Acute infections of the upper respiratory tract contribute to over 20% of the morbidity of the population in ambulatory care, with the highest incidence in children.

Although the majority of cases of tonsillopharyngitis are caused by viruses, antibacterial treatment is important because of the risk of rheumatic fever.

For almost five decades, penicillin has been the drug of choice for the treatment of Streptococcal pharyngitis. This antibiotic has proven efficacy and safety with a narrow spectrum of activity and low cost. However, there has been poor compliance to penicillins due to:

• Penicillin allergy (observed in about 10 percent patients) and

• A four-times-daily dosing.

Studies conducted over the past 40 years have reported penicillin V bacteriologic failure rates ranging from 10 to 30 percent and clinical failure rates ranging from 5 to 15 percent.

Cephalosporins have been used successfully for the treatment of GABHS tonsillopharyngitis since early 1970s.

Cefprozil is a novel third generation, broad-spectrum oral cephalosporin.

The ?? -lactamase stability of cefprozil may exceed that of other oral cephalosporins for some important pathogens. The present paper reviews the pharmacokinetics, microbiology, clinical efficacy, safety and tolerance of cefprozil in pediatric tonsillopharyngitis.

Pharmacokinetics Favoring Treatment of Tonsillo­pharyngitis

Cefprozil is rapidly absorbed, reaching a maximum concentration 0.9 to 1.2 h post-dose. Following oral doses of 250 and 500 mg, the Cmax is 6.2 and 10.0 mg/l respectively. Serum half-lives are generally reported as between 1.2 and 1.4 h, and urine recovery is high, 57-70%.

Administration of cefprozil with food or antacids produces negligible effects on the rate or extent of absorption .

The sustained cefprozil levels in tissue may have been responsible for the effectiveness in treating pharyngitis. The excellent penetration of cefprozil into tonsillar and adenoidal tissue corresponds well with the clinical outcome.

Microbiology Favoring Treatment of Tonsillopharyn­gitis

MIC90 of cefprozil against the most common pathogens associated with pharyngitis and tonsillitis, such as Streptococcus pyogenes , is 0.03 mg/ml.

In vitro data suggest that cefprozil is more active than either cefaclor or cephalexin against Staphylococcus aureus , Streptococcus pyogenes , Haemophilus influenzae , and Moraxella catarrhalis .

Clinical Efficacy, Safety and Tolerance Evaluation

An Indian prospective, open, non-comparative multicentric study evaluated the efficacy and safety of cefprozil in pediatric tonsillopharyngitis. 316 patients (mean age 6.61 years) with tonsillopharyngitis were included. Cefprozil caused a significant improvement in all the signs and symptoms after a 10-day treatment period . A clinical cure of 96.6% and bacteriological eradication of 94.29% was achieved with cefprozil. Gastrointestinal side effects were the only adverse events reported, most of which were mild and self-limiting in nature.