Ceclor^(�)(Cefaclor, Lilly)와 Mandol^(�)(Cefamandole nafate, Lilly)의 임상적 효능과 안전성에 관한 연구

이수걸,박순규 최신의학사 1993 最新醫學 Vol.36 No.12

Proper Cut-off Levels of Serum Specific IgE to Cefaclor for Patients with Cefaclor Allergy

남영희,이소희,류효인,이영수,박승희,이영희,신유섭,박해심,예영민 연세대학교의과대학 2018 Yonsei medical journal Vol.59 No.8

Purpose: Cefaclor, a second-generation oral cephalosporin, is known to cause IgE-mediated hypersensitivity. Assays of serumspecificIgE (sIgE) to cefaclor are commercially available via the ImmunoCAP system (Thermo Fisher Scientific). While serumlevels of sIgE >0.35 kU/L are considered indicative of an allergy, some patients with cefaclor allergy show low serum IgE levels. This study aimed to evaluate the proper cut-off levels of sIgE in the diagnosis of immediate hypersensitivity to cefaclor. Materials and Methods: A total of 269 patients with drug allergy history, who underwent assays of sIgE to cefaclor at Ajou Universityhospital and Dong-A University Hospital, were reviewed retrospectively. Among them, 193 patients exhibited cefaclor-inducedimmediate hypersensitivity with certain or probable causality of an adverse drug reaction according to the WHO-UMC (theWorld Health Organization–the Uppsala Monitoring Centre) algorithm, and 76 controls showed delayed hypersensitivity reactionsto non-antibiotics. Results: In total, 126 of the 193 patients (65.3%) experienced anaphylaxis; they had higher serum sIgE levels than patients withimmediate hypersensitivity who did not experience anaphylaxis (6.36±12.39 kU/L vs. 4.28±13.61 kU/L, p<0.001). The best cut-offvalue for cefaclor-induced immediate hypersensitivity was 0.11 kU/L, with sensitivity of 80.2% and specificity of 81.6%. A cut-offvalue of 0.44 kU/L showed the best sensitivity (75.4%) and specificity (65.7%) for differentiating anaphylaxis from immediate hypersensitivityreactions. Conclusion: Patients with cefaclor anaphylaxis exhibit high serum IgE levels. A cut-off value of 0.11 kU/L of sIgE to cefaclor isproper for identifying patients with cefaclor allergy, and 0.44 kU/L may be useful to detect anaphylaxis.

Immunologic Evaluation of Immediate Hypersensitivity to Cefaclor

유혜수,박해심,김승현,권혁수,김태범,남영희,예영민 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6

Purpose: Cefaclor is widely prescribed for various infectious diseases. As its consumptionincreases, the number of hypersensitivity reactions to cefaclor has increased. This study aimed to evaluate the immunologic findings of immediate hypersensitivityto cefaclor. Materials and Methods: We enrolled 47 patients with immediate hypersensitivity to cefaclor from Ajou University Hospital and Asan Medical Center. Serum specific IgE, IgG1, and IgG4 antibodies to cefaclor-human serum albumin (HSA) conjugate were measured by enzyme-linked immunosorbentassay (ELISA). Results: The most common phenotype was anaphylaxis (Group I, 78.7%), followed by urticaria (Group II, 21.3%). The detection of specificIgE, IgG1, and IgG4 to cefaclor-HSA conjugate by ELISA tended to be higher in Group I (40.5%, 41.7%, 21.6%) than in Group II (20.0%, 20.0%, 0%) with no statistical significance. Significant associations were found between specific IgE and IgG1 or IgG4 (p<0.001, p=0.019). ELISA inhibition tests showed significant inhibitions by both free cefaclor and cefaclor-HSA conjugate. For basophil activationtests in patients having no specific IgE antibody, the CD63 expression level on basophils increased with incubations of free cefaclor. Conclusion: The most commonmanifestation of immediate hypersensitivity to cefaclor was anaphylaxis, most of which was mediated by IgE; however, a non-IgE mediated direct basophil activation mechanism was suggested in a subset of anaphylaxis patients.

국내 Cefaclor 캅셀 제제의 약동학적 특성

장인진,임동석,신상구 大韓臨床藥理學會 1994 臨床藥理學會誌 Vol.2 No.2

Controlled Release and Stabilization of Cefaclor from Alginate-based Matrices for Oral Delivery Design

Bak, So-Im,Lee, Jue-Yeon,Song, Hye-Won,Hwang, Jeong-Hyo,Lee, Seung-Jin 한국약제학회 2002 Journal of Pharmaceutical Investigation Vol.32 No.4

Alginate based polymeric matrices were designed for controlled release and stabilization of cefaclor in gastrointestinal fluid. Cefaclor is known to be acid stable and subjected to be degraded at neutral and alkaline pHs. In order to achieve an effective release profile of cefaclor in gastrointestinal tract, a particular strategy in dosage form design should be required from the view point of maintaining its activity. The amphiphilic nature of cefaclor allowed its controlled release using ionic polymers based on ionic interaction between the drug and polymers. The thrust of this study was to develop a technique that delivers cefaclor keeping effective release rate in the intestinal tract. Considering the fast degradation of cefaclor in the intestinal fluid, the matrices were designed to release surplus amount of cefaclor. The alginate based matrices demonstrated increase in release rate in the simulated intestinal fluid, which was favorable to compensate the degraded portion of cefaclor. In addition, stabilization of cefaclor in the intestinal fluid was obtained by employing citric acid that provides an local acidic environment. The matrices might be valuably used for the development of an oral cefaclor dosage form.

Controlled Release and Stabilization of Cefaclor from Alginate-based Matrices for Oral Delivery Design

Bak, So-Im,Lee, Jue-Yeon,Song, Hye-Won,Hwang, Jeong-Hyo,Lee, Seung-Jin 梨花女子大學校 藥學硏究所 2002 藥學硏究論文集 Vol.- No.11

Alginate based polymeric matrices were designed for controlled release and stabilization of cefaclor in gas-trointestinal fluid. Cefaaclor is known to be acid stable and subjected to be degraded at neutral and alkaline pHs. In orderto achieve an effective release profi1e of cefaclor in gastrointestinal tract, a particular strategy in dosage form design shouldbe required from the view point of maintaining its activity. The amphiphilic nature of cefacler allowed its controlled releaseusing ionic polymers based on ionic interaction between the drug and polymers. The thrust of this study was to develop atechnique that delivers cefaclor keeping effrctive release rate in the intestinal tract. Considering the fast degradation of cefa-clor in the intestinal fluid, the matrices were designed to release surplus amount of cefaclor. The alginate baged mntricesdemonstrated increase in release rate in the simulated intestinal fluid, which was favorable to compensate the degraded por-tion of ceflclor. In addition, stabiliration of cefaclor in the intestinal fluid was obtained by employing citric acid that pro-vides an local acidic environment. The matrices might be valuably used for the development of an oral cefaclor dosage form.

급성 기관지염에 대한 Cefaclor의 치료 효과

박순규,여동승,이수걸,최광웅,이중길,신영기 최신의학사 1992 最新醫學 Vol.35 No.11

Cefaclor에 의한 아나필락시스 환자에서 cefaclor 특이 IgE 항체 측정

최정희 ( Jeong Hee Choi ),서유진 ( Yu Jin Suh ),신유섭 ( Yu Seob Shin ),서창희 ( Chang Hee Suh ),남동호 ( Dong Ho Nahm ),박해심 ( Hae Sim Park ) 대한천식알레르기학회 2003 천식 및 알레르기 Vol.23 No.2

Cephalosporines are the most important ?lactams inducing IgE-mediated reactions such as urticaria, angioedema and anaphylaxis. There have been a few reports that describes assays of serum specific IgE for cephalosporins. We experienced a case of cefaclor-

세파클로에 의한 아나필락시스

변진수 ( Jin Soo Byon ),이영목 ( Young Mok Lee ),김양기 ( Yang Ki Kim ),김기업 ( Ki Up Kim ),어수택 ( Soo Taek Uh ) 대한천식알레르기학회 2008 천식 및 알레르기 Vol.28 No.3

Cefaclor is an oral second-generation board-spectrum cephalosporin. Allergic reaction of this may be caused by an immediate hypersensitivity mechanism correlated with the reports of anaphylaxis to cefaclor. We experienced a case of anaphylaxis induced by cefaclor. (Korean J Asthma Allergy Clin Immunol 2008;28:231-233)

페넴계 항생제 faropenem의 주요 임상분리세균에 대한 항균력

김재석,심영숙,김의종 대한화학요법학회 2001 대한화학요법학회지 Vol.19 No.4

목적 : Faropenem에 대한 국내 임상 분리 균주의 감수성 여부를 파악하기 위하여 임상 환자에서 흔히 분리되는 통성 혐기성 세균을 대상으로 최소억제농도(MIC_)를 측정하였으며, 대조항생제로는 amoxicillin과 cefaclor를 사용하여 그 결과와 서로 비교하였다. 방법 : 시험 균종은 2000년과 2001년 서울대학교병원 임상병리과로 세균배양이 의뢰된 혈액, 객담, 소변 등 임상검체에서 분리된 균주로서 임상환자에서 흔히 분리되는 통성 혐기성 세균 총 523주를 대상으로 하였다. 미국 임상검사표준화협회(NCCLS)에서 권장하는 방법에 따라 S. pneumoniae를 제외한 모든 균종은 한천희석법으로 MIC를 측정하였으며, S. pneumoniae는 microdilution broth법으로 MIC를 측정하였다. 결과 : Faropenem의 MIC는 전반적으로 비교약제에 비해 전반적으로 낮았다. E. coli, K. pneumoniae에 대한 MIC_(90)는 각각 1㎍/mL, 2㎍/mL이었으며, E. aerogenes, C. freundii, M. morganii는 4㎍/mL, E. cloacae는 8㎍/mL의 결과를 보였다. S. marcescens, A. baumanni의 MIC_(90)은 16㎍/mL, 32㎍/mL를 보였으며, P. aeruginosa와 S. maltophilia에서는 64㎍/mL 이상으로서 항균력이 없었다. S. aureus와 S. epidermidis에서는 메티실린 내성인 경우는 MIC_(90)이 64㎍/mL이상, 8㎍/mL이었다. 메티실린 감수성인 경우 0.125㎍/mL와 0.125㎍/mL이었다. E. faecalis와 E. faecium의 경우 MIC_(90)은 모두 64㎍/mL 이상을 보였으나, E. faecalis의 경우 MIC_(90)이 1㎍/mL로서 항생제 내성인 균주가 일부 포함되어 MIC_(90)이 높아진 것으로 보인다. S. pneumoniae의 경우 MIC_(90)은 0.5㎍/mL이었다. 결론 : Faropenem은 E. coli, K. pneumoniae에 대해서도 우수한 항균력을 보였다. 대조항생제에 비해 faropenem의 Enterobacteriacae에 대한 항균력은 높았다. 앞으로 faropenem에 대한 추가 연구가 필요하며, 특히 경구용 제재로 사용할 경우 약력학적 연구가 필요할 것으로 생각한다. Background : Minimal inhibitory concentrations (MICs) of facultative anaerobic bacteria isolated from several kinds of specimens of patients were determined for the in vitro susceptibility against the new oral penem, faropenern and compared with MICs of amoxicillin and cefaclor in Korea. Methods : Total 523 strains isolated from blood, sputum, or urine of patients at Seoul National University Hospital in 2000 and 2001 were examined by agar dilution or microdilution broth method according to the recommendations of National Committee for Clinical Laboratory Standards. Results : In general, the MICs of faropenem against major clinical isolates were lower than those of amoxicillin and cefaclor. MIC data showed that faropenern was active against Escherichia coli (MIC_(90)= 1㎍/mL) and Klebsiella pneumoniae (MIC_(90) = 2㎍/mL). The MICwS of Enterobacter aerogenes, Citrobacter freundii, Morganella morganii were 4 ㎍/mL. The MIC_(90)s of Enterobacter cloacae, Serratia marcescens, and Acinetobacter baumannii were relatively raised, 8 ㎍/mL, 16 ㎍/mL, and 32 ㎍/mL, respectively. Faropenem was not active against P. aeniginosa and S. maltophilia (MIC≥64 ㎍/mL). Although for MRSA MICs were high (MIC_(90)>64 ㎍/mL) compared with those for MRSE (MIC_(90) = 8 ㎍/mL), faropenern was active against methicillin-susceptible staphylococci (MIC_(90) = 0.125 ug/nmL). For Enterococcus faecalis and Enterococcus faecium, the MIC_(90)s were > 64 ㎍/mL. However, MICs of E. faecalis (MIC_(90) = 1 ㎍/mL) seems to be overestimated by including some resistant strains. The MIC_(90) of faropenern against S. pneumoniae was 0.5 ㎍/mL Conclusions : Faropenem was more active against E. coli, K. pneumoniae, and S. pneumoniae than reference drugs. The in vitro activity of faropenern was in many cases superior to those of amoxicillin and cefaclor. Pharmacokinetic study is needed, especially for the use of faropenern as an oral drug.