<?xml version="1.0" encoding="UTF-8" standalone="no"?><?xml-stylesheet href="../../stylesheet/spl.xsl" type="text/xsl"?><document xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 https://www.accessdata.fda.gov/spl/schema/spl.xsd">
  <id root="61ec00e0-d37d-4aa4-8f50-031ee7a37ecc"/>
  <code code="34391-3" codeSystem="2.16.840.1.113883.6.1" displayName="HUMAN PRESCRIPTION DRUG LABEL"/>
  <title>
    <content styleCode="bold">CEFACLOR EXTENDED-RELEASE TABLETS USP<br/>Rx only</content>
  </title>
  <effectiveTime value="20190731"/>
  <setId root="0878bdc2-0410-4938-9890-96523aa81c2f"/>
  <versionNumber value="11"/>
  <author>
    <time/>
    <assignedEntity>
      <representedOrganization>
        <id extension="001627975" root="1.3.6.1.4.1.519.1"/>
        <name>Teva Pharmaceuticals USA, Inc.</name>
        <assignedEntity>
          <assignedOrganization/>
        </assignedEntity>
      </representedOrganization>
    </assignedEntity>
  </author>
  <component>
    <structuredBody>
      <component>
        <section>
          <id root="cdf4d553-520a-4406-8c59-405c77811b6c"/>
          <code code="48780-1" codeSystem="2.16.840.1.113883.6.1" displayName="SPL listing data elements section"/>
          <effectiveTime value="20190731"/>
          <subject>
            <manufacturedProduct>
              <manufacturedProduct>
                <code code="0093-1087" codeSystem="2.16.840.1.113883.6.69"/>
                <name>Cefaclor</name>
                <formCode code="C42930" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="TABLET, FILM COATED, EXTENDED RELEASE"/>
                <asEntityWithGeneric>
                  <genericMedicine>
                    <name>Cefaclor</name>
                  </genericMedicine>
                </asEntityWithGeneric>
                <ingredient classCode="ACTIM">
                  <quantity>
                    <numerator unit="mg" value="500"/>
                    <denominator unit="1" value="1"/>
                  </quantity>
                  <ingredientSubstance>
                    <code code="69K7K19H4L" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>CEFACLOR</name>
                    <activeMoiety>
                      <activeMoiety>
                        <code code="3Z6FS3IK0K" codeSystem="2.16.840.1.113883.4.9"/>
                        <name>CEFACLOR ANHYDROUS</name>
                      </activeMoiety>
                    </activeMoiety>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="L06K8R7DQK" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>FD&amp;C BLUE NO. 2</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="D3741U8K7L" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>INDIGOTINDISULFONATE SODIUM</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="LMI26O6933" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>ALUMINUM OXIDE</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="B1QE5P712K" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>HYPROMELLOSE 2208 (100 MPA.S)</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="0WZ8WG20P6" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>HYPROMELLOSE 2910 (6 MPA.S)</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="70097M6I30" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>MAGNESIUM STEARATE</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="3OWL53L36A" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>MANNITOL</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="B697894SGQ" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>POLYETHYLENE GLYCOL 400</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="U725QWY32X" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>POVIDONE K30</name>
                  </ingredientSubstance>
                </ingredient>
                <ingredient classCode="IACT">
                  <ingredientSubstance>
                    <code code="15FIX9V2JP" codeSystem="2.16.840.1.113883.4.9"/>
                    <name>TITANIUM DIOXIDE</name>
                  </ingredientSubstance>
                </ingredient>
                <asContent>
                  <quantity>
                    <numerator unit="1" value="100"/>
                    <denominator value="1"/>
                  </quantity>
                  <containerPackagedProduct>
                    <code code="0093-1087-01" codeSystem="2.16.840.1.113883.6.69"/>
                    <formCode code="C43169" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BOTTLE"/>
                  </containerPackagedProduct>
                  <subjectOf>
                    <characteristic>
                      <code code="SPLCMBPRDTP" codeSystem="2.16.840.1.113883.1.11.19255"/>
                      <value code="C112160" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="Type 0: Not a Combination Product" xsi:type="CV"/>
                    </characteristic>
                  </subjectOf>
                  <subjectOf>
                    <marketingAct>
                      <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                      <statusCode code="active"/>
                      <effectiveTime>
                        <low value="20020926"/>
                      </effectiveTime>
                    </marketingAct>
                  </subjectOf>
                </asContent>
              </manufacturedProduct>
              <subjectOf>
                <approval>
                  <id extension="ANDA065058" root="2.16.840.1.113883.3.150"/>
                  <code code="C73584" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ANDA"/>
                  <author>
                    <territorialAuthority>
                      <territory>
                        <code code="USA" codeSystem="2.16.840.1.113883.5.28"/>
                      </territory>
                    </territorialAuthority>
                  </author>
                </approval>
              </subjectOf>
              <subjectOf>
                <marketingAct>
                  <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                  <statusCode code="active"/>
                  <effectiveTime>
                    <low value="20020926"/>
                  </effectiveTime>
                </marketingAct>
              </subjectOf>
              <subjectOf>
                <characteristic classCode="OBS">
                  <code code="SPLCOLOR" codeSystem="2.16.840.1.113883.1.11.19255"/>
                  <value code="C48333" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="blue" xsi:type="CV">
                    <originalText>dark blue</originalText>
                  </value>
                </characteristic>
              </subjectOf>
              <subjectOf>
                <characteristic classCode="OBS">
                  <code code="SPLIMPRINT" codeSystem="2.16.840.1.113883.1.11.19255"/>
                  <value xsi:type="ST">93;1087</value>
                </characteristic>
              </subjectOf>
              <subjectOf>
                <characteristic classCode="OBS">
                  <code code="SPLSCORE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                  <value value="1" xsi:type="INT"/>
                </characteristic>
              </subjectOf>
              <subjectOf>
                <characteristic classCode="OBS">
                  <code code="SPLSHAPE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                  <value code="C48345" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="OVAL" xsi:type="CV"/>
                </characteristic>
              </subjectOf>
              <subjectOf>
                <characteristic classCode="OBS">
                  <code code="SPLSIZE" codeSystem="2.16.840.1.113883.1.11.19255"/>
                  <value unit="mm" value="17" xsi:type="PQ"/>
                </characteristic>
              </subjectOf>
              <consumedIn>
                <substanceAdministration>
                  <routeCode code="C38288" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ORAL"/>
                </substanceAdministration>
              </consumedIn>
            </manufacturedProduct>
          </subject>
        </section>
      </component>
      <component>
        <section ID="LINK_84fb3fb2-1938-4216-82ae-49f893b6a7ba">
          <id root="65a63742-3c80-449e-a5fa-296dd1161fd5"/>
          <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
          <title/>
          <text>
            <paragraph>To reduce the development of drug-resistant bacteria and maintain the effectiveness of cefaclor extended-release tablets USP and other antibacterial drugs, cefaclor extended-release tablets USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.</paragraph>
          </text>
          <effectiveTime value="20190731"/>
        </section>
      </component>
      <component>
        <section ID="LINK_8ae46adc-f03c-44a0-82d4-f51bacefab54">
          <id root="e5e0a7d9-d0c8-4bcf-8f9e-15f75a1da00a"/>
          <code code="34089-3" codeSystem="2.16.840.1.113883.6.1" displayName="DESCRIPTION SECTION"/>
          <title>DESCRIPTION</title>
          <text>
            <paragraph>Cefaclor, USP, the active ingredient in cefaclor extended-release tablets USP, is a semisynthetic cephalosporin antibiotic for oral administration. Cefaclor, USP, is chemically designated as 3-chloro-7-D­(2-phenylglycinamido)-3-cephem-4-carboxylic acid monohydrate. The cefaclor extended-release tablets formulation of cefaclor differs pharmacokinetically from the immediate-release formulation of cefaclor.</paragraph>
            <renderMultiMedia referencedObject="MM1"/>
            <paragraph>C<sub>15</sub>H<sub>14</sub>ClN<sub>3</sub>O<sub>4</sub>S • H<sub>2</sub>O          M.W. 385.82</paragraph>
            <paragraph>Each cefaclor extended-release tablet contains cefaclor monohydrate equivalent to 500 mg (1.36 mmol) anhydrous cefaclor. In addition, each extended-release tablet contains the following inactive ingredients: FD&amp;C Blue #2 - indigo carmine lake, hypromellose, magnesium stearate, mannitol, polyethylene glycol, povidone and titanium dioxide.</paragraph>
          </text>
          <effectiveTime value="20190731"/>
          <component>
            <observationMedia ID="MM1">
              <text>cefaclor structural formula</text>
              <value mediaType="image/jpeg" xsi:type="ED">
                <reference value="image-1.jpg"/>
              </value>
            </observationMedia>
          </component>
        </section>
      </component>
      <component>
        <section ID="LINK_7ae1edba-13c6-4561-995e-19638d6067b7">
          <id root="36e5b2e1-0f28-4f07-a2f2-83db7c313723"/>
          <code code="34090-1" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL PHARMACOLOGY SECTION"/>
          <title>CLINICAL PHARMACOLOGY</title>
          <effectiveTime value="20190731"/>
          <component>
            <section ID="LINK_654ef4e8-4cae-4ff9-84dc-f33741063395">
              <id root="9e991bd5-2d0c-4765-9e50-261416d68852"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>Pharmacokinetics</title>
              <text>
                <paragraph>The cefaclor extended-release tablet formulation of cefaclor is pharmacokinetically different from the cefaclor immediate-release capsule formulation of cefaclor. (See <content styleCode="bold">TABLE 1</content>.) No direct comparisons with the suspension formulation of cefaclor have been conducted; therefore, there are no data with which to compare the pharmacokinetic properties of the extended-release tablet formulation and the suspension formulation. Until further data are available, the pharmacokinetic equivalence of the extended-release tablet and the suspension formulations should NOT be assumed.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
              <component>
                <section ID="LINK_af033448-2984-44c6-b2fc-76094d469ace">
                  <id root="81277d63-be9c-4f08-9815-b097a2f045c7"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Absorption and Metabolism</title>
                  <text>
                    <paragraph>The extent of absorption (AUC) and the maximum plasma concentration (C<sub>max</sub>) of cefaclor from cefaclor extended-release tablets are greater when the extended-release tablet is taken with food.</paragraph>
                    <paragraph>[<content styleCode="bold">NOTE:</content> The extent of absorption (AUC) of cefaclor from cefaclor immediate-release capsules is unaffected by food intake; however, when cefaclor immediate-release capsules are taken with food, the C<sub>max</sub> is decreased.]</paragraph>
                    <paragraph>There is no evidence of metabolism of cefaclor in humans.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
              <component>
                <section ID="LINK_db4bcb2e-b0a9-425c-a323-5f9a50ec464e">
                  <id root="34adfbc3-ea00-43c0-90ae-214a75d9baa7"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Comparative Serum Pharmacokinetics</title>
                  <text>
                    <paragraph>Serum pharmacokinetic parameters for cefaclor extended-release tablets and cefaclor immediate-release capsules are shown in the table below.</paragraph>
                    <table>
                      <caption>Table 1: COMPARATIVE PHARMACOKINETICS OF CEFACLOR IMMEDIATE-RELEASE CAPSULES VS. CEFACLOR EXTENDED-RELEASE TABLETS IN FASTING AND FED STATES</caption>
                      <col width="12%"/>
                      <col width="18%"/>
                      <col width="11%"/>
                      <col width="14%"/>
                      <col width="14%"/>
                      <col width="15%"/>
                      <col width="15%"/>
                      <tbody>
                        <tr>
                          <td styleCode="     Botrule          Toprule         Lrule     " valign="top">
                            <paragraph>Parameter</paragraph>
                          </td>
                          <td align="center" colspan="2" styleCode="     Botrule          Toprule         Lrule     " valign="top">
                            <paragraph>Cefaclor Extended-Release Tablets</paragraph>
                          </td>
                          <td align="center" colspan="2" styleCode="     Botrule          Toprule         Lrule     " valign="top">
                            <paragraph>Cefaclor Extended-Release Tablets</paragraph>
                          </td>
                          <td align="center" colspan="2" styleCode="     Botrule          Toprule         Lrule          Rrule     " valign="top">
                            <paragraph>Cefaclor Immediate-Release Capsules</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td styleCode="     Botrule         Lrule     " valign="top"/>
                          <td align="center" colspan="2" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>375 mg</paragraph>
                          </td>
                          <td align="center" colspan="2" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>500 mg</paragraph>
                          </td>
                          <td align="center" colspan="2" styleCode="     Botrule         Lrule          Rrule     " valign="top">
                            <paragraph>2 x 250 mg</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td styleCode="     Botrule         Lrule     " valign="top"/>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>fed</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>fast</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>fed</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>fast</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>fed</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule          Rrule     " valign="top">
                            <paragraph>fast</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td styleCode="     Botrule         Lrule     " valign="top"/>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>n = 10</paragraph>
                          </td>
                          <td styleCode="     Botrule         Lrule     " valign="top"/>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>n = 16</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>n = 16</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>n = 15</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule          Rrule     " valign="top">
                            <paragraph>n = 16</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>C<sub>max</sub>
                            </paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>3.7 (1.1)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>NA</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>8.2 (4.2)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>5.4 (1.6)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>9.3 (2.7)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule          Rrule     " valign="top">
                            <paragraph>16.8 (4.7)</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>T<sub>max</sub>
                            </paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>2.7 (1.0)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>NA</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>2.5 (0.8)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>1.5 (0.7)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>1.5 (0.6)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule          Rrule     " valign="top">
                            <paragraph>0.9 (0.4)</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>AUC</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>9.9 (2.2)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>NA</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>18.1 (4.2)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>14.8 (4.0)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule     " valign="top">
                            <paragraph>20.5 (2.8)</paragraph>
                          </td>
                          <td align="center" styleCode="     Botrule         Lrule          Rrule     " valign="top">
                            <paragraph>19.2 (5.0)</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td colspan="7" styleCode="     Rrule     " valign="top">
                            <paragraph>(± 1 standard deviation)</paragraph>
                          </td>
                        </tr>
                        <tr>
                          <td colspan="7" styleCode="     Botrule          Rrule     " valign="top">
                            <paragraph>NA = data not available</paragraph>
                          </td>
                        </tr>
                      </tbody>
                    </table>
                    <paragraph>No drug accumulation was noted when cefaclor extended-release tablets were given twice daily.</paragraph>
                    <paragraph>The plasma half-life in healthy subjects is independent of dosage form and averages approximately 1 hour.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
              <component>
                <section ID="LINK_b239c812-fee8-46bf-ada6-4bc49e7c1b30">
                  <id root="492ca876-e44b-419d-9a76-a64c6997340d"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Food Effect on Pharmacokinetics</title>
                  <text>
                    <paragraph>When cefaclor extended-release tablets are taken with food, the AUC is 10% lower while the C<sub>max </sub>is 12% lower and occurs 1 hour later compared to cefaclor immediate-release capsules. In contrast, when cefaclor extended-release tablets are taken without food, the AUC is 23% lower while the C<sub>max</sub> is 67% lower and occurs 0.6 hours later, using an equivalent milligram dose of cefaclor immediate-release capsules as a reference. <content styleCode="bold">Therefore, cefaclor extended-release tablets should be taken with food. </content>
                    </paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
            </section>
          </component>
          <component>
            <section ID="LINK_8e564cab-714e-4304-9579-f7571a883653">
              <id root="f593973e-d580-4a6c-941f-ad0fdff36797"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>Special Populations</title>
              <effectiveTime value="20190731"/>
              <component>
                <section ID="LINK_c772bea3-dd25-4836-9551-22536e231439">
                  <id root="337e7990-3c4b-44ec-bee9-aa7a94239ccc"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Renal Insufficiency</title>
                  <text>
                    <paragraph>In patients with reduced renal function, the serum half-life of cefaclor is slightly prolonged. In those with complete absence of renal function, the plasma half-life of the intact molecule is 2.3 to 2.8 hours. Excretion pathways in patients with markedly impaired renal function have not been determined. Hemodialysis shortens the half-life by 25% to 30%.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
              <component>
                <section ID="LINK_a2082d39-de0c-48de-a48b-2492d84dfbfc">
                  <id root="0ea8a179-3565-4b07-b997-ec386af359f0"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Geriatric Patients</title>
                  <text>
                    <paragraph>Healthy geriatric volunteers (≥ 65 years old) who received a single 750 mg dose of cefaclor extended­release tablets had 40%-50% higher AUC and 20% lower renal clearance values when compared to healthy adult volunteers less than 45 years of age. These differences are considered to be primarily a result of age-related decreases in renal function.</paragraph>
                    <paragraph>In elderly subjects (over age 65) with normal serum creatinine values, higher peak plasma concentrations and AUCs have been observed. This is considered to be primarily a result of an age-related decrement in renal function and has no apparent clinical significance. Therefore, dosage adjustment is not necessary in elderly subjects with normal serum creatinine values.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
            </section>
          </component>
          <component>
            <section ID="LINK_b58cb74e-74f2-41bf-849f-a5c84ea54cea">
              <id root="aa087036-2674-40f6-89f3-af188a1d4aeb"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>Microbiology</title>
              <text>
                <paragraph>
                  <content styleCode="bold">Mechanism of Action</content>
                </paragraph>
                <paragraph>As with other cephalosporins, the bactericidal action of cefaclor results from inhibition of cell-wall synthesis. </paragraph>
                <paragraph>
                  <content styleCode="bold">Mechanism of Resistance</content>
                </paragraph>
                <paragraph>Resistance to cefaclor is primarily through hydrolysis of ß-lactamases alteration of penicillin-binding proteins (PBPs) and decreased permeability. <content styleCode="italics">Pseudomonas </content>spp., <content styleCode="italics">Acinetobacter calcoaceticus </content>and most isolates of <content styleCode="italics">Enterococci (Enterococcus faecalis, </content>group D streptococci), <content styleCode="italics">Enterobacter </content>spp., indole-positive <content styleCode="italics">Proteus, Morganella morganii </content>(formerly <content styleCode="italics">Proteus morganii), Providencia rettgeri </content>(formerly <content styleCode="italics">Proteus</content>
                  <content styleCode="italics"> rettgeri) </content>and <content styleCode="italics">Serratia </content>spp. are resistant to cefaclor. Cefaclor is inactive against methicillin-resistant staphylococci, ß-lactamase-negative, ampicillin-resistant isolates of <content styleCode="italics">H. influenzae </content>should be considered resistant to cefaclor despite apparent <content styleCode="italics">in vitro </content>susceptibility to this agent. </paragraph>
                <paragraph>
                  <content styleCode="bold">List of Microorganisms</content>
                </paragraph>
                <paragraph>Cefaclor has been shown to be active against most isolates of the following microorganisms both <content styleCode="italics">in vitro</content> and in clinical infections as described in the <content styleCode="bold">INDICATIONS AND USAGE</content> section.</paragraph>
                <paragraph>
                  <content styleCode="bold">Gram-positive Bacteria</content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Staphylococcus aureus </content>(methicillin susceptible only)</paragraph>
                <paragraph>
                  <content styleCode="italics">Streptococcus pneumoniae </content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Streptococcus pyogenes </content>
                </paragraph>
                <paragraph>
                  <content styleCode="bold">Gram-negative Bacteria</content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Haemophilus influenzae</content> (excluding β-lactamase-negative, ampicillin-resistant isolates) </paragraph>
                <paragraph>
                  <content styleCode="italics">Moraxella catarrhalis</content>
                </paragraph>
                <paragraph>The following <content styleCode="italics">in vitro </content>data are available, but their clinical significance is unknown. At least 90 percent of the following bacteria exhibit <content styleCode="italics">in vitro </content>minimum inhibitory concentrations (MICs) less than or equal to the susceptible breakpoint for cefaclor against isolates of similar genus or organism group. However, the efficacy of cefaclor in treating clinical infections caused by these bacteria has not been established in adequate and well-controlled trials.</paragraph>
                <paragraph>
                  <content styleCode="bold">Gram-positive Bacteria</content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Staphylococcus epidermidis </content>(methicillin susceptible only)</paragraph>
                <paragraph>
                  <content styleCode="bold">Gram-negative Bacteria</content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Haemophilus parainfluenzae </content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Klebsiella pneumoniae </content>
                </paragraph>
                <paragraph>
                  <content styleCode="bold">Anaerobic Bacteria</content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Peptococcus niger </content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Peptostreptococci </content>
                </paragraph>
                <paragraph>
                  <content styleCode="italics">Propionibacterium acnes </content>
                </paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_81d612ef-5c08-475a-8674-2dfafbe3dc0e">
              <id root="b75d5019-446c-4f8e-ad32-6f8c04e96803"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>Susceptibility Testing</title>
              <text>
                <paragraph>For specific information regarding susceptibility test interpretive criteria and associated test methods and quality control standards recognized by FDA for this drug, please see: <linkHtml href="#STIC">https://www.fda.gov/STIC</linkHtml>.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section ID="LINK_9879c276-581c-4541-aa52-a297860d3767">
          <id root="396e42e3-83ad-41d5-afde-e162bd9d67e5"/>
          <code code="34067-9" codeSystem="2.16.840.1.113883.6.1" displayName="INDICATIONS &amp; USAGE SECTION"/>
          <title>INDICATIONS AND USAGE</title>
          <text>
            <paragraph>To reduce the development of drug-resistant bacteria and maintain the effectiveness of cefaclor extended-release tablets USP and other antibacterial drugs, cefaclor extended-release tablets USP should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.</paragraph>
            <paragraph>
              <content styleCode="bold">The safety and effectiveness of cefaclor extended-release tablets in treating some of the indications and pathogens for which other formulations of cefaclor are approved have NOT been established.</content> When administered at the recommended dosages and durations of therapy, cefaclor extended-release tablets are indicated for the treatment of patients with the following mild to moderate infections when caused by susceptible strains of the designated organisms. (See <content styleCode="bold">DOSAGE AND ADMINISTRATION</content> and <content styleCode="bold">CLINICAL STUDIES</content> sections.)</paragraph>
            <paragraph>
              <content styleCode="bold">Acute bacterial exacerbations of chronic bronchitis</content> due to <content styleCode="italics">Haemophilus influenzae</content> (excluding ß-lactamase-negative, ampicillin-resistant isolates), <content styleCode="italics">Moraxella catarrhalis,</content> or <content styleCode="italics">Streptococcus pneumoniae</content>.</paragraph>
            <paragraph>
              <content styleCode="bold">NOTE:</content> In view of the insufficient numbers of isolates of ß-lactamase-producing isolates of <content styleCode="italics">Haemophilus</content>
              <content styleCode="italics"> influenzae </content>that were obtained from clinical trials with cefaclor extended-release tablets for patients with acute bacterial exacerbations of chronic bronchitis, it was not possible to adequately evaluate the effectiveness of cefaclor extended-release tablets for bronchitis known, suspected, or considered potentially to be caused by ß-lactamase-producing <content styleCode="italics">H. influenzae</content>.</paragraph>
            <paragraph>
              <content styleCode="bold">Pharyngitis and tonsillitis</content> due to <content styleCode="italics">Streptococcus pyogenes</content>.</paragraph>
            <paragraph>
              <content styleCode="bold">NOTE:</content> Only penicillin by the intramuscular route of administration has been shown to be effective in the prophylaxis of rheumatic fever. Cefaclor extended-release tablets are generally effective in the eradication of <content styleCode="italics">S. pyogenes</content> from the oropharynx; however, data establishing the efficacy of cefaclor extended-release tablets for the prophylaxis of subsequent rheumatic fever are not available.</paragraph>
            <paragraph>
              <content styleCode="bold">Uncomplicated skin and skin and structure infections</content> due to <content styleCode="italics">Staphylococcus aureus</content> (methicillin-susceptible only).</paragraph>
            <paragraph>
              <content styleCode="bold">NOTE:</content> In view of the insufficient numbers of isolates of <content styleCode="italics">Streptococcus pyogenes</content> that were obtained from clinical trials with cefaclor extended-release tablets for patients with uncomplicated skin and skin structure infections, it was not possible to adequately evaluate the effectiveness of cefaclor extended-release tablets for skin infections known, suspected, or considered potentially to be caused by <content styleCode="italics">S. pyogenes</content>.</paragraph>
          </text>
          <effectiveTime value="20190731"/>
        </section>
      </component>
      <component>
        <section ID="LINK_e308913f-ebba-4d94-aaff-834d8c984bf7">
          <id root="382e0727-9a27-4d1d-8dd1-641fe77fb5a4"/>
          <code code="34070-3" codeSystem="2.16.840.1.113883.6.1" displayName="CONTRAINDICATIONS SECTION"/>
          <title>CONTRAINDICATIONS</title>
          <text>
            <paragraph>Cefaclor extended-release tablets are contraindicated in patients with known hypersensitivity to cefaclor and other cephalosporins.</paragraph>
          </text>
          <effectiveTime value="20190731"/>
        </section>
      </component>
      <component>
        <section ID="LINK_77eb4241-7faf-43b5-92d2-61dbc9beb0c6">
          <id root="4eb36ac7-6333-45c6-be2d-2bd13191366d"/>
          <code code="34071-1" codeSystem="2.16.840.1.113883.6.1" displayName="WARNINGS SECTION"/>
          <title>WARNINGS</title>
          <text>
            <paragraph>
              <content styleCode="bold">BEFORE THERAPY WITH CEFACLOR EXTENDED-RELEASE TABLETS IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEFACLOR, CEPHALOSPORINS, PENICILLINS, OR OTHER DRUGS. IF THIS PRODUCT IS TO BE GIVEN TO PENICILLIN-SENSITIVE PATIENTS, CAUTION SHOULD BE EXERCISED BECAUSE CROSS-SENSITIVITY AMONG BETA-LACTAM ANTIBIOTICS HAS BEEN CLEARLY DOCUMENTED AND MAY OCCUR IN UP TO 10% OF PATIENTS WITH A HISTORY OF PENICILLIN ALLERGY. IF AN ALLERGIC REACTION TO CEFACLOR EXTENDED-RELEASE TABLETS OCCURS, DISCONTINUE THE DRUG. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE TREATMENT WITH EPINEPHRINE AND OTHER EMERGENCY MEASURES, INCLUDING OXYGEN, INTRAVENOUS FLUIDS, INTRAVENOUS ANTIHISTAMINES, CORTICOSTEROIDS, PRESSOR AMINES, AND AIRWAY MANAGEMENT, AS CLINICALLY INDICATED. </content>
            </paragraph>
            <paragraph>
              <content styleCode="italics">Clostridium difficile</content> associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including cefaclor and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of <content styleCode="italics">C. difficile</content>.</paragraph>
            <paragraph>
              <content styleCode="italics">C. difficile</content> produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of <content styleCode="italics">C. difficile</content> cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.</paragraph>
            <paragraph>If CDAD is suspected or confirmed, ongoing antibiotic use not directed against <content styleCode="italics">C. difficile</content> may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of <content styleCode="italics">C. difficile</content>, and surgical evaluation should be instituted as clinically indicated.</paragraph>
          </text>
          <effectiveTime value="20190731"/>
        </section>
      </component>
      <component>
        <section ID="LINK_0f74a307-ff5d-46c7-a9dd-06f6ea1662a6">
          <id root="3a8142a2-5b4a-45ea-b277-191cc1bc9b73"/>
          <code code="42232-9" codeSystem="2.16.840.1.113883.6.1" displayName="PRECAUTIONS SECTION"/>
          <title>PRECAUTIONS</title>
          <effectiveTime value="20190731"/>
          <component>
            <section ID="LINK_976630b0-5ecb-4e12-8e58-109b4e597d31">
              <id root="683eb737-f18e-4f75-860d-70b46d19675b"/>
              <code code="34072-9" codeSystem="2.16.840.1.113883.6.1" displayName="GENERAL PRECAUTIONS SECTION"/>
              <title>General</title>
              <text>
                <paragraph>Prescribing cefaclor extended-release tablets USP in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.</paragraph>
                <paragraph>Superinfection (overgrowth by non-susceptible organisms) should always be considered a possibility in a patient being treated with a broad spectrum antimicrobial. Careful observation of the patient is essential. If superinfection occurs during therapy, appropriate measures should be taken.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_f4e2e852-5def-4374-8275-1143728104c2">
              <id root="d4641e83-c48f-4516-bb69-946801f55818"/>
              <code code="34076-0" codeSystem="2.16.840.1.113883.6.1" displayName="INFORMATION FOR PATIENTS SECTION"/>
              <title>Information for Patients</title>
              <text>
                <paragraph>Patients should be counseled that antibacterial drugs including cefaclor extended-release tablets USP should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold). When cefaclor extended-release tablets USP are prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed. Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by cefaclor extended-release tablets USP or other antibacterial drugs in the future.</paragraph>
                <paragraph>Diarrhea is a common problem caused by antibiotics which usually ends when the antibiotic is discontinued. Sometimes after starting treatment with antibiotics, patients can develop watery and bloody stools (with or without stomach cramps and fever) even as late as two or more months after having taken the last dose of the antibiotic. If this occurs, patients should contact their physician as soon as possible.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_d3b6c22c-8a25-4b5a-bdaa-70e04430a304">
              <id root="2fa67efc-2234-4cb0-ba0c-6d924b9b93ba"/>
              <code code="34073-7" codeSystem="2.16.840.1.113883.6.1" displayName="DRUG INTERACTIONS SECTION"/>
              <title>Drug Interactions</title>
              <effectiveTime value="20190731"/>
              <component>
                <section ID="LINK_b830adec-7c04-4652-9581-209db7d749c6">
                  <id root="62c0f384-4da3-48c0-8483-2a392ea20bbb"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Antacids</title>
                  <text>
                    <paragraph>The extent of absorption of cefaclor extended-release tablets is diminished if magnesium or aluminum hydroxide-containing antacids are taken within 1 hour of administration; H<sub>2</sub> blockers do not alter either the rate or the extent of absorption of cefaclor extended-release tablets.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
              <component>
                <section ID="LINK_b57a5b88-d202-494d-9abb-b8024cf612ad">
                  <id root="42237073-d1f2-4bde-a567-298906a14487"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Probenecid</title>
                  <text>
                    <paragraph>The renal excretion of cefaclor is inhibited by probenecid.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
              <component>
                <section ID="LINK_952795e5-e86b-45bc-8550-b406dd6b526b">
                  <id root="ad424fc6-7c87-4cf0-9bd7-10a79abdf578"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Warfarin</title>
                  <text>
                    <paragraph>There have been rare reports of increased prothrombin time with or without clinical bleeding in patients receiving cefaclor and warfarin concomitantly. No specific studies have been performed to rule in or rule out this potential drug/drug interaction.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
            </section>
          </component>
          <component>
            <section ID="LINK_ba1f02b3-6be6-42ab-a886-1e6ff9ef6441">
              <id root="a091e0da-9d62-4155-902c-091d4f58f97f"/>
              <code code="34074-5" codeSystem="2.16.840.1.113883.6.1" displayName="DRUG &amp; OR LABORATORY TEST INTERACTIONS SECTION"/>
              <title>Laboratory Test Interactions</title>
              <text>
                <paragraph>Administration of cefaclor extended-release tablets may result in a false-positive reaction for glucose in the urine. This phenomenon has been seen in patients taking cephalosporin antibiotics when the test is performed using Benedict's and Fehling's solutions and also with Clinitest<sup>® </sup>tablets.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_55a40cea-f6b3-4463-904f-d22a5c014918">
              <id root="cfbe86da-eab8-4dd5-bf82-cb64bdf0848f"/>
              <code code="34083-6" codeSystem="2.16.840.1.113883.6.1" displayName="CARCINOGENESIS &amp; MUTAGENESIS &amp; IMPAIRMENT OF FERTILITY SECTION"/>
              <title>Carcinogenesis, Mutagenesis, Impairment of Fertility</title>
              <text>
                <paragraph>Studies in animals have not been performed to evaluate the carcinogenic or mutagenic potential for cefaclor. Reproduction studies have revealed no evidence of impaired fertility.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_58ff8157-163e-486f-9483-55a33177d239">
              <id root="38118472-62d3-4f38-98d6-4ef1dcf07970"/>
              <code code="42228-7" codeSystem="2.16.840.1.113883.6.1" displayName="PREGNANCY SECTION"/>
              <title>Usage in Pregnancy</title>
              <effectiveTime value="20190731"/>
              <component>
                <section ID="LINK_d5a5f4e6-703e-4fae-ba3d-cc416d4d8f59">
                  <id root="e04deec7-9ca3-4de5-902d-8edef7539f7a"/>
                  <code code="34077-8" codeSystem="2.16.840.1.113883.6.1" displayName="TERATOGENIC EFFECTS SECTION"/>
                  <title>Teratogenic Effect</title>
                  <text>
                    <paragraph>Reproduction studies using cefaclor have been performed in mice, rats and ferrets at doses up to 3 to 5 times the maximum human dose (1500 mg/day) based on mg/m<sup>2</sup>. These studies have revealed no harm to the fetus due to cefaclor. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, cefaclor extended-release tablets should be used during pregnancy only if clearly needed.<br/>
                    </paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
            </section>
          </component>
          <component>
            <section ID="LINK_e8a1f1c2-bf71-42b8-b3c2-d8fbc68f1cbf">
              <id root="87d58bb1-09b6-40db-b9e6-bf6651210a15"/>
              <code code="34079-4" codeSystem="2.16.840.1.113883.6.1" displayName="LABOR &amp; DELIVERY SECTION"/>
              <title>Labor and Delivery</title>
              <text>
                <paragraph>Cefaclor extended-release tablets have not been studied for use during labor and delivery. Treatment should be given only if clearly needed.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_75d41d4b-077e-4338-9d2f-2fd40210326f">
              <id root="b737f472-d39c-4d97-bc70-c926e12569c0"/>
              <code code="34080-2" codeSystem="2.16.840.1.113883.6.1" displayName="NURSING MOTHERS SECTION"/>
              <title>Nursing Mothers</title>
              <text>
                <paragraph>No studies in lactating women have been performed with cefaclor extended-release tablets. Small amounts of cefaclor (≤ 0.21 mcg/mL) have been detected in human milk following administration of single 500 mg doses of cefaclor extended-release tablets. The effect on nursing infants is not known. Caution should be exercised when cefaclor extended-release tablets are administered to a nursing woman.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_a3d930cc-1787-4777-a619-47fa36c60a57">
              <id root="8d9ff8c0-1d53-4e5e-b960-1fae56f5667c"/>
              <code code="34081-0" codeSystem="2.16.840.1.113883.6.1" displayName="PEDIATRIC USE SECTION"/>
              <title>Pediatric Use</title>
              <text>
                <paragraph>Safety and effectiveness of cefaclor extended-release tablets in pediatric patients less than 16 years of age have not been established.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_bc178f1f-f561-4e53-82c5-56a3d8556274">
              <id root="50188246-3c39-4a34-9a72-af91490e6abb"/>
              <code code="34082-8" codeSystem="2.16.840.1.113883.6.1" displayName="GERIATRIC USE SECTION"/>
              <title>Geriatric Use</title>
              <text>
                <paragraph>Of the 3272 patients in clinical studies of cefaclor extended-release tablets, 608 (18.2%) were 65 and older. No overall differences in safety or effectiveness were observed between these and younger patients. Other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.</paragraph>
                <paragraph> This drug is known to be substantially excreted by the kidney (see <content styleCode="bold">CLINICAL PHARMACOLOGY</content>), and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function (see <content styleCode="bold">DOSAGE AND ADMINISTRATION</content>).</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section ID="LINK_1ff337eb-736e-4aeb-b03d-7454e316663a">
          <id root="27ad4635-7405-4e69-85bc-43df43cbf28b"/>
          <code code="34084-4" codeSystem="2.16.840.1.113883.6.1" displayName="ADVERSE REACTIONS SECTION"/>
          <title>ADVERSE REACTIONS</title>
          <effectiveTime value="20190731"/>
          <component>
            <section ID="LINK_74a3ff1e-189c-46ce-b50d-9d9338225b20">
              <id root="c253ae90-5904-4834-b578-667ba45fdb10"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>Clinical Trials</title>
              <text>
                <paragraph>There were 3272 patients treated with multiple doses of cefaclor extended-release tablets in controlled clinical trials and an additional 211 subjects in pharmacology studies. There were no deaths in these trials thought to be related to toxicity from cefaclor extended-release tablets. Treatment was discontinued in 1.7% of patients due to adverse events thought to be possibly or probably drug-related.</paragraph>
                <paragraph>The following adverse clinical and laboratory events were reported during the cefaclor extended-release tablets clinical trials conducted in North America at doses of 375 mg or 500 mg BID; however, relatedness of the adverse events to the drug was not assigned by clinical investigators during the trials (see <content styleCode="bold">TABLES 4</content> and <content styleCode="bold">5</content>).</paragraph>
                <table>
                  <caption>Table 4: ADVERSE CLINICAL EVENTS - CEFACLOR EXTENDED-RELEASE TABLETS MULTIPLE DOSE DOSING REGIMENS CLINICAL TRIALS - NORTH AMERICA (n = 1400)</caption>
                  <col width="39%"/>
                  <col width="21%"/>
                  <col width="11%"/>
                  <tbody>
                    <tr>
                      <td rowspan="12" styleCode="     Botrule          Toprule         Lrule     " valign="top">
                        <paragraph>Incidence Equal to or Greater Than 1%</paragraph>
                      </td>
                      <td align="center" styleCode="     Botrule          Toprule         Lrule     " valign="top">
                        <paragraph>Event</paragraph>
                      </td>
                      <td align="center" styleCode="     Botrule          Toprule         Lrule          Rrule     " valign="top">
                        <paragraph>Incidence</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Headache</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>4.9%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Rhinitis</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>3.9%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Diarrhea</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>3.8%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Nausea</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>3.4%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Vaginitis<footnote ID="FOOT_19318">n = 934 for these events (subset of female participants).</footnote>
                        </paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>2.4%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Vaginal Moniliasis<footnoteRef IDREF="FOOT_19318"/>
                        </paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>2.2%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Abdominal Pain</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>1.6%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Cough Increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>1.5%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Pharyngitis</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>1.4%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Pruritus</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>1.4%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Back Pain</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>1.0%</paragraph>
                      </td>
                    </tr>
                  </tbody>
                </table>
                <paragraph>Adverse reactions occurring during the clinical trials with cefaclor extended-release tablets with an incidence of less than 1% but greater than 0.1% included the following (listed alphabetically):</paragraph>
                <paragraph>Accidental injury, anorexia, anxiety, arthralgia, asthma, bronchitis, chest pain, chills, congestive heart failure, conjunctivitis, constipation, dizziness, dysmenorrhea, dyspepsia, dysuria, ear pain, edema, fever, flatulence, flu syndrome, gastritis, infection, insomnia, leukorrhea, lung disorder, maculopapular rash, malaise, menstrual disorder, myalgia, nausea and vomiting, neck pain, nervousness, nocturia, otitis media, pain, palpitation, peripheral edema, rash, respiratory disorder, sinusitis, somnolence, surgical procedure, sweating, tremor, urticaria, vomiting.</paragraph>
                <paragraph>
                  <content styleCode="bold">NOTE:</content> One case of <content styleCode="bold">serum-sickness-like</content> reaction was reported among the 3272 adult patients treated with cefaclor extended-release tablets during the controlled clinical trials. These reactions have also been reported with the use of cefaclor in other oral formulations and are seen more frequently in pediatric patients than in adults. These reactions are characterized by findings of erythema multiforme, rash, and other skin manifestations accompanied by arthritis/arthralgia, with or without fever, and differ from classic serum sickness in that there is infrequently associated lymphadenopathy and proteinuria, no circulating immune complexes and no evidence to date of sequelae of the reaction. While further investigation is ongoing, <content styleCode="bold">serum-sickness-like</content> reactions appear to be due to hypersensitivity and more often occur during or following a second (or subsequent) course of therapy with cefaclor. Such reactions have been reported with overall occurrence ranging from 1 in 200 (0.5%) in one focused trial; to 2 in 8346 (0.024%) in overall clinical trials (with an incidence in pediatric patients in clinical trials of 0.055%); to 1 in 38,000 (0.003%) in spontaneous event reports. Signs and symptoms usually occur a few days after initiation of therapy and subside within a few days after cessation of therapy. Occasionally these reactions have resulted in hospitalization, usually of short duration (median hospitalization = 2 to 3 days, based on postmarketing surveillance studies). In those patients requiring hospitalization, the symptoms have ranged from mild to severe at the time of admission with more of the severe reactions occurring in pediatric patients.</paragraph>
                <table>
                  <caption>Table 5: ADVERSE CLINICAL LABORATORY EVENTS CEFACLOR EXTENDED-RELEASE TABLETS MULTIPLE DOSE DOSING REGIMENS CLINICAL TRIALS – NORTH AMERICA</caption>
                  <col width="47%"/>
                  <col width="37%"/>
                  <col width="11%"/>
                  <tbody>
                    <tr>
                      <td styleCode="     Botrule          Toprule         Lrule     " valign="top"/>
                      <td styleCode="     Botrule          Toprule         Lrule     " valign="top">
                        <paragraph>Event</paragraph>
                      </td>
                      <td styleCode="     Botrule          Toprule         Lrule          Rrule     " valign="top">
                        <paragraph>Incidence</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td rowspan="20" styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Incidence Less Than 1%, but Greater Than 0.1%</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Albumin decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Alkaline phosphatase increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>ALT/SGPT increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Bilirubin total increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Blood urea nitrogen (BUN) increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.2%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Calcium decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.7%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Creatine phosphokinase increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.7%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Creatinine increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.5%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Eosinophils increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Erythrocyte count decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>GGT increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.2%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Hemoglobin decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.2%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Lymphocytes decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Mean Cell Volume (MCV) increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.7%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Neutrophils segmented decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Phosphorous increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.7%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Platelet count decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Potassium increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.4%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Sodium decreased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.3%</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Sodium increased</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>0.4%</paragraph>
                      </td>
                    </tr>
                  </tbody>
                </table>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_28f8cda8-dddc-4b7c-babd-562cff6976fa">
              <id root="50054fd1-e730-470f-88f0-27160b4890e8"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>In Postmarketing Experience</title>
              <text>
                <paragraph>In addition to the events reported during clinical trials with cefaclor extended-release tablets, the following adverse experiences are among those that have been reported during worldwide postmarketing surveillance: allergic reaction, anaphylactoid reaction, angioedema, face edema, hypotension, Stevens-Johnson syndrome, syncope, paresthesia, vasodilatation and vertigo.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_ad7934ce-f4ba-4f4c-8c78-f842f2e9f7f2">
              <id root="56dcd4c5-7783-4379-80b1-ba32da85b005"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>Other Adverse Reactions Associated With Other Formulations of Cefaclor</title>
              <text>
                <paragraph>In addition to the above, the following other adverse reactions and altered laboratory tests have been associated with cefaclor in other oral formulations:</paragraph>
              </text>
              <effectiveTime value="20190731"/>
              <component>
                <section ID="LINK_0a5d3c03-b3fc-49d0-85fd-cce33e354651">
                  <id root="c2f5db72-f260-4aa8-86b9-efcefdbe1c55"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Clinical</title>
                  <text>
                    <paragraph>Severe hypersensitivity reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, and anaphylaxis, have been reported rarely. Anaphylactoid events may be manifested by solitary symptoms, including angioedema, edema (including face and limbs), paresthesias, syncope, or vasodilatation. Anaphylaxis may be more common in patients with a history of penicillin allergy. Rarely, hypersensitivity symptoms may persist for several months.</paragraph>
                    <paragraph>Symptoms of pseudomembranous colitis may appear either during or after antibiotic treatment. (See <content styleCode="bold">WARNINGS</content>.)</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
              <component>
                <section ID="LINK_713ff755-1e09-44a1-9fce-8b4f24058906">
                  <id root="727d72a0-a241-4249-b3bf-586613618d06"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Laboratory</title>
                  <text>
                    <paragraph>Abnormal urinalysis, eosinophilia, leukopenia, neutropenia, transient elevations in AST, and transient thrombocytopenia have been reported.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
            </section>
          </component>
          <component>
            <section ID="LINK_7de04702-2d80-4cd3-a775-07d09e6c615d">
              <id root="5ea0739e-1282-4eef-b3a7-5da49884005c"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>Cephalosporin-Class Reactions</title>
              <text>
                <paragraph>In addition to the adverse reactions listed above, the following adverse reactions and altered laboratory tests have been reported for cephalosporin-class antibiotics:</paragraph>
              </text>
              <effectiveTime value="20190731"/>
              <component>
                <section ID="LINK_6b662f87-b451-4a95-9ac3-d846e8e6d1f9">
                  <id root="7eeb927c-c29d-4b78-afa3-dc80463d2784"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Clinical</title>
                  <text>
                    <paragraph>Confusion, erythema multiforme, genital pruritus, hepatic dysfunction including cholestasis, hemolytic anemia, reversible hyperactivity, hypertonia, and reversible interstitial nephritis.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
              <component>
                <section ID="LINK_ec6d95b5-910e-4dad-8b05-8f651d1054c4">
                  <id root="049de63b-f24c-4668-9af6-94a9a26a08f7"/>
                  <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                  <title>Laboratory</title>
                  <text>
                    <paragraph>Positive direct Coombs’ test.</paragraph>
                  </text>
                  <effectiveTime value="20190731"/>
                </section>
              </component>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section ID="LINK_c4786ee5-37f7-4116-af63-7cae071ab898">
          <id root="b14e6a61-117d-40da-9e91-80e7ebef48ca"/>
          <code code="34088-5" codeSystem="2.16.840.1.113883.6.1" displayName="OVERDOSAGE SECTION"/>
          <title>OVERDOSAGE</title>
          <text>
            <paragraph>The toxic symptoms following an overdose of cefaclor may include nausea, vomiting, epigastric distress, and diarrhea. The severity of the epigastric distress and the diarrhea are dose-related.</paragraph>
            <paragraph>Absorption of drugs from the gastrointestinal tract may be decreased by giving activated charcoal, which, in many cases, is more effective than emesis or lavage. Consider charcoal instead of or in addition to gastric emptying. Repeated doses of charcoal over time may hasten elimination of some drugs that have been absorbed.</paragraph>
            <paragraph>Although cefaclor is considered dialyzable, neither forced diuresis, peritoneal dialysis, hemodialysis, nor charcoal hemoperfusion have been demonstrated to be beneficial in an overdose of cefaclor.</paragraph>
          </text>
          <effectiveTime value="20190731"/>
        </section>
      </component>
      <component>
        <section ID="LINK_98625f08-abeb-42d6-80b9-57d9d92fedeb">
          <id root="6f5faac6-5d89-40c6-a323-7653e3865523"/>
          <code code="34068-7" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE &amp; ADMINISTRATION SECTION"/>
          <title>DOSAGE AND ADMINISTRATION</title>
          <text>
            <paragraph>The absorption of cefaclor extended-release tablets is enhanced when it is administered with food. (See <content styleCode="bold">CLINICAL PHARMACOLOGY</content>.) Therefore, <content styleCode="bold">cefaclor extended-release tablets should be administered with meals (i.e., at least within one hour of eating)</content>. The extended-release tablets should not be cut, crushed, or chewed.</paragraph>
            <paragraph>
              <content styleCode="bold">See INDICATIONS AND USAGE for information about patients for whom cefaclor extended-release tablets are indicated.</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">NOTE:</content> 500 mg BID of cefaclor extended-release tablets is clinically equivalent to 250 mg TID of cefaclor immediate-release as a capsule in those indications listed in the <content styleCode="bold">INDICATIONS AND USAGE</content> section of this label. <content styleCode="bold">500 mg BID of cefaclor extended-release tablets is NOT equivalent to 500 mg TID of other cefaclor formulations. </content>
            </paragraph>
            <paragraph>Adults (age 16 years and older):</paragraph>
            <table>
              <col width="65%"/>
              <col width="10%"/>
              <col width="14%"/>
              <col width="11%"/>
              <tbody>
                <tr>
                  <td styleCode="     Botrule          Toprule         Lrule     " valign="top">
                    <paragraph>Type of Infection (as qualified in the <content styleCode="bold">INDICATIONS AND USAGE</content> section of this labeling)</paragraph>
                  </td>
                  <td styleCode="     Botrule          Toprule         Lrule     " valign="top">
                    <paragraph>Total Daily Dose</paragraph>
                  </td>
                  <td styleCode="     Botrule          Toprule         Lrule     " valign="top">
                    <paragraph>Dose and Frequency</paragraph>
                  </td>
                  <td styleCode="     Botrule          Toprule         Lrule          Rrule     " valign="top">
                    <paragraph>Duration</paragraph>
                  </td>
                </tr>
                <tr>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>Acute Bacterial Exacerbations of Chronic Bronchitis due to <content styleCode="italics">H. influenzae</content> (non-ß-lactamase-producing strains only). <content styleCode="italics">Moraxella catarrhalis</content> (including ß-lactamase-producing strains), or <content styleCode="italics">Streptococcus pneumoniae</content> (See <content styleCode="bold">INDICATIONS AND USAGE</content>.)</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>1000 mg</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>500 mg q 12 hours</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                    <paragraph>7 days</paragraph>
                  </td>
                </tr>
                <tr>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>Pharyngitis and/or tonsillitis due to <content styleCode="italics">S. pyogenes</content>
                    </paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>750 mg</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>375 mg q 12 hours</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                    <paragraph>10 days</paragraph>
                  </td>
                </tr>
                <tr>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>Uncomplicated Skin and Skin Structure Infections due to <content styleCode="italics">S. aureus</content> (methicillin-susceptible strains) (See <content styleCode="bold">INDICATIONS AND USAGE</content>.)</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>750 mg</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule     " valign="top">
                    <paragraph>375 mg q 12 hours</paragraph>
                  </td>
                  <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                    <paragraph>7 to 10 days</paragraph>
                  </td>
                </tr>
              </tbody>
            </table>
            <paragraph>Elderly patients with normal renal function do not require dosage adjustments.</paragraph>
          </text>
          <effectiveTime value="20190731"/>
        </section>
      </component>
      <component>
        <section ID="LINK_ebbcc534-d7cf-4095-8694-12ae54a48a17">
          <id root="8947160c-7893-4659-a1c6-2237a3fe45a6"/>
          <code code="34069-5" codeSystem="2.16.840.1.113883.6.1" displayName="HOW SUPPLIED SECTION"/>
          <title>HOW SUPPLIED</title>
          <text>
            <paragraph>Cefaclor Extended-release Tablets USP, 500 mg (based on the anhydrous), are available as film-coated, oval-shaped, unscored, dark blue tablets, debossed with “93” on one side and “1087” on the other side. They are available in bottles of 100. (NDC 0093-1087-01)</paragraph>
            <paragraph>Store at 20° to 25°C (68° to 77°F) [See USP Controlled Room Temperature].</paragraph>
            <paragraph>Dispense in a tight, light-resistant container as defined in the USP, with a child-resistant closure (as required).</paragraph>
          </text>
          <effectiveTime value="20190731"/>
        </section>
      </component>
      <component>
        <section ID="LINK_43ca6567-86e9-408a-9abf-1b908aa882d6">
          <id root="4ff464dc-ec37-4d00-ac6d-0b2ff0a1efdf"/>
          <code code="34092-7" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL STUDIES SECTION"/>
          <title>CLINICAL STUDIES</title>
          <effectiveTime value="20190731"/>
          <component>
            <section ID="LINK_a879f559-998b-49ab-804d-17e58cb8bd52">
              <id root="7054e56a-c1d0-4f32-aea5-4f39c86dde98"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>ACUTE BACTERIAL EXACERBATIONS OF CHRONIC BRONCHITIS</title>
              <text>
                <paragraph>In adequate and well-controlled clinical trials of cefaclor extended-release tablets in the treatment of acute bacterial exacerbations of chronic bronchitis (ABECB), only 4 evaluable patients with ABECB had infections caused by ß-lactamase-producing <content styleCode="italics">H. influenzae. </content>Four patients do not provide adequate data upon which to judge clinical efficacy of cefaclor extended-release tablets against ß-lactamase-producing <content styleCode="italics">H. influenzae</content>.</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
          <component>
            <section ID="LINK_69ea57fb-3500-4e71-8f46-05c621dd8e02">
              <id root="b62d749c-bb65-4f92-a4f3-6a41037951e7"/>
              <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
              <title>UNCOMPLICATED SKIN AND SKIN STRUCTURE INFECTIONS</title>
              <text>
                <paragraph>Cefaclor extended-release tablets (375 mg Q12H) (n = 115) were compared to cefaclor immediate-release capsules (250 mg TID) (n = 106) for the treatment of patients with uncomplicated skin and skin structure infections, including cellulitis, pyoderma, abscess and impetigo. Patients were treated for 7 to 10 days and were evaluated for clinical resolution and bacterial eradication approximately one week after completing therapy. To be evaluable, all patients had to have a recognized pathogen isolated from the skin infection just prior to the initiation of therapy. The results of this randomized, double-blinded, U.S. trial demonstrated:</paragraph>
                <list listType="ordered" styleCode="Arabic">
                  <item>overall clinical cure rates were 72% (83 of 115 patients) and 75% (80 of 106 patients), respectively, for cefaclor extended-release tablets and cefaclor immediate-release capsules [95% CI around the 3% difference = -16% to +9%],</item>
                  <item>overall bacteriologic eradication rates against <content styleCode="italics">Staphylococcus aureus</content> were comparable (see <content styleCode="bold">TABLE 6</content>).</item>
                </list>
                <table>
                  <caption>Table 6: CLINICAL RESPONSE<footnote ID="FOOT_19319">Cure plus improvement</footnote> IN PATIENTS WITH SKIN AND SKIN STRUCTURE INFECTIONS</caption>
                  <col width="22%"/>
                  <col width="20%"/>
                  <col width="18%"/>
                  <col width="19%"/>
                  <col width="21%"/>
                  <tbody>
                    <tr>
                      <td styleCode="     Botrule          Toprule         Lrule     " valign="top">
                        <paragraph>Outcome by Pathogen</paragraph>
                      </td>
                      <td colspan="2" styleCode="     Botrule          Toprule         Lrule     " valign="top">
                        <paragraph>CEFACLOR EXTENDED-RELEASE TABLETS</paragraph>
                      </td>
                      <td colspan="2" styleCode="     Botrule          Toprule         Lrule          Rrule     " valign="top">
                        <paragraph>CEFACLOR IMMEDIATE-RELEASE CAPSULES</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>
                          <content styleCode="italics">Staphylococcus aureus</content>
                        </paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>67/95</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>(71%)</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>58/81</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>(71%)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>
                          <content styleCode="italics">Streptococcus pyogenes</content>
                        </paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>10/16</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>(63%)</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>8/9</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>(89%)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Other streptococci</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>7/11</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>(64%)</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>5/6</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>(83%)</paragraph>
                      </td>
                    </tr>
                    <tr>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>Total</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>84/122</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>(69%)</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule     " valign="top">
                        <paragraph>71/96</paragraph>
                      </td>
                      <td styleCode="     Botrule         Lrule          Rrule     " valign="top">
                        <paragraph>(74%)</paragraph>
                      </td>
                    </tr>
                  </tbody>
                </table>
                <paragraph>All brand names listed are the registered trademarks of their respective owners and are not trademarks of Teva Pharmaceuticals USA.</paragraph>
                <paragraph>
                  <content styleCode="bold">Teva Pharmaceuticals USA, Inc.</content>
                </paragraph>
                <paragraph>North Wales, PA 19454</paragraph>
                <paragraph> Rev. N 7/2019</paragraph>
              </text>
              <effectiveTime value="20190731"/>
            </section>
          </component>
        </section>
      </component>
      <component>
        <section ID="LINK_105ec4e4-0fd6-4848-bdbc-2a0feb93b478">
          <id root="5bde340e-161c-4f56-8a6b-d38628c19067"/>
          <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
          <title>Package/Label Display Panel</title>
          <text>
            <paragraph>
              <content styleCode="bold">NDC</content> 0093-<content styleCode="bold">1087</content>-01</paragraph>
            <paragraph>
              <content styleCode="bold">Cefaclor</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">Extended-Release</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">Tablets USP</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">500 mg</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">Rx only</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">100 TABLETS</content>
            </paragraph>
            <paragraph>
              <content styleCode="bold">TEVA</content>
            </paragraph>
            <paragraph>
              <renderMultiMedia referencedObject="MM2"/>
              <br/>
            </paragraph>
          </text>
          <effectiveTime value="20190731"/>
          <component>
            <observationMedia ID="MM2">
              <text>1</text>
              <value mediaType="image/jpeg" xsi:type="ED">
                <reference value="image-2.jpg"/>
              </value>
            </observationMedia>
          </component>
        </section>
      </component>
    </structuredBody>
  </component>
</document>