CEFPROZIL

CEFPROZIL (cef'pro-zil) Cefzil Classifications: antibiotic; second-generation cephalosporin; Therapeutic: antibiotic; cephalosporin Prototype: Cefaclor Pregnancy Category: B

Availability

250 mg, 500 mg tablets; 125 mg/5 mL, 250 mg/5 mL suspension

Action

Semisynthetic, second-generation cephalosporin antibiotic with drug structure characterized by a beta-lactam ring; generally resistant to hydrolysis by beta-lactamases. Preferentially binds to proteins in cell walls of susceptible organisms, thus killing the bacteria.

Therapeutic Effect

Third-generation cephalosporins are more active and have a broader spectrum against gram-negative bacteria than first- or second-generation of cephalosporins.

Uses

Upper and lower respiratory tract infections, otitis media, skin infections.

Contraindications

Hypersensitivity to cephalosporin and related antibiotics; severely impaired renal or hepatic function; phenylketonuria (PKU); infants <6 mo.

Cautious Use

Patients with delayed reaction to penicillin or other drugs; coagulopathy; renal impairment, renal disease; GI disease, especially colitis; pregnancy (category B).

Route & Dosage

Mild to Moderate Infections Adult: PO 250–500 mg q12–24h for 10–14 d Child (>6 mo): PO 15 mg/kg q12h

Administration

Oral

• Drug may be given without regard to meals.
• Consult physician for patients with impaired renal function. Dose is reduced by 50% when creatinine clearance is 0–30 mL/min.
• Administer after hemodialysis since drug is partially removed by dialysis.
• After reconstitution, oral suspension is refrigerated. Discard unused portion after 14 d.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity reactions, superinfections. GI: Nausea, vomiting, diarrhea, abdominal pain. Hematologic: Eosinophilia. CNS: Headache. Skin: Rash, diaper rash. Urogenital: Genital pruritus, vaginal candidiasis.

Diagnostic Test Interference

May cause a positive direct Coombs' test; false-negative results in the ferricyanide assay for blood glucose; false-positive reactions for urine glucose with copper reduction tests such as Benedict's or Fehling's solution or Clinitest tablets; increased partial thromboplastin time, indicating thrombocytosis, eosinophilia; minor elevations in serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin.

Interactions

Drug: Probenecid prolongs the elimination of cefprozil.

Pharmacokinetics

Absorption: Readily from GI tract. Peak: 1–2 h. Distribution: Distributes into blister fluid at 50% of the serum level. Elimination: Primarily by kidneys. Half-Life: 1–2 h.

Nursing Implications

Assessment & Drug Effects

• Determine previous hypersensitivity to cephalosporins or penicillins before treatment.
• Withhold drug and notify physician if hypersensitivity occurs (e.g., rash, urticaria).
• Lab tests: Perform culture and sensitivity tests before and periodically during therapy. Therapy may be initiated while results are pending.
• Monitor for and report diarrhea, as pseudomembranous colitis is a potential adverse effect.
• Monitor for and report signs of superinfection (see Appendix F).
• When given concurrently with other cephalosporins or aminoglycosides, monitor for signs of nephrotoxicity.

Patient & Family Education

• Complete the prescribed course of therapy, even if symptom free.
• Report rash or other signs of hypersensitivity immediately.
• Report signs of superinfection (see Appendix F).
• Report loose stools and diarrhea even after completion of drug therapy.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug