Is cefprozil (Cefzil) effective for treating urinary tract infections (UTIs)?

Cefprozil for UTI: Limited Role as Second-Line Agent

Cefprozil can be used for uncomplicated UTIs when first-line agents cannot be used, but it is not a preferred option due to inferior efficacy compared to nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin. 1

Guideline Position on β-Lactams for UTIs

The Infectious Diseases Society of America explicitly categorizes β-lactam agents, including cefprozil, as appropriate choices only when other recommended agents cannot be used for acute uncomplicated cystitis. 1 This recommendation reflects several key limitations:

• β-lactams have inferior efficacy compared to first-line UTI antimicrobials 1, 2
• More adverse effects than other UTI treatments 1, 2
• Should be used with caution for uncomplicated cystitis 1

Clinical Evidence for Cefprozil

While older studies demonstrate that cefprozil is effective for uncomplicated UTIs, the evidence shows comparable but not superior outcomes:

• Clinical cure rates of 87-94% when given as 500 mg once daily for 10 days 3, 4, 5
• Bacteriological cure rates of 83-93% in comparative trials 3, 4, 5
• Performance was similar to cefaclor (another second-line agent) but has not been adequately compared to first-line agents like trimethoprim-sulfamethoxazole 6

Preferred First-Line Alternatives

Before considering cefprozil, prioritize these agents for uncomplicated cystitis:

• Nitrofurantoin (100 mg twice daily for 5-7 days) 2
• Trimethoprim-sulfamethoxazole (160/800 mg twice daily for 3 days) if local resistance <20% 1, 2
• Fosfomycin (3 g single dose) 1

For complicated UTIs or pyelonephritis, fluoroquinolones (if local resistance <10%) or parenteral cephalosporins like ceftriaxone are preferred over oral agents like cefprozil. 7, 2

When Cefprozil May Be Considered

Cefprozil 500 mg once daily for 7-10 days is reasonable when:

• Patient has documented allergies or contraindications to first-line agents 1
• Local resistance patterns preclude use of trimethoprim-sulfamethoxazole or fluoroquinolones 1
• Organism is confirmed susceptible on culture 3, 4

Important Caveats

• Do not use for empiric therapy when first-line agents are available 1, 2
• Obtain urine culture before starting therapy if using a second-line agent 7, 2
• β-lactams may promote more rapid UTI recurrence compared to other antimicrobials 2
• Cefprozil is not appropriate for complicated UTIs where broader coverage or parenteral therapy is needed 7