cefpodoxime proxetil
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.