What is the proper dosage and use of Cephprozil for bacterial infections?

Cefprozil Dosing and Administration for Bacterial Infections

Cefprozil is an oral second-generation cephalosporin dosed at 250-500 mg every 12-24 hours in adults and 7.5-20 mg/kg every 12-24 hours in children, depending on infection type and severity, with treatment duration typically 10 days. 1

Adult Dosing

Upper Respiratory Tract Infections

• Pharyngitis/Tonsillitis: 500 mg once daily for 10 days 1
• Acute Sinusitis: 250 mg every 12 hours OR 500 mg every 12 hours for 10 days (use higher dose for moderate-to-severe infections) 1

Lower Respiratory Tract Infections

• Acute Bacterial Exacerbation of Chronic Bronchitis: 500 mg every 12 hours for 10 days 1

Skin and Soft Tissue Infections

• Uncomplicated infections: 250 mg every 12 hours OR 500 mg once daily OR 500 mg every 12 hours for 10 days 1

Pediatric Dosing (Ages 2-12 Years)

Upper Respiratory Tract Infections

• Pharyngitis/Tonsillitis: 7.5 mg/kg every 12 hours for 10 days 1
• Otitis Media (6 months-12 years): 15 mg/kg every 12 hours for 10 days 1
• Acute Sinusitis (6 months-12 years): 7.5 mg/kg every 12 hours OR 15 mg/kg every 12 hours for 10 days (use higher dose for moderate-to-severe infections) 1

Skin and Soft Tissue Infections

• Uncomplicated infections: 20 mg/kg once daily for 10 days 1

Special Populations

Renal Impairment

• Creatinine clearance 30-120 mL/min: Standard dose at standard intervals 1
• Creatinine clearance 0-29 mL/min: 50% of standard dose at standard intervals 1
• Hemodialysis patients: Administer after dialysis completion, as cefprozil is partially removed by hemodialysis 1

Hepatic Impairment

• No dosage adjustment necessary 1

Clinical Context and Antimicrobial Spectrum

Microbiologic Activity

Cefprozil demonstrates good activity against Streptococcus pneumoniae comparable to cefuroxime axetil and cefdinir 2. However, cefprozil is markedly less active against Haemophilus influenzae compared to other oral cephalosporins like cefpodoxime 2. This limitation is clinically significant when treating infections where H. influenzae is a likely pathogen.

Guideline-Recommended Uses

• Community-acquired pneumonia: Listed as an alternative oral cephalosporin for S. pneumoniae when pathogen is identified 2
• Acute bacterial rhinosinusitis: Recognized as a broad-spectrum option, though its reduced H. influenzae activity is a notable limitation 2
• Urinary tract infections in children: 30 mg/kg/day divided into 2 doses for 7-14 days 2

Important Caveats

• Streptococcal infections require 10-day treatment: When treating Streptococcus pyogenes pharyngitis/tonsillitis, complete the full 10-day course to prevent rheumatic fever 1
• Not for methicillin-resistant S. aureus: Cefprozil has no activity against MRSA 3
• Consider alternatives for H. influenzae-predominant infections: Due to reduced activity, cefpodoxime or amoxicillin-clavulanate may be preferable when H. influenzae is suspected 2

Comparative Efficacy

Clinical trials demonstrate cefprozil is comparable to cefaclor, amoxicillin-clavulanate, and erythromycin for respiratory tract infections, with superior bacteriological eradication compared to cefaclor in streptococcal pharyngitis 3, 4, 5. The medication is well-tolerated with lower gastrointestinal adverse effects than amoxicillin-clavulanate 6.

Practical Considerations

• Convenient dosing: Once or twice-daily administration improves adherence 3, 4
• Palatability: The suspension is well-tolerated in children, unlike some alternatives (e.g., cefpodoxime) 2
• Cost: Generally reserved for second-line therapy when first-line generic alternatives fail or are contraindicated 6