Cefzil

cefprozil

Apo-Cefprozil, Cefzil, Ran-Cefprozil, Sandoz Cefprozil

Pharmacologic class: Second-generation cephalosporin

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

Powder for suspension: 125 mg/5 ml, 250 mg/5 ml

Tablets: 250 mg, 500 mg

Indications and dosages

➣ Uncomplicated skin infections caused by Staphylococcus aureus and Streptococcus pyogenes
Adults and children ages 13 and older: 250 to 500 mg P.O. q 12 hours or 500 mg P.O. daily for 10 days

➣ Pharyngitis or tonsillitis caused by S. pyogenes
Adults and children ages 13 and older: 500 mg P.O. daily for at least 10 days

➣ Acute bronchitis; acute bacterial chronic bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis
Adults and children ages 13 and older: 500 mg P.O. q 12 hours for 10 days

➣ Acute sinusitis caused by S. pneumoniae, H. influenzae, and M. catarrhalis
Adults and children ages 13 and older: 250 mg P.O. q 12 hours for 10 days; for moderate to severe infections, 500 mg P.O. q 12 hours for 10 days
Children ages 6 months to 12 years: 7.5 mg/kg P.O. q 12 hours for 10 days; for moderate to severe infections, 15 mg/kg P.O. q 12 hours for 10 days

➣ Otitis media caused by S. pneumoniae, H. influenzae, and M. catarrhalis
Children ages 6 months to 12 years: 15 mg/kg P.O. q 12 hours for 10 days

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

• Renal failure

Precautions

Use cautiously in:

• renal or hepatic impairment

• pregnant or breastfeeding patients

• children.

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.

• Give drug with food.

Adverse reactions

CNS: headache, dizziness, drowsiness, hyperactivity, hypotonia, insomnia, confusion, seizures

GI: nausea, vomiting, diarrhea, abdominal pain, dyspepsia, pseudomembranous colitis

GU: hematuria, vaginal candidiasis, genital pruritus, renal dysfunction, toxic nephropathy

Hematologic: eosinophilia, aplastic anemia, hemolytic anemia, hemorrhage, bone marrow depression, hypoprothrombinemia

Hepatic: hepatic dysfunction

Skin: toxic epidermal necrolysis, diaper rash, erythema multiforme, Stevens-Johnson syndrome

Other: allergic reactions, carnitine deficiency, drug fever, superinfection, serum sickness-like reaction, anaphylaxis

Interactions

Drug-drug. Aminoglycosides: increased risk of nephrotoxicity

Antacids containing aluminum or magnesium, histamine2-receptor antagonists: increased cefprozil absorption

Probenecid: decreased excretion and increased blood level of cefprozil

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase, white blood cells in urine: increased levels

Blood glucose, Coombs' test, urine glucose tests using Benedict's solution: false-positive results

Platelets, white blood cells: decreased counts

Drug-food. Moderate- or high-fat meal: increased drug bioavailability

Patient monitoring

Stay alert for life-threatening reactions, including anaphylaxis, serum sickness-like reaction, Stevens-Johnson syndrome, and pseudomembranous colitis.

• Monitor neurologic status, particularly for signs and symptoms of impending seizures.

• Monitor kidney and liver function test results and assess fluid intake and output.

• Monitor CBC with white cell differential, prothrombin time, and bleeding time. Watch for signs and symptoms of blood dyscrasias, especially hypoprothrombinemia.

• Monitor temperature. Stay alert for signs and symptoms of superinfection.

Patient teaching

Advise patient to immediately report rash, bleeding tendency, or CNS changes.

• Teach patient to recognize signs and symptoms of superinfection, and instruct him to report these right away.

• Tell patient to take drug with food.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

cefprozil

(sef-proe-zil) cefprozil,

Cefzil

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: second generation cephalosporins
Pregnancy Category: B

Indications

Treatment of the following infections caused by susceptible organisms:
  • Respiratory tract infections,
  • Uncomplicated skin and skin structure infections,
  • Otitis media.

Action

Binds to bacterial cell wall membrane, causing cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria.Similar to that of first-generation cephalosporins but has increased activity against several other gram-negative pathogens including:
  • Haemophilus influenzae (including β-lactamase-producing strains),
  • Proteus,
  • Moraxella catarrhalis (including β-lactamase-producing strains).
Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics

Absorption: Well absorbed following oral administration.Distribution: Widely distributed. Enters breast milk in low concentrations.Metabolism and Excretion: Excreted primarily unchanged by the kidneys.Half-life: 90 min (increased in renal impairment).

Time/action profile

ROUTEONSETPEAKDURATION
PO unknown1–2 hr12–24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins.Use Cautiously in: Renal impairment (dosage reduction recommended if CCr <30 mL/min); History of GI disease, especially colitis; Suspension contains aspartame and should be avoided in patients with phenylketonuria; Geriatric patients (dosage adjustment due to age-related decrease in renal function may be necessary); Pregnancy and lactation (has been used safely).

Adverse Reactions/Side Effects

Central nervous system

  • seizures (very high doses) (life-threatening)
  • dizziness

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • abdominal pain
  • diarrhea
  • nausea
  • vomiting

Dermatologic

  • rashes
  • urticaria

Genitourinary

  • vaginitis

Hematologic

  • eosinophilia
  • hemolytic anemia
  • leukopenia

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • superinfection

Interactions

Drug-Drug interaction

Probenecid decreases excretion and increases blood levels.Concurrent use of aminoglycosides may increase risk of nephrotoxicity.

Route/Dosage

Oral (Adults and Children ≥13 yr) Most infections—250–500 mg every 12 hr or 500 mg every 24 hr.Oral (Children 6 mo–12 yr) Otitis media—15 mg/kg every 12 hr; Acute sinusitis—7.5–15 mg/kg every 12 hr (higher dose to be used for moderate-to-severe infections).Oral (Children 2–12 yr) Pharyngitis/tonsillitis—7.5 mg/kg every 12 hr; Skin and skin structure infections—20 mg/kg every 24 hr.

Renal Impairment

(Adults and Children ≥6 mo) CCr <30 mL/min—½ of usual dose at normal dosing interval.

Availability (generic available)

Tablets: 250 mg, 500 mg Oral suspensionbubblegum flavor: 125 mg/5 mL, 250 mg/5 mL

Nursing implications

Nursing assessment

  • Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
  • Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: May cause positive results for Coombs' test.
    • May cause increased serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
    • May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and eosinophilia.

Potential Nursing Diagnoses

Risk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Oral: Administer around the clock. May be administered on full or empty stomach. Administration with food may minimize GI irritation. Shake oral suspension well before administering. Suspension is stable for 14 days after reconstitution if refrigerated.

Patient/Family Teaching

  • Instruct patient to take medication around the clock at evenly spaced times and to finish the medication completely, even if feeling better. Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses. Instruct patient to use calibrated measuring device with suspension. Advise patient that sharing of this medication may be dangerous.
  • Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
  • Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.

Evaluation/Desired Outcomes

  • Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

Cefzil

(sĕf′zĭl) A trademark for the drug cefprozil.