Cefpodoxime

Pronunciation

(sef pode OKS eem)

U.S. Brand Names

Vantin®

Synonyms

Cefpodoxime Proxetil

Generic Available

Yes: Tablet

Canadian Brand Names

Vantin®

Use

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

Pregnancy Risk Factor

Lactation

Enters breast milk (small amounts)/use caution

Contraindications

Hypersensitivity to cefpodoxime, any component of the formulation, or other cephalosporins

Warnings/Precautions

Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection. Use with caution in patients with a history of penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis, urticaria).

Adverse Reactions

>10%:

Dermatologic: Diaper rash (12%)

Gastrointestinal: Diarrhea in infants and toddlers (15%)

1% to 10%:

Central nervous system: Headache (1%)

Dermatologic: Rash (1%)

Gastrointestinal: Diarrhea (7%), nausea (4%), abdominal pain (2%), vomiting (1% to 2%)

Genitourinary: Vaginal infection (3%)

<1%: Anaphylaxis, chest pain, hypotension, fungal skin infection, pseudomembranous colitis, vaginal candidiasis, pruritus, flatulence, decreased salivation, malaise, fever, decreased appetite, cough, epistaxis, dizziness, fatigue, anxiety, insomnia, flushing, weakness, nightmares, taste alteration, eye itching, tinnitus, purpuric nephritis

Reactions reported with other cephalosporins include seizure, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, urticaria, serum-sickness reactions, renal dysfunction, interstitial nephritis toxic nephropathy, cholestasis, aplastic anemia, hemolytic anemia, hemorrhage, pancytopenia, agranulocytosis, colitis, vaginitis, superinfection

Overdosage/Toxicology

Symptoms of overdose include neuromuscular hypersensitivity and convulsions. Many beta-lactam containing antibiotics have the potential to cause neuromuscular hyperirritability or convulsive seizures. Hemodialysis may be helpful to aid in removal of the drug from blood; otherwise, treatment is supportive or symptom-directed.

Drug Interactions

Decreased effect: Antacids and H2-receptor antagonists (reduce absorption and serum concentration of cefpodoxime)

Increased effect: Probenecid may decrease cephalosporin elimination

Increased toxicity: Aminoglycosides and furosemide may increase nephrotoxic potential

Ethanol/Nutrition/Herb Interactions

Food: Food delays absorption; cefpodoxime serum levels may be increased if taken with food.

Stability

After mixing, keep suspension in refrigerator, shake well before using; discard unused portion after 14 days

Mechanism of Action

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

Pharmacodynamics/Kinetics

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

Dosage

Oral:

Children 2 months to 12 years:

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

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

Pharyngitis/tonsillitis: 10 mg/kg/day in 2 divided doses for 5-10 days (maximum: 100 mg/dose)

Children 12 years and Adults:

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

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

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

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

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

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

Dosing adjustment in renal impairment: Clcr<30 mL/minute: Administer every 24 hours

Hemodialysis: Administer dose 3 times/week following hemodialysis

Monitoring Parameters

Observe for signs and symptoms of anaphylaxis during first dose

Test Interactions

Positive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction

Dietary Considerations

May be taken with food.

Patient Education

Inform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber. Take as directed, at regular intervals around-the-clock (with or without food). Chilling oral suspension improves flavor (do not freeze). Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. Complete full course of medication, even if you feel better. May cause false test results with Clinitest®; use of another type of glucose testing is preferable. May cause nausea or vomiting (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (yogurt, boiled milk, or buttermilk may help). Report changes in urinary pattern (decreased output); severe, unresolved diarrhea; opportunistic infection (vaginal itching or drainage; sores in mouth; or blood in urine, unusual fever or chills); or rash. Breast-feeding precaution: Consult prescriber if breast-feeding.

Dental Health: Effects on Dental Treatment

No significant effects or complications reported

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

May cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins

Mental Health: Effects on Psychiatric Treatment

May rarely cause neutropenia; use caution with clozapine and carbamazepine

Dosage Forms

Granules for oral suspension: 50 mg/5 mL (50 mL, 75 mL, 100 mL); 100 mg/5 mL (50 mL, 75 mL, 100 mL) [contains sodium benzoate; lemon creme flavor]

Tablet [film coated]: 100 mg, 200 mg

References

Adam D, Bergogne-Berezin E, and Jones RN, "Symposium on Cefpodoxime Proxetil: A New Third Generation Oral Cephalosporin," Drugs , 1991, 42(Suppl 3):1-66.

American Thoracic Society, "Guidelines for the Initial Management of Adults With Community-Acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy," Am Rev Respir Dis , 1993, 148(5):1418-26.

Backhouse C, Wade A, Williamson P, et al, "Multiple Dose Pharmacokinetics of Cefpodoxime in Young Adult and Elderly Patients," J Antimicrob Chemother , 1990, 26(Supp E):29-34.

Borin MT, "A Review of the Pharmacokinetics of Cefpodoxime Proxetil," Drugs , 1991, 42(Suppl 3):13-21.

Cohen R, "Clinical Experience With Cefpodoxime Proxetil in Acute Otitis Media," Pediatr Infect Dis J , 1995, 14(Suppl 4):12-8.

Fujii R, "Clinical Trials of Cefpodoxime Proxetil Suspension in Pediatrics," Drugs , 1991, 42(Suppl 3):57-60.

Marshall WF and Blair JE, "The Cephalosporins," Mayo Clin Proc , 1999, 74(2):187-95.

Mendelman PM, Del-Beccaro MA, McLinn SE, et al, "Cefpodoxime Proxetil Compared With Amoxicillin-Clavulanate for the Treatment of Otitis Media," J Pediatr , 1992, 121(3):459-65.

Schatz BS, Karavokiros KT, Taeubel MA, et al, "Comparison of Cefprozil, Cefpodoxime Proxetil, Loracarbef, Cefixime, and Ceftibuten," Ann Pharmacother , 1996, 30(3):258-68.

International Brand Names

Banan® (ID, JP, TH); Biocef® (AT); Cefodox® (IE, IT, LU); Cepodem® (IN, PL, ZA); Garia® (ES); Instana® (ES); Kelbium® (ES); Obrelan® (YU); Orelox® (BR, CH, CZ, DE, FR, GB, HU, IT, LU, MX, NL, PL, RU, SE, ZA); Otreon® (AT, ES, IT); Podomexef® (CH, DE); Vantin® (CA)

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