Cefprozil

cefprozil

(sef pro' zil)

Cefzil

Pregnancy Category B

Drug classes

Antibiotic

Cephalosporin (second generation)

Therapeutic actions

Bactericidal: Inhibits synthesis of bacterial cell wall, causing cell death.

Indications

·        Pharyngitis or tonsillitis caused by S. pyogenes

·        Secondary bacterial infection of acute bronchitis and exacerbation of chronic bronchitis caused by S. pneumoniae, H. influenzae, M. catarrhalis

·        Dermatologic infections caused by S. aureus, S. pyogenes

·        Otitis media caused by S. pneumoniae, H. influenzae, M. catarrhalis

·        Acute sinusitis caused by S. pneumoniae, S. aureus, H. influenzae, M. catarrhalis

Contraindications and cautions

·        Contraindicated with allergy to cephalosporins or penicillins.

·        Use cautiously with renal failure, lactation, pregnancy.

Available forms

Tablets—250, 500 mg; powder for suspension—125, 250 mg/5 mL

Dosages

ADULTS

250–500 mg PO q 12–24 hr. Continue treatment for 10 days.

PEDIATRIC PATIENTS

Acute sinusitis, otitis media

·        6 mo–12 yr: 7.5–15 mg/kg PO q 12 hr for 10 days.

Parhyngitis, tonsillitis

·        2–12 yr: 7.5–20 mg/kg PO q 12 hr; continue treatment for 10 days.

Skin/Skin structure infection

·        2–12 yr: 7.5–20 mg/kg PO once daily; continue treatment for 10 days.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL IMPAIRMENT

For creatinine clearance of 30–120 mL/min, use standard dose; for creatinine clearance 0–30 mL/min, use 50% of standard dose.

Pharmacokinetics

Route	Peak	Duration
PO	6–10 hr	24–28 hr

Metabolism: T_1/2: 78 min

Distribution: Crosses the placenta, enters breast milk

Excretion: Urine, unchanged

Adverse effects

·        CNS: Headache, dizziness, lethargy, paresthesias

·        GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, liver toxicity

·        GU: Nephrotoxicity

·        Hematologic: Bone marrow depression

·        Hypersensitivity: Ranging from rash to fever to anaphylaxis; serum sickness reaction

·        Other: Superinfections

Interactions

Drug-drug

·        Increased nephrotoxicity with aminoglycosides

·        Increased bleeding effects if taken with oral anticoagulants

Drug-lab test

·        Possibility of false results on tests of urine glucose using Benedict's solution, Fehling's solution, Clinitest tablets; urinary 17-ketosteroids; direct Coombs' test.

Nursing considerations

Assessment

·        History: Penicillin or cephalosporin allergy, pregnancy or lactation, renal failure

·        Physical: Renal function tests, respiratory status, skin status, culture and sensitivity tests of infected area

Interventions

·        Culture infection before drug therapy.

·        Give drug with food to decrease GI discomfort.

·        Refrigerate suspension after reconstitution, and discard after 14 days.

·        Discontinue if hypersensitivy reaction occurs.

·        Give the patient yogurt or buttermilk in case of diarrhea.

·        Arrange for oral vancomycin for serious colitis that fails to respond to discontinuation.

Teaching points

·        Take this drug with food.

·        Complete the full course of this drug, even if you feel better.

·        This drug is prescribed for this particular infection; do not use it to self-treat any other infection.

·        You may experience these side effects: Stomach upset, loss of appetite, nausea (take drug with food); diarrhea; headache, dizziness.

·        Report severe diarrhea with blood, pus, or mucus; rash or hives; difficulty breathing; unusual tiredness, fatigue; unusual bleeding or bruising.

Adverse effects in Italic are most common; those in Bold are life-threatening.