• Most common: Mild gastrointestinal symptoms 2
• Rare: Eosinophilia 3

Clinical Pearls

1. For otitis media, use the higher dose range (40 mg/kg/day) for optimal efficacy 3
2. The twice-daily dosing option for pharyngitis and otitis media can improve treatment adherence compared to three-times-daily regimens 5
3. When treating streptococcal pharyngitis, cefaclor has demonstrated higher cure rates compared to erythromycin (91.9% vs 76.8%) 5
4. For streptococcal infections, ensure the full 10-day course is completed to prevent recurrence 1

Cefaclor provides an effective treatment option for common pediatric infections with a favorable safety profile and convenient dosing options.