Vantin

cefpodoxime proxetil

Orelox (UK), Vantin

Pharmacologic class: Third-generation cephalosporin

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

Oral suspension: 50 mg/5 ml, 100 mg/5 ml

Tablets: 100 mg, 200 mg

Indications and dosages

Acute community-acquired pneumonia caused by Haemophilus influenzae or Streptococcus pneumoniae
Adults and children ages 13 and older: 200 mg P.O. q 12 hours for 14 days

Acute bacterial or chronic bronchitis
Adults and children ages 13 and older: 200 mg P.O. q 12 hours for 10 days

Uncomplicated gonorrhea; rectal gonococcal infection caused by Neisseria gonorrhoeae
Adults: 200 mg P.O. as a single dose

Uncomplicated urinary tract infections caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Staphylococcus saprophyticus
Adults: 100 mg P.O. q 12 hours for 7 days

Skin and soft-tissue infections caused by Staphylococcus aureus and Streptococcus pyogenes
Adults and children ages 13 and older: 400 mg P.O. q 12 hours for 7 to 14 days

Acute otitis media caused by H. influenzae, S. pneumoniae, and Moraxella catarrhalis
Children ages 5 months to 12 years: 5 mg/kg P.O. q 12 hours (maximum of 200 mg/dose) or 10 mg/kg q 24 hours (maximum of 400 mg/dose) for 10 days

Tonsillitis and pharyngitis caused by S. pyogenes
Adults and children ages 13 and older: 100 mg P.O. q 12 hours for 5 to 10 days
Children ages 2 months to 12 years: 5 mg/kg P.O. q 12 hours for 5 to 10 days

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:

• renal impairment, phenylketonuria

• history of GI disease

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.

• Give tablets with food to enhance absorption. Oral suspension may be given with or without food.

• Don't give antacids within 2 hours of cefpodoxime.

Adverse reactions

CNS: headache, lethargy, paresthesia, syncope, seizures

CV: hypotension, palpitations, chest pain, vasodilation

EENT: hearing loss

GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis

GU: vaginal candidiasis, nephrotoxicity

Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression

Hepatic: hepatic failure, hepatomegaly

Musculoskeletal: arthralgia

Respiratory: dyspnea

Skin: urticaria, maculopapular or erythematous rash

Other: chills, fever, superinfection, anaphylaxis, serum sickness

Interactions

Drug-drug. Aminoglycosides, loop diuretics: increased risk of nephrotoxicity

Antacids: decreased cefpodoxime absorption

Probenecid: decreased excretion and increased blood level of cefpodoxime

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results

Hemoglobin, platelets, white blood cells: decreased values

Drug-herbs. Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding

Patient monitoring

• Assess CBC and kidney and liver function test results.

• Monitor for signs and symptoms of superinfection and other serious adverse reactions.

• Be aware that cross-sensitivity to penicillins may occur.

Patient teaching

• Instruct patient to take drug with food or milk to reduce GI distress and enhance absorption.

• Advise patient not to take antacids within 2 hours of drug.

• Tell patient to continue to take full amount prescribed even when he feels better.

• Instruct patient to report signs and symptoms of allergic response and other adverse reactions, such as rash, easy bruising, bleeding, severe GI problems, or difficulty breathing.

• If patient is being treated for gonorrhea, instruct him to have partner tested and treated (as needed) and to use barrier contraception to prevent reinfection.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

cefpodoxime

(sef-poe-dox-eem) ,

Vantin

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: third generation cephalosporins
Pregnancy Category: B

Indications

Treatment of the following infections caused by susceptible organisms:
  • Skin and skin structure infections,
  • Uncomplicated urinary tract infections,
  • Uncomplicated gynecological infections including gonorrhea,
  • Respiratory tract infections,
  • Otitis media.

Action

Binds to the bacterial cell wall membrane, causing cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria.
Similar to that of second-generation cephalosporins, but activity against staphylococci is less, whereas activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents.Notable is increased action against:
  • Haemophilus influenzae (including β-lactamase-producing strains),
  • Escherichia coli,
  • Klebsiella pneumoniae,
  • Neisseria gonorrhoeae,
  • Proteus.
Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics

Absorption: Cefpodoxime proxetil is a prodrug that is converted to cefpodoxim (the active component) in GI tract during absorption; 50% absorbed after oral administration; absorption of tablets increased with food.
Distribution: Widely distributed. Crosses the placenta; enters breast milk.
Metabolism and Excretion: 29–33% excreted unchanged in urine.
Half-life: 2–3 hr (increased in renal impairment).

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
POunknown2–3 hr12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins; Lactation: Lactation.
Use Cautiously in: Renal impairment (↑ dosing interval recommended if CCr <30 mL/min); History of GI disease, especially colitis; Geriatric: Dose adjustment due to age-related ↓ in renal function may be necessary; Obstetric / Pediatric: Pregnancy and infants <2 mo (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • seizures (very high doses) (life-threatening)
  • headache

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea (most frequent)
  • abdominal pain
  • nausea
  • vomiting

Dermatologic

  • rashes
  • urticaria

Genitourinary

  • vaginal moniliasis

Hematologic

  • bleeding
  • blood dyscrasias
  • hemolytic anemia

Miscellaneous

  • allergic reactions including anaphylaxis (life-threatening)
  • superinfection

Interactions

Drug-Drug interaction

Probenecid ↓ excretion and increases blood levels.Concurrent use of loop diuretics or nephrotoxic agents including aminoglycosides may ↑ risk of nephrotoxicity.Antacids or histamine H2 receptor antagonists ↓ absorption of cefpodoxime (take 2 hr before or after).

Route/Dosage

Oral (Adults and Children ≥12 yr) Most infections—200 mg every 12 hr; Skin and skin structure infections—400 mg every 12 hr; Urinary tract infections/pharyngitis—100 mg every 12 hr; Gonorrhea—200 mg single dose.
Oral (Children 2 mo–12 yr) Pharyngitis/tonsillitis/otitis media/acute maxillary sinusitis—5 mg/kg every 12 hr (not to exceed 200 mg/dose).

Renal Impairment

Oral (Adults) CCr <30 mL/min—Increase dosing interval to every 24 hr.

Availability (generic available)

Tablets: 100 mg, 200 mg
Oral suspensionlemon creme flavor: 50 mg/5 mL, 100 mg/5 mL

Nursing implications

Nursing assessment

  • Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
  • Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
  • Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
  • Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: May cause positive results for Coombs' test.
    • May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
    • May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, lymphocytosis, and thrombocytosis.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Oral: Administer around the clock. Administer tablets with meals to enhance absorption. Suspension may be administered without regard to meals. Shake oral suspension well before administering. Suspension is stable for 14 days after reconstitution in refrigerator.
    • Do not administer concurrently with antacids or other drugs taken to reduce stomach acid.

Patient/Family Teaching

  • Instruct patient to take medication at evenly spaced times and to finish the medication completely, even if feeling better. Take missed doses as soon as possible unless almost time for next dose; do not double doses. Instruct patient to use calibrated measuring device with suspension. Advise patient that sharing of this medication may be dangerous.
  • Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
  • Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.

Evaluation/Desired Outcomes

  • Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

Vantin

(văn′tn)
A trademark for the drug cefpodoxime proxetil.

Vantin®

Cefpodoxime proxetil Infectious disease An antibiotic used for acute maxillary sinusitis and otitis media. See Cephalosporin.
References in periodicals archive ?
in the past, it was thought that anyone with a penicillin (or amoxicillin, or ampicillin) allergy couldn't take any antibiotics from the class of "cephalosporins," like Omnicef, Ceftin, Vantin, Keflex or many others.
A generic version of Vantin has also been debuted by Sandoz.
While amoxicillin, trimethoprim/sulfamethoxazole (TMP/SMX) (Septra/Bactrim), erythromycin and doxycycline are still flrstline drugs for upper and lower respiratory tract infections, it is important to save Ceftin, Vantin, Spectracef, Avelox, Levaquin and Tequin for cases involving resistant pneumococcus, Moraxella catarrhalis and Haemophilus influenzae.
Amoxicillin/clavulanate * Augmentin Azithromycin * Zithromax Cefdinir * Omnicef Cefixime * Suprax Cefpodoxime * Vantin Cefprozil * Cefzil Ceftriaxone * Rocephin Cefuroxime * Ceftin Clarithromycin * Biaxin Erythromycin-sulfisoxazole * Eryzole, Pediazole Gatifloxacin * Tequin Levofloxacin * Levaquin Loracarbef * Lorabid Telithromycin * Ketek TMP-SMZ * Bactrim, Cotrim, Septra, Sulfatrim
Cefpodoxime proxetil tablets Ranbaxy Laboratories Vantin tablets
Maximum dose 1 g per day Cefpodoxime Vantin 10 mg/kg/day for 10 proxetil days, divided every 12 hours.
It's difficult to explain why [a physician] treating problem otitis media should be using anything other than amoxicillin and Augmentin, or a few of the cephalosporins: Omnicef, Vantin, and Ceftin.