cefprozil

Action

Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

Powder for suspension: 125 mg/5 ml, 250 mg/5 ml

Tablets: 250 mg, 500 mg

Indications and dosages

➣ Uncomplicated skin infections caused by Staphylococcus aureus and Streptococcus pyogenes
Adults and children ages 13 and older: 250 to 500 mg P.O. q 12 hours or 500 mg P.O. daily for 10 days

➣ Pharyngitis or tonsillitis caused by S. pyogenes
Adults and children ages 13 and older: 500 mg P.O. daily for at least 10 days

➣ Acute bronchitis; acute bacterial chronic bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
Adults and children ages 13 and older: 500 mg P.O. q 12 hours for 10 days

➣ Acute sinusitis caused by S. pneumoniae, H. influenzae, and M. catarrhalis
Adults and children ages 13 and older: 250 mg P.O. q 12 hours for 10 days; for moderate to severe infections, 500 mg P.O. q 12 hours for 10 days
Children ages 6 months to 12 years: 7.5 mg/kg P.O. q 12 hours for 10 days; for moderate to severe infections, 15 mg/kg P.O. q 12 hours for 10 days

➣ Otitis media caused by S. pneumoniae, H. influenzae, and M. catarrhalis
Children ages 6 months to 12 years: 15 mg/kg P.O. q 12 hours for 10 days

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

• Renal failure

Precautions

Use cautiously in:

• renal or hepatic impairment

• pregnant or breastfeeding patients

• children.

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.

• Give drug with food.

Adverse reactions

CNS: headache, dizziness, drowsiness, hyperactivity, hypotonia, insomnia, confusion, seizures

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, pseudomembranous colitis

GU: hematuria, vaginal candidiasis, genital pruritus, renal dysfunction, toxic nephropathy

Hematologic: eosinophilia, aplastic anemia, hemolytic anemia, hemorrhage, bone marrow depression, hypoprothrombinemia

Hepatic: hepatic dysfunction

Skin: toxic epidermal necrolysis, diaper rash, erythema multiforme, Stevens-Johnson syndrome

Other: allergic reactions, carnitine deficiency, drug fever, superinfection, serum sickness-like reaction, anaphylaxis

Interactions

Drug-drug. Aminoglycosides: increased risk of nephrotoxicity

Antacids containing aluminum or magnesium, histamine₂-receptor antagonists: increased cefprozil absorption

Probenecid: decreased excretion and increased blood level of cefprozil

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase, white blood cells in urine: increased levels

Blood glucose, Coombs' test, urine glucose tests using Benedict's solution: false-positive results

Platelets, white blood cells: decreased counts

Drug-food. Moderate- or high-fat meal: increased drug bioavailability

Patient monitoring

Stay alert for life-threatening reactions, including anaphylaxis, serum sickness-like reaction, Stevens-Johnson syndrome, and pseudomembranous colitis.

• Monitor neurologic status, particularly for signs and symptoms of impending seizures.

• Monitor kidney and liver function test results and assess fluid intake and output.

• Monitor CBC with white cell differential, prothrombin time, and bleeding time. Watch for signs and symptoms of blood dyscrasias, especially hypoprothrombinemia.

• Monitor temperature. Stay alert for signs and symptoms of superinfection.

Patient teaching

Advise patient to immediately report rash, bleeding tendency, or CNS changes.

• Teach patient to recognize signs and symptoms of superinfection, and instruct him to report these right away.

• Tell patient to take drug with food.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.