Pharmacologic class: Second-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
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.
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
• Renal impairment
• Hypersensitivity to cephalosporins or penicillins
• Renal failure
Use cautiously in:
• renal or hepatic impairment
• pregnant or breastfeeding patients
• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Give drug with food.
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
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
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.
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.
ClassificationTherapeutic: anti infectives
Pharmacologic: second generation cephalosporins
- Respiratory tract infections,
- Uncomplicated skin and skin structure infections,
- Otitis media.
- Haemophilus influenzae (including β-lactamase-producing strains),
- Moraxella catarrhalis (including β-lactamase-producing strains).
|PO||unknown||1–2 hr||12–24 hr|
Adverse Reactions/Side Effects
Central nervous system
- seizures (very high doses) (life-threatening)
- pseudomembranous colitis (life-threatening)
- abdominal pain
- hemolytic anemia
- allergic reactions including anaphylaxis (life-threatening)
Drug-Drug interactionProbenecid decreases excretion and increases blood levels.Concurrent use of aminoglycosides may increase risk of nephrotoxicity.
Renal Impairment(Adults and Children ≥6 mo) CCr <30 mL/min—½ of usual dose at normal dosing interval.
Availability (generic available)
- 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 DiagnosesRisk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)
- 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.
- 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.
- Resolution of signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.