Maximum Dose of Cefprozil for a 2-Year-Old
For a 2-year-old child, the maximum dose of cefprozil is 30 mg/kg/day divided into two doses (15 mg/kg every 12 hours), which should not exceed the adult maximum of 1000 mg/day. 1
Standard Dosing by Indication
The FDA-approved dosing for cefprozil varies by infection type in children aged 2-12 years:
Upper Respiratory Tract Infections
- Pharyngitis/Tonsillitis: 7.5 mg/kg every 12 hours (15 mg/kg/day total) for 10 days 1
- Acute Sinusitis: 7.5-15 mg/kg every 12 hours depending on severity (15-30 mg/kg/day total) for 10 days 1
Otitis Media (6 months to 12 years)
- Standard dose: 15 mg/kg every 12 hours (30 mg/kg/day total) for 10 days 1
- This represents the maximum approved daily dose for pediatric patients 1
Skin and Skin Structure Infections
- Uncomplicated infections: 20 mg/kg once daily for 10 days 1
Clinical Context and Positioning
Cefprozil is positioned as an alternative second-generation cephalosporin, not first-line therapy, for most pediatric infections. 2 The Infectious Diseases Society of America lists cefprozil alongside cefpodoxime and cefuroxime as acceptable alternatives for oral step-down therapy in pneumococcal pneumonia when penicillin MICs are <2.0 µg/mL. 2
Key Limitations
- Not recommended for resistant organisms: High-dose amoxicillin (90 mg/kg/day) remains superior for penicillin-resistant Streptococcus pneumoniae 2
- Limited role in severe infections: Cefprozil should not be used as first-line therapy when resistant pathogens are suspected 2
Practical Dosing Example
For a typical 2-year-old weighing 12 kg:
- Otitis media (maximum dose): 15 mg/kg × 12 kg = 180 mg every 12 hours (360 mg/day total) 1
- Pharyngitis: 7.5 mg/kg × 12 kg = 90 mg every 12 hours (180 mg/day total) 1
- Skin infections: 20 mg/kg × 12 kg = 240 mg once daily 1
Important Safety Considerations
Renal adjustment is required only when creatinine clearance falls below 30 mL/min, where the dose should be reduced by 50%. 1 No hepatic dose adjustment is necessary. 1
Pharmacokinetic Profile
- Approximately 94% oral bioavailability with peak concentrations at 1-2 hours 3
- 60-70% excreted unchanged in urine, indicating renal elimination 3
- Elimination is slightly slower in infants and children compared to adults, but no routine dose adjustment is needed for age alone 3
Common Pitfalls to Avoid
- Do not exceed 30 mg/kg/day in children, even for severe infections—this is the FDA-approved maximum 1
- Do not use for methicillin-resistant Staphylococcus aureus—cefprozil has no activity against MRSA 4
- Ensure 10-day duration for streptococcal pharyngitis to prevent rheumatic fever, regardless of clinical improvement 1