Cefpodoxime

# Cefpodoxime ## Overview - **Classification**: Third-generation cephalosporin antibiotic. - **Mechanism**: Inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to bactericidal action. ## Primary Indications 1. **Acute Otitis Media (AOM)** 2. **Pharyngitis/Tonsillitis** (Streptococcal) 3. **Acute Bacterial Exacerbation of Chronic Bronchitis (ABECB)** 4. **Community-Acquired Pneumonia (CAP)** 5. **Acute Maxillary Sinusitis** 6. **Uncomplicated Skin and Skin Structure Infections** 7. **Uncomplicated Urinary Tract Infections (UTIs)** 8. **Uncomplicated Gonorrhea** ## Adult Dosing ### Standard Dosing **Pharyngitis/Tonsillitis, Uncomplicated UTIs** - **Dose**: **100 mg** - **Frequency**: Every 12 hours - **Route**: Oral - **Duration**: Pharyngitis: 5 days; UTIs: 7 days **Acute Otitis Media, ABECB, CAP, Acute Maxillary Sinusitis, Uncomplicated Skin/Skin Structure Infections** - **Dose**: **200 mg** - **Frequency**: Every 12 hours - **Route**: Oral - **Duration**: AOM: 5-10 days; ABECB: 10 days; CAP: 14 days; Sinusitis: 10 days; Skin: 7-14 days **Uncomplicated Gonorrhea** - **Dose**: **200 mg** - **Frequency**: Single dose - **Route**: Oral ### Dose Adjustments - **Renal Impairment**: - **CrCl 10-30 mL/min**: Administer standard dose every **24 hours**. - **CrCl <10 mL/min**: Administer standard dose every **48 hours**. - **Hemodialysis**: Administer 3 times weekly after dialysis. - **Hepatic Impairment**: No dose adjustment needed. - **Elderly Patients**: Adjust dose based on renal function; otherwise, no specific adjustment. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: Safety and efficacy **not established**. - **Special Notes**: Not generally recommended for this age group. ### Infants (1-12 months) **Acute Otitis Media** - **Dose**: **5 mg/kg/dose** - **Frequency**: Every 12 hours - **Maximum**: **200 mg/day** (total daily dose). - **Special Notes**: Oral suspension is the preferred formulation. ### Children (1-12 years) **Acute Otitis Media, Acute Maxillary Sinusitis** - **Dose**: **5 mg/kg/dose** - **Frequency**: Every 12 hours - **Maximum**: **200 mg/dose** (or **400 mg/day**). - **Duration**: 5-10 days (AOM); 10 days (Sinusitis). **Pharyngitis/Tonsillitis** - **Dose**: **5 mg/kg/dose** - **Frequency**: Every 12 hours - **Maximum**: **100 mg/dose** (or **200 mg/day**). - **Duration**: 5 days. ### Adolescents (13-18 years) - **Dose**: Use **adult dosing guidelines**. - **Maximum**: Follow adult maximum doses. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to cefpodoxime or other cephalosporins. - **Absolute**: Anaphylaxis to penicillin (due to potential cross-reactivity). ### Common Adverse Effects - **Very Common (>10%)**: Diarrhea. - **Common (1-10%)**: Nausea, vomiting, abdominal pain, headache, rash, vaginitis. - **Serious but Rare**: *Clostridioides difficile*-associated diarrhea (CDAD), severe hypersensitivity reactions (anaphylaxis, SJS), hemolytic anemia, acute kidney injury. ### Key Drug Interactions - **Antacids/H2 Blockers/PPIs**: Decrease cefpodoxime absorption. Administer **at least 2 hours before or after**. - **Probenecid**: Increases cefpodoxime plasma levels; consider lower cefpodoxime dose. - **Oral Contraceptives**: May decrease efficacy; advise backup contraception. - **Warfarin**: May enhance anticoagulant effect; monitor INR closely. ## Monitoring & Follow-up - **Before Treatment**: Assess renal function (CrCl) in patients with kidney disease. - **During Treatment**: Monitor for resolution of infection symptoms. - **Clinical Signs**: Watch for severe diarrhea (CDAD), rash, or signs of allergic reaction. ## Clinical Pearls - 💡 **Administration**: Take **with food** to enhance absorption and minimize GI upset. - 💡 **Suspension Stability**: Reconstituted oral suspension is stable for **14 days refrigerated**; discard after. - 💡 **Penicillin Allergy**: Use with caution in patients with penicillin allergy (5-10% cross-reactivity risk). - 💡 **Diarrhea**: Counsel patients to report severe or persistent diarrhea, as it could indicate *C. difficile*. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.