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James M. McCarty, Antonio Renteria, Treatment of Pharyngitis and Tonsillitis with Cefprozil: Review of Three Multicenter Trials, Clinical Infectious Diseases, Volume 14, Issue Supplement_2, June 1992, Pages S224–S230, https://doi.org/10.1093/clinids/14.Supplement_2.S224
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Abstract
Cefprozil is a new oral cephalosporin with an in vitro spectrum of activity that includes group A β-hemolytic streptococci (Streptococcus pyogenes). Three multicenter, randomized trials were conducted for comparing the clinical efficacy and safety of cefprozil administered once or twice daily with that of cefaclor, penicillin, or erythromycin ethylsuccinate administered three or four times daily in the treatment of mild-to-moderate tonsillopharyngitis. In the cefprozil-cefaclor trial, the pathogen eradication rate for evaluable patients receiving cefprozil was 83%, which was significantly better than that for patients receiving cefaclor (76%) (P = .035). The rate of satisfactory clinical response was similar with cefprozil (89%) and cefaclor (84%). The overall response rate was significantly better with cefprozil (80%) than with cefaclor (72%, P = .018). Differences in response rates were not noted when analyzing only patients 2–12 years of age. In the cefprozil-penicillin trial, the eradication rate of bacteriologic pathogens was similar in patients receiving cefprozil (91%) and in patients receiving penicillin (87%). A satisfactory clinical response was seen in 95% of the evaluable cefprozil-treated patients, which was significantly better than the rate of satisfactory clinical response seen in the penicillin-treated patients (88%; P = .023). In addition, during-therapy cultures for penicillin-treated patients yielded a significantly higher rate of β-lactamase-producing Staphylococcus aureus than did those for the group of cefprozil-treated patients (13% vs. 4.5%, respectively; P = .046). Significantly more clinically symptomatic bacteriologic failures occurred in the penicillin group (P = .037). Cefprozil was as equally efficacious as erythromycin in both clinical response (96% vs. 92%, respectively) and bacteriologic response (95% for both). These studies suggest that cefprozil, as currently labeled for once-daily dosing in adults, is a reasonable alternative to penicillin, cefaclor, and erythromycin in the treatment of mild-to-moderate pharyngitis and tonsillitis.
