Usage
Cefprozil is a second-generation cephalosporin antibiotic prescribed for various bacterial infections. It is effective against a range of gram-positive and gram-negative bacteria. Specifically, it is used to treat:
- Upper Respiratory Tract Infections: Pharyngitis, tonsillitis, sinusitis, otitis media (ear infection).
- Lower Respiratory Tract Infections: Bronchitis, pneumonia.
- Skin and Soft Tissue Infections: Abscesses, cellulitis, impetigo.
- Urinary Tract Infections: Cystitis, pyelonephritis.
Cefprozil’s pharmacological classification is antibiotic.
Cefprozil’s mechanism of action involves inhibiting bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). This binding disrupts the final transpeptidation step of peptidoglycan synthesis, leading to bacterial cell lysis and death.
Alternate Names
Cefprozil is also known by the brand name Cefzil. There are no widely used international or regional variations of this name.
How It Works
Pharmacodynamics: Cefprozil exerts its bactericidal effect by disrupting bacterial cell wall synthesis. By binding to PBPs, it weakens the bacterial cell wall, rendering the bacteria susceptible to osmotic lysis.
Pharmacokinetics:
- Absorption: Cefprozil is well-absorbed orally, with bioavailability around 90-95%, whether taken with or without food. However, taking it with meals may reduce gastrointestinal discomfort.
- Distribution: Cefprozil is widely distributed throughout body tissues, with about 35-45% bound to plasma proteins.
- Metabolism: Cefprozil is primarily excreted unchanged in the urine.
- Elimination: The plasma half-life is approximately 1-1.4 hours, but this is prolonged in patients with renal impairment. Around 60% of the drug is excreted unchanged in the urine.
Mode of Action: Cefprozil’s mode of action is through PBP binding. PBPs are enzymes essential for the synthesis and cross-linking of peptidoglycans in bacterial cell walls. Cefprozil binds to these PBPs, inhibiting their activity and ultimately causing bacterial cell death.
Elimination Pathways: Cefprozil is primarily eliminated through renal excretion (approximately 60% unchanged). The remainder may be eliminated through other routes like hepatic metabolism.
Dosage
Standard Dosage
Adults:
- Standard dose: 250-500 mg orally every 12 hours or 500 mg once daily.
- Duration: Typically 10-14 days, but can be adjusted based on clinical and bacteriological response.
Children:
- Standard dose: Based on body weight, usually 7.5–30 mg/kg/day divided every 12 hours, with a maximum dose of 1 g/day. The exact dose and frequency depend on the infection being treated.
- Pediatric safety considerations: Use with caution in infants under 6 months old, as safety and effectiveness haven’t been fully established in this age group.
Special Cases:
- Elderly Patients: Dosage adjustment isn’t usually necessary unless significant renal impairment is present. Monitor renal function closely.
- Patients with Renal Impairment: For creatinine clearance (CrCl) ≤ 30 mL/min, reduce the standard dose by 50%. A supplemental dose may be necessary after hemodialysis.
- Patients with Hepatic Dysfunction: While the half-life of cefprozil may be increased in hepatic impairment, dosage adjustments are not typically required.
- Patients with Comorbid Conditions: Careful monitoring is advised in patients with gastrointestinal disorders, especially colitis.
Clinical Use Cases
Cefprozil’s standard dosing applies to various clinical settings, including intubation, surgical procedures, mechanical ventilation, and ICU use. The dosage may need to be adjusted in cases of severe infections or based on patient-specific factors, such as renal impairment. There are no specific dosage recommendations for emergency situations like status epilepticus or cardiac arrest, as Cefprozil is not indicated for these conditions.
Dosage Adjustments
Dose adjustments should be based on renal function (CrCl) and patient response. In cases of concomitant use with nephrotoxic drugs, close monitoring of renal function is necessary.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Dizziness
- Headache
- Rash
- Genital itching
Rare but Serious Side Effects
- Severe allergic reactions (anaphylaxis)
- Clostridium difficile-associated diarrhea (CDAD)
- Stevens-Johnson syndrome (SJS)
- Toxic epidermal necrolysis (TEN)
- Seizures (especially in patients with renal impairment)
- Renal dysfunction
- Hepatic dysfunction
- Hematologic disorders
Long-Term Effects
Long-term use can increase the risk of C. difficile infection and fungal overgrowth.
Adverse Drug Reactions (ADR)
Clinically significant ADRs include severe allergic reactions, CDAD, SJS, and TEN, all of which require immediate intervention.
Contraindications
- Known allergy to cefprozil or other cephalosporins
- Known allergy to any component of the cefprozil formulation
Drug Interactions
- Probenecid: Increases cefprozil serum levels.
- Nephrotoxic drugs (e.g., aminoglycosides, loop diuretics): Increased risk of nephrotoxicity.
- Anticoagulants (e.g., warfarin): May affect coagulation parameters.
- Oral contraceptives: May reduce the efficacy of oral contraceptives.
- Alcohol: Although not a direct interaction, excessive alcohol intake can weaken the immune system and may interfere with the treatment of infections.
Pregnancy and Breastfeeding
- Pregnancy Safety Category: B (Animal studies have not demonstrated a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women.)
- Fetal Risks: While no specific fetal risks have been identified, cefprozil should be used during pregnancy only if clearly needed.
- Breastfeeding: Cefprozil is excreted in breast milk in small amounts. Although considered compatible with breastfeeding by the American Academy of Pediatrics, caution is advised. Monitor the infant for potential side effects like diarrhea or thrush.
Drug Profile Summary
- Mechanism of Action: Inhibits bacterial cell wall synthesis by binding to PBPs.
- Side Effects: Common: Nausea, diarrhea, vomiting. Serious: Allergic reactions, C. difficile infection, SJS/TEN.
- Contraindications: Allergy to cephalosporins.
- Drug Interactions: Probenecid, nephrotoxic drugs, anticoagulants.
- Pregnancy & Breastfeeding: Category B; use with caution during breastfeeding.
- Dosage: Adults: 250-500 mg every 12 hours or 500 mg daily. Children: 7.5-30 mg/kg/day divided every 12 hours.
- Monitoring Parameters: Renal function, signs of superinfection (e.g., diarrhea, thrush), and allergic reactions.
Popular Combinations
Cefprozil is not typically used in combination with other antibiotics.
Precautions
- General Precautions: Assess for allergies to penicillins or cephalosporins. Monitor renal function, especially in patients with pre-existing renal impairment.
- Specific Populations: Use with caution in pregnant/breastfeeding women, and in infants under 6 months.
- Lifestyle Considerations: Excessive alcohol consumption should be avoided during treatment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefprozil?
A: Adults: 250-500 mg every 12 hours or 500 mg daily. Children: 7.5-30 mg/kg/day divided every 12 hours. Dosage adjustments are necessary for renal impairment.
Q2: What are the common side effects of Cefprozil?
A: Common side effects include nausea, vomiting, diarrhea, and abdominal pain.
Q3: What are the serious side effects of Cefprozil?
A: Serious side effects include allergic reactions (anaphylaxis), C. difficile infection, SJS/TEN, seizures, and renal dysfunction.
Q4: Is Cefprozil safe to use during pregnancy?
A: Cefprozil is Pregnancy Category B. While animal studies haven’t shown harm, there are no controlled studies in pregnant women. Use only if clearly needed.
Q5: Can Cefprozil be used while breastfeeding?
A: Cefprozil is excreted in breast milk in small amounts. The AAP considers it compatible with breastfeeding, but caution is advised. Monitor the infant for potential adverse effects.
Q6: What are the contraindications to using Cefprozil?
A: Cefprozil is contraindicated in patients with known allergies to cephalosporins or any components of the cefprozil formulation.
Q7: Does Cefprozil interact with other medications?
A: Yes, Cefprozil can interact with probenecid, nephrotoxic drugs, anticoagulants, and oral contraceptives.
Q8: How does Cefprozil work?
A: Cefprozil inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins.
Q9: What types of infections is Cefprozil used to treat?
A: Cefprozil is used to treat a variety of bacterial infections, including respiratory tract infections (pharyngitis, tonsillitis, sinusitis, bronchitis, pneumonia), skin and soft tissue infections, and urinary tract infections.
