No

Antibiotic, Cephalosporin (Third Generation)

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

B

Hypersensitivity to cefpodoxime or cephalosporins

Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; a low incidence of cross-hypersensitivity to penicillins exists

>10%:

Dermatologic: Diaper rash (12.1%)

Gastrointestinal: Diarrhea in infants and toddlers (15.4%)

1% to 10%:

Central nervous system: Headache (1.1%)

Dermatologic: Rash (1.4%)

Gastrointestinal: Diarrhea (7.2%), nausea (3.8%), abdominal pain (1.6%), vomiting (1.1% to 2.1%)

Genitourinary: Vaginal infections (3.1%)

<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

Other reactions with cephalosporins include seizures, 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

After acute overdose, most agents cause only nausea, vomiting, and diarrhea, although neuromuscular hypersensitivity and seizures are possible, especially in patients with renal insufficiency; many beta-lactam antibiotics have the potential to cause neuromuscular hyperirritability or seizures

Hemodialysis may be helpful to aid in the removal of the drug from the blood but not usually indicated, otherwise most treatment is supportive or symptom directed following GI decontamination

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

Increased effect: Probenecid may decrease cephalosporin elimination

Increased toxicity: Furosemide, aminoglycosides may be a possible additive to nephrotoxicity

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

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.

Absorption: Oral: Rapidly 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: Oral: De-esterified in the GI tract to the active metabolite, cefpodoxime

Half-life: 2.2 hours (prolonged with renal impairment)

Time to peak: Within 1 hour (oral)

Elimination: Primarily eliminated by the kidney with 80% of dose excreted unchanged in urine in 24 hours

Oral:

Acute otitis media: 10 mg/kg/day as a single dose or divided every 12 hours (400 mg/day)

Pharyngitis/tonsillitis: 10 mg/kg/day in 2 divided doses (maximum: 200 mg/day)

Children greater than or equal to 13 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

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 10 days

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

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

May be taken with food, however, there is delayed absorption

Observe for signs and symptoms of anaphylaxis during first dose

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

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

May rarely cause neutropenia; use caution with clozapine and carbamazepine

No information available to require special precautions

No effects or complications reported

Take as directed, at regular intervals around-the-clock (with or without food). Chilling oral suspension improves flavor (do not freeze). Complete full course of medication, even if you feel better. Drink 2-3 L fluid/day. If diarrhea occurs, yogurt or buttermilk may help. May cause false-positive test with Clinitest®; use another form of testing. May interfere with oral contraceptives; additional contraceptive measures are necessary. Report severe, unresolved diarrhea; vaginal itching or drainage; sores in mouth; blood, pus, or mucus in stool or urine; easy bleeding or bruising; unusual fever or chills; rash; or respiratory difficulty. Breast-feeding precautions: Consult prescriber if breast-feeding.

Assess patient at beginning and throughout therapy for infection; administer around-the-clock to promote less variation in peak and trough serum levels

Granules for oral suspension, as proxetil (lemon creme flavor): 50 mg/5 mL (100 mL); 100 mg/5 mL (100 mL)

Tablet, film coated, as proxetil: 100 mg, 200 mg

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):S12-8.

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.