Comparative efficacy and safety of cefprozil (BMY-28100) and cefaclor in the treatment of acute group A beta-hemolytic streptococcal pharyngitis

Christenson, John C.; Swenson, Elise; Gooch, W. Manford; Herrod, John N.

doi:10.1128/aac.35.6.1127

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…1992). An additional oral second generation agent, cefprozil, has been associated with an incidence of 6% for gastrointestinal adverse effects, primarily diarrhoea (Barbharya et al 1990;Christenson et al 1991). With the exception of pseudomembranous colitis and superinfection discussed below, these symptoms are usually mild and self-limiting, resolving with discontinuation of the drug.…”

Section: Gastrointestinal Reactionsmentioning

confidence: 96%

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Adverse Effects of Newer Cephalosporins

Thompson

Jacobs

1993

Drug Safety

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While classifications into generations according to antimicrobial activity has helped clinicians incorporate the increasing number of cephalosporins into their pharmacological repertoire, adverse effects among the different agents fail to follow similar categories. In general, cephalosporins are fairly well tolerated antibiotics, and toxicity has been limited to specific agents. Subtle differences in chemical structure and pharmacokinetics can influence the potential for adverse effects. The route of administration may result in minor adverse reactions, including thrombophlebitis and pain. The most common adverse effects of cephalosporins are allergic reactions, occurring in 0.9 to 3.2% of patients. Cephalosporins have very rarely been associated with haematological toxicity (less than 1% of patients), but specific agents have been associated with neutropenia, hypoprothrombinaemia, haemolytic anaemia, and problems with platelet production and function. Other reactions include localised gastrointestinal disturbances, hepatotoxicity (e.g. biliary sludging), nephrotoxicity and mild central nervous system effects. The cephalosporins are generally well tolerated in the paediatric population. Very few interactions have been observed between cephalosporins and other drugs, largely because cephalosporins do not affect the microsomal P450 hepatic enzyme system. While cephalosporins are considered to be relatively 'safe' drugs, the introduction of newer members warrants continued careful observation for reporting of adverse drug reactions.

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Section: Gastrointestinal Reactionsmentioning

confidence: 96%

“…1986a]. The recent observation of an increased partial thromboplastin time in a patient receiving Drug Safety 9 (2) 1993 the newer agent cefprozil indicates that continued observation for coagulation disturbances is warranted (Christenson et al 1991).…”

Section: Nomentioning

confidence: 99%

Adverse Effects of Newer Cephalosporins

Thompson

Jacobs

1993

Drug Safety

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“…19 In vitro data suggest that cefprozil is more active than either cefaclor or cephalexin against Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis. 20 It is also active against group A Streptococci. Cefprozil is more stable than cefaclor for the penicillinase-producing Staphylococcus aureus isolates.…”

Section: Microbiology Favoring Treatment Of Tonsillopharyngitismentioning

confidence: 99%

“…Since in vitro data indicate that susceptibility of common pediatric pathogens to cefprozil is superior to that of cefaclor, cefprozil may be of benefit in the management of these infections. 14,20,[22][23][24] In another comparative randomized multicenter study, the efficacy and safety of cefprozil were compared with those of penicillin V in the treatment of group A Streptococcal tonsillopharyngitis in children. 323 children were evaluable for their clinical and bacteriological responses.…”

Section: Clinical Efficacy Safety and Tolerance Evaluationmentioning

confidence: 99%

Redefining the management of pediatric tonsillopharyngitis with Cefprozil

Jerath

Shetty²

2007

Indian J Pediatr

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Tonsillopharyngitis is very common in children, with Group A Streptococci being the most common bacterial etiology. Effective antibacterial treatment is imperative due to risk of rheumatic fever. Cephalosporins have been used successfully for the treatment of Group A beta-hemolytic Streptococcal (GABHS) tonsillopharyngitis. Cefprozil is a novel broad-spectrum oral cephalosporin. Cefprozil is rapidly absorbed from the gastrointestinal tract with high bioavailability. The excellent penetration of cefprozil into tonsillar and adenoidal tissue corresponds well with the clinical outcome. The drug provides excellent coverage against both gram-negative and -positive bacteria that may cause pharyngitis/tonsillitis. The beta-lactamase stability of cefprozil appears to exceed that of other oral cephalosporins for important gram negative pathogens. In clinical trials, cefprozil appears to be at least as effective as commonly used comparison agents such as cefaclor and cefixime. Additionally, cefprozil is better tolerated than the latter, especially with regard to gastrointestinal adverse effects. Thus cefprozil can be considered a safe and reliable drug for the treatment of Streptococcal tonsillopharyngitis in children.

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“…Its half-life of 1.3 h allows for once-or twice-daily dosing. In one comparative study, cefprozil was evaluated for the treatment of streptococcal pharyngitis in adults, and it was found to be as efficacious as cefaclor (4 (15), which is based on the reduction of nutrients and enhancement of streptolysin S production. Thus, beta-hemolytic streptococci are easily recognized by their characteristic growth (very small colonies surrounded by a large hemolytic zone).…”

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confidence: 99%

Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis

Milatovic

Adam

Hamilton

et al. 1993

Antimicrob Agents Chemother

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In a randomized multicenter study, the efficacy and safety of cefprozil were compared with those of penicillin in the treatment of group A streptococcal tonsillopharyngitis in children. Of the 409 patients enrolled, 323 were evaluable for their clinical and bacteriological responses; of these 323 children, 172 received cefprozil and 151 received penicillin V. The clinical responses in patients treated with cefprozil were significantly better than those in patients who received penicillin (95.3 versus 88.1%; P = 0.023). Eradication of the original serotype of group A streptococci was achieved in 91.3% of patients treated with cefprozil and 87.4% of patients treated with penicillin, the difference not being statistically significant (P = 0.125). However, there were significantly more symptomatic patients among the bacteriological failures in the penicillin group (68.4%) than in the cefprozil group (26.7%). 13-Lactamase-producing Staphylococcus aureus was more frequently isolated from the throat flora during penicillin therapy than during cefprozil treatment. No difference in the incidence of adverse events probably related or of unknown relationship to the study drugs was observed in the two treatment groups (5.2% of those treated with cefprozil and 6.0% of those treated with penicillin). Cefprozil can be considered a safe and reliable drug for the treatment of streptococcal pharyngitis in children.Streptococcal tonsillopharyngitis is one of the most common bacterial infections in pediatric patients. Penicillin is still considered the drug of choice, although failure rates of up to 30% have been reported (7,10,12). Since no penicillinresistant group A beta-hemolytic streptococci (GABHS) have been isolated, other reasons for the failure of therapy have been discussed, such as inactivation of penicillin by the P-lactamases produced by the concomitant throat flora or penicillin tolerance of the pathogen (2,13,14).Cephalosporins are stable to hydrolysis by the 1-lactamases of the bacteria that commonly colonize the mucous membranes of the upper respiratory tract. A meta-analysis of 19 different studies has shown that cephalosporins are more efficacious than penicillin in the treatment of streptococcal tonsillopharyngitis (19).Cefprozil is a new semisynthetic oral cephalosporin which has an in vitro spectrum that includes Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis (3, 6). Its half-life of 1.3 h allows for once-or twice-daily dosing. In one comparative study, cefprozil was evaluated for the treatment of streptococcal pharyngitis in adults, and it was found to be as efficacious as cefaclor (4). It has recently been approved in the United States for the treatment of upper respiratory tract infections in adults. We performed a multicenter trial comparing the efficacy and safety of cefprozil with those of penicillin V in 409 children with streptococcal tonsillopharyngitis. with severe renal and hepatic dysfunction, or those who had taken antibiotics within the previous 4...

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Comparative efficacy and safety of cefprozil (BMY-28100) and cefaclor in the treatment of acute group A beta-hemolytic streptococcal pharyngitis

Cited by 11 publications

References 11 publications

Adverse Effects of Newer Cephalosporins

Adverse Effects of Newer Cephalosporins

Redefining the management of pediatric tonsillopharyngitis with Cefprozil

Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis

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