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Side Effects by Body SystemGastrointestinalGastrointestinal side effects have included diarrhea, nausea, vomiting, and abdominal pain. Extended-release cefaclor has been associated with diarrhea (3.8%), nausea (3.4%), and anorexia, constipation, dyspepsia, flatulence, gastritis, nausea and vomiting, and vomiting in 0.1% to 1% of patients. Pseudomembranous colitis has been reported in patients treated with cephalosporins.If diarrhea occurs and it is unresponsive to discontinuation of the drug and/or standard therapy, pseudomembranous colitis should be considered.HypersensitivityHypersensitivity reactions have included rash, morbilliform eruptions (1%), pruritus, serum-sickness-like reactions, urticaria, anaphylactic reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylactoid reaction, and angioedema.Anaphylactic reactions are rare, but may occur, especially in patients with a history of penicillin allergy.Serum-sickness-like reactions are more frequent in pediatric patients and following a second or subsequent course of cefaclor and have been characterized by erythema multiforme, rash, arthritis, and/or arthralgia with or without fever.HepaticHepatic side effects have included slight elevations AST, ALT, and alkaline phosphatase in 2.5% of patients. Extended-release cefaclor has been associated with increased ALT (0.3%), increased alkaline phosphatase (0.3%), increased bilirubin (0.3%), increased creatine phosphokinase (0.7%), and increased GGT (0.2%). Cephalosporins as a class have been associated with elevated LDH, hepatic dysfunction, and cholestasis.
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RenalRenal side effects have included transient elevations in blood urea nitrogen (BUN) and serum creatinine in 0.2% of patients, reversible interstitial nephritis (rare), and abnormal urinalysis (0.5%). Extended-release cefaclor has been associated with increased BUN (0.2%), and increased creatinine (0.5%). Cephalosporins as a class have been associated with toxic nephropathy, reversible interstitial nephritis, and renal dysfunction.One case report of acute interstitial nephritis and nonoliguric renal failure has been reported following cefaclor therapy. (Reversible fever, azotemia, pyuria, and eosinophiluria are the hallmarks of cephalosporin-induced interstitial nephritis.)HematologicHematologic side effects have included eosinophilia (2%), positive Coombs’ test (less than 0.5%), leukopenia, thrombocytosis, transient thrombocytopenia (rare), transient lymphocytosis, hemolytic anemia, aplastic anemia, agranulocytosis, and reversible neutropenia. Extended-release cefaclor has been associated with increased eosinophils (0.3%), decreased erythrocyte count (0.3%), decreased hemoglobin (0.2%), decreased lymphocytes (0.3%), increased mean cell volume (0.7%), decreased segmented neutrophils (0.3%), and decreased platelet count (0.4%). Cephalosporins as a class have been associated with hemorrhage and pancytopenia.GenitourinaryGenitourinary side effects have included genital pruritus and vaginitis in less than 1% of patients. Extended-release cefaclor has been associated with vaginitis (2.4%) and vaginal moniliasis (2.2%), and dysmenorrhea, dysuria, leukorrhea, menstrual disorder, and nocturia in 0.1% to 1% of patients. Cephalosporins as a class have been associated with false-positive tests for urine glucose.Nervous systemNervous system side effects have rarely included reversible hyperactivity, agitation, nervousness, insomnia, confusion, hypertonia, dizziness, hallucinations, and somnolence. Extended release cefaclor has been associated with headache in 4.9% of patients, and dizziness, insomnia, nervousness, somnolence, and tremor in 0.1% to 1% of patients, and paresthesia and vertigo. Some cephalosporins have been associated with seizures, primarily when dosages were not reduced in renally impaired patients.
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