Cefpodoxime

Therapeutic Class
 Antibiotic, Cephalosporin (Third Generation)
Indications

Treatment of susceptible acute, community-acquired pneumonia caused by S. pneumoniae or nonbeta-lactamase producing H. influenzae; acute uncomplicated gonorrhea caused by N. gonorrhoeae; uncomplicated skin and skin structure infections caused by S. aureus or S. pyogenes; acute otitis media caused by S. pneumoniae, H. influenzae, or M. catarrhalis; pharyngitis or tonsillitis; and uncomplicated urinary tract infections caused by E. coli, Klebsiella, and Proteus.
Adult Doses

Oral:

Acute community-acquired pneumonia and bacterial exacerbations of chronic bronchitis: 
200 mg every 12 hours for 14 days and 10 days, respectively.

Uncomplicated gonorrhea (male and female) and rectal gonococcal infections (female): 
200 mg as a single dose

Uncomplicated urinary tract infection: 
100 mg every 12 hours for 7 days.

Acute maxillary sinusitis: 
|200 mg every 12 hours for 10 days.

Pharyngitis/tonsillitis: 
100 mg every 12 hours for 5-10 days.

Skin and skin structure: 
400 mg every 12 hours for 7-14 days.
Pediatric Doses

Oral:

Acute otitis media: 
2 months to 12 years: 10 mg/kg/day divided every 12 hours (400 mg/day) for 5 days (maximum: 200 mg/dose)

Acute maxillary sinusitis:
2 months to 12 years: 10 mg/kg/day divided every 12 hours for 10 days (maximum: 200 mg/dose)

Pharyngitis/tonsillitis: 
2 months to 12 years: 10 mg/kg/day in 2 divided doses for 5-10 days (maximum: 100 mg/dose.

≥12 years: Refer to adult dosing
Doses in Renal impairment

Clcr <30 mL/minute: Administer every 24 hours.
Clcr <10 mL/minute: Increase dosing intervals to 48 hrly.

Hemodialysis: Dose 3 times/week following dialysis.
Contraindications

Hypersensitivity to cefpodoxime, any component of the preparation , or other cephalosporins.
Warnings / Precautions

Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).
Prolonged use may result in superinfection of fungal or bacterial origin , including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis which can be Potentially Fatal.
Renal impairment: modify dosage in severe impairment, see doses in renal impairment section.
Adverse Reactions

Potentially Fatal: Pseudomembranous colitis; nephrotoxicity.
Dermatologic: rash
Gastrointestinal: Diarrhea, nausea, abdominal pain, vomiting
Central nervous system: Headache
Genitourinary: Vaginal infection

Agranulocytosis, aplastic anemia, cholestasis, colitis, erythema multiforme, hemolytic anemia, hemorrhage, interstitial nephritis, toxic nephropathy, pancytopenia, renal dysfunction, seizure, serum-sickness reactions, Stevens-Johnson syndrome, superinfection, toxic epidermal necrolysis, urticaria, vaginitis
Overdose Reactions

Toxic symptoms may include nausea, vomiting, epigastric distress and diarrhoea. Haemodialysis or peritoneal dialysis may aid in the removal of cefpodoxime from the body, particularly if renal function is compromised.
Drug Interactions

Antacids or H2-blockers may decrease the absorption of cefpodoxime. Probenecid inhibits renal excretion.
Potentially Fatal: Monitor renal function during admin. Additive nephrotoxic effects with furosemide.
See Below for More cefpodoxime Drug Interactions
Lab Interactions

Urinary glucose test by Benedict's and Fehling's tests solution may produce false-positive result. May induce a positive direct Coombs' test.
Food Interactions

Food delays absorption; cefpodoxime levels may be increased with food.
Mechanism of Actions

Cefpodoxime binds to one or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly ; Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Pharmacodynamics

Absorption: Rapid and well absorbed (50%), acid stable; enhanced in the presence of food or low gastric pH

Distribution: Good tissue penetration, including lung and tonsils; penetrates into pleural fluid

Protein binding: 18% to 23%

Metabolism: De-esterified in GI tract to active metabolite, cefpodoxime

Half-life elimination: 2.2 hours; prolonged with renal impairment

Time to peak: Within 1 hour

Excretion: Urine (80% as unchanged drug) in 24 hours
Monitoring

Observe for signs and symptoms of anaphylaxis during first dose; give test dose.
Administration

Administer at proper / regular intervals to promote less variation in peak and trough serum levels.
May be taken with food.
Pregnancy Category

B: Drug Pregnancy Category Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.
Lactation

Enters breast milk (small amounts)/not recommended.
Storage Conditions

Oral: Store at 20-25°C.
ATC Classification
 J01DD13
GenericPedia Classification
    • Storage

    Oral: Store at 20-25°C.
    Available As
  • Cefpodoxime 100 mg
  • Cefpodoxime Proxetil 100 mg
  • Cefpodoxime 1000 mg
  • Cefpodoxime Proxetil 125 mg
  • Cefpodoxime Proxetil 15 mg
  • Cefpodoxime Proxetil 150 mg
  • Cefpodoxime 150 mg
  • Cefpodoxime Proxetil 162.5 mg
  • Cefpodoxime 18 mg
  • Cefpodoxime Proxetil 200 mg
  • Cefpodoxime 200 mg
  • Cefpodoxime 2000 mg
  • Cefpodoxime 25 mg
  • Cefpodoxime 250 mg
  • Cefpodoxime Proxetil 30 mg
  • Cefpodoxime Proxetil 325 mg
  • Cefpodoxime Proxetil 40 mg
  • Cefpodoxime Proxetil 50 mg
  • Cefpodoxime 50 mg
  • Cefpodoxime 500 mg

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