Cefprozil

Antibiotic Class:

Second-Generation Cephalosporin (true 2^nd generation cephalosporin)

Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp. Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae

Mechanism of Action:

Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to play a role in the activation of bacterical cell autolysins which may contribute to bacterial cell lysis.

Pharmacodynamics:

Cephalosporins exhibit time-dependent killing (T > MIC)

Pharmacokinetics:

Dose of 500mg: Cmax: 17.3 mcg/L; Tmax: 0.7 hours; Half-life: 0.6 hours; Table 10

Adverse Effects:

Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia

Hematologic: Neutropenia, Leukopenia, Thrombocytopenia

GI: Diarrhea, C. difficile disease

Renal: Interstitial nephritis

Table 14

Dosage:

PO: 250mg, 500mg tablet

Powder for Suspension: 125mg/5mL, 250mg/5mL

Dosing in adults:

Acute exacerbation of chronic bronchitis: 500mg PO q12h x 10 days

Uncomplicated skin and/or subcutaneous tissue infection: 250mg PO q12h, or 500mg PO q12-24 h x 10 days

Pharyngitis: 500 mg PO q24h x 10 days

Sinusitis, acute: 250-500mg PO q12h x 10 days

Dosing in pediatrics:

15-30mg/kg/day divided PO q12h

Disease state based dosing:

Renal failure: CrCl < 30 mL/min, 50% of standard dose at same interval

Hepatic failure: No dosing changes recommended at this time.

Contraindications/Warnings/Precautions:

Precautions: hypersensitivity to penicillins (cross-reactivity 5-10%), history of gastrointestinal disease, particularly colitis, renal impairment

Drug Interactions:

Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine

Probenecid: increased serum cefprozil levels

Pregnancy:

Category B: No evidence of risk in humans but studies inadequate.

Monitoring Requirements:

Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count

Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia, Prothrombin time in patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy.

Brand names/Manufacturer:

Cefzil Ò/Bristol-Myers Squibb