Cefprozil

ROCHESTER, MINN. -- Cefprozil and levofloxacin are two oral antibiotics that deserve greater use in treating common cutaneous infections, Dr. Walter R. Wilson said at a dermatology meeting sponsored by the Mayo Foundation.

A good case can be made for the preferential dermatologic use of these drugs over the No. 1 sellers in their respective classes, argued Dr. Wilson, professor of medicine and chair of the division of infectious diseases at the Mayo Clinic.

"If you don't already use these two, I think you might want to consider it," urged Dr. Wilson, who stressed his lack of financial ties to pharmaceuticals makers.

Cefprozil (Cefzil) is a second-generation cephalosporin with a broad range of activity against both gram-positive and gram-negative organisms. It's one of the least expensive second-generation cephalosporins, he noted. Cefaclor (Ceclor), the No. 1 seller, is one of the costliest.

In head-to-head comparative studies totaling well over 1,000 adults and children with cutaneous infections, cure rates with cefprozil verged on being statistically significantly better than with cefaclor.

Cefprozil has a strong edge in compliance, he said. Bioavailability is such that 250 mg once daily is sufficient for most cutaneous infections in adults, with twice-daily dosing reserved for more serious infections. Cefaclor, in contrast, is given three times per day.

Cefprozil is also perhaps the best tolerated of all the oral cephalosporins. Children actually like the taste. Absorption of the drug isn't affected by food or concomitant use of antacids or other agents that alter gastric motility. The dose doesn't need to be adjusted in the elderly or in patients with renal dysfunction, so long as their creatinine clearance is at least 30 mL/min, he said.

The top-selling fluoroquinolone worldwide is ciprofloxacin (Cipro), but Dr. Wilson said he wouldn't use it much in cutaneous infections.

"Unless you know for sure that you've only got a gram-negative organism present, I would not use this drug. I would instead use levofloxacin," he said at the meeting also sponsored by the Minnesota Dermatologic Society.

Levofloxacin has far greater activity than ciprofloxacin against gram-positive cocci, figuring prominently in dermatologic infections, such as Streptococcus pyogenes, Staphylococcus epidermidis, and Staphylococcus aureus, including methicillin-resistant S. aureus. It is a once-daily drug, which generally means there is better compliance than with ciprofloxacin, a twice-daily drug.

"Against gram-negative organisms, ciprofloxacin is still the champion, but levofloxacin is not far behind. Against Pseudomonas aeruginosa, though, I would still use ciprofloxacin," Dr. Wilson said.

Levofloxacin is safe and very well tolerated. The cost is slightly less than for ciprofloxacin, he noted.

Dr. Wilson mentioned the macrolide azithromycin (Zithromax) as being particularly well suited for treating skin infections. Like levofloxacin, its long half-life permits once-daily dosing. Zithromax is quite effective against gram-positive cocci. He regards it as an excellent drug for prophylaxis in cases of recurrent cellulitis.

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