Cefprozil versus penicillin V in treatment of streptococcal tonsillopharyngitis

Abstract

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...

Redefining the management of pediatric tonsillopharyngitis with Cefprozil

“…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.…”

“…No difference in the incidence of adverse events was observed in the two treatment groups. 14 A prospective, open labelled, comparative, randomised trial of 265 evaluable patients studied the clinical efficacy, safety and bacteriological eradication of GABHS in streptococcal tonsillopharyngitis with three commonly used oral antibiotics: penicillin V q8 hourly and clarithromycin q12 hourly were given for 10 days and cefprozil q12 hourly for 5 days. Clinical results and adverse events were similar for all three antibiotics used, with a prompt clinical outcome of >95%.…”

“…13 Cefprozil has an in vitro spectrum that includes Staphylococcus aureus, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis. 14 The β-lactamase stability of cefprozil may exceed that of other oral cephalosporins for some important pathogens. 13 Its half-life of 1.3 h allows for once-or twicedaily dosing.…”

“…15 Use of cefprozil for the treatment of these infections is supported by evidence from adequate and wellcontrolled studies of cefprozil in pediatric patients. 14 The present paper reviews the pharmacokinetics, microbiology, clinical efficacy, safety and tolerance of cefprozil in pediatric tonsillopharyngitis.…”

Pharmacodynamic Analysis and Clinical Trial of Amoxicillin Sprinkle Administered Once Daily for 7 Days Compared to Penicillin V Potassium Administered Four Times Daily for 10 Days in the Treatment of Tonsillopharyngitis Due to Streptococcus pyogenes in Children

“…Plot of eradication rate versus T ϾMIC (assuming a MIC 95 of 0.015 g/ml) achieved over the duration of therapy, i.e., total T ϾMIC, for various penicillin (Pen VK) dose regimens (OE) (4,11,12,13,14,16,18,20,21,22,23,24,25,26,30,31,32,34,37,38,39,40,41,42,43,44,45,49,50) compared to those achieved by amoxicillin sprinkle (f, with 95% confidence interval shown as a bar) (based on average of both doses) and various amoxicillin dose regimens (᭜) (1,8,11,16,33,38) for the treatment of tonsillopharyngitis due to S. pyogenes. Model fit is based on penicillin VK data.…”