Cefpodoxime

Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli

Mechanism of Action:

Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to play a role in the activation of bacterical cell autolysins which may contribute to bacterial cell lysis.

Pharmacodynamics:

Cephalosporins exhibit time-dependent killing (T > MIC)

Pharmacokinetics:

Dose of 200mg: Cmax: 2.6 mcg/L; Tmax: 2.4 hour; Half-life: 2.3 hours; Table 10

Adverse Effects:

Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia

Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia

GI: Diarrhea, C. difficile disease

Renal: Interstitial nephritis

Table 14

Dosage:

PO: 200mg, 400mg tablets

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

Dosing in adults:

Acute exacerbation of chronic bronchitis: 200 mg PO q 12h x 10 days

Lower respiratory tract infection: 200 mg PO q12h x 10 days

Acute maxillary sinusitis: 200 mg PO q12h x 10 days

UTI: 100 mg PO q12h x 7 days

Dosing in pediatrics:

10g/kg/day divided q12h

Disease state based dosing:

Renal failure: CrCl < 30 mL/min: increase dosing interval to every 24 hr

Hepatic failure: No dosing changes recommended at this time.

Contraindications/Warnings/Precautions:

Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment

Drug Interactions:

Antacids: decreased cefpodoxime effectiveness

Calcium: decreased cefpodoxime effectiveness

H2 blockers: decreased cefpodoxime effectiveness

Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine

Probenecid: increased serum cefpodoxime levels

Sodium Bicarbonate: decreased cefpodoxime effectiveness

Pregnancy:

Category B: No evidence of risk in humans but studies inadequate.

Monitoring Requirements:

Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count

Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia, Prothrombin time in patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy.

Brand names/Manufacturer:

Vantin/Pharmacid & Upjohn