Cefpodoxime Proxetil

Pronunciation: SEF-pode-OX-eem PROX-uh-til
Class: Antibiotic, Cephalosporin

Trade Names

Cefpodoxime Proxetil
- Granules for Suspension 50 mg/5 mL
- Granules for Suspension 100 mg/5 mL

Vantin
- Tablets 100 mg
- Tablets 200 mg

Pharmacology

Inhibits mucopeptide synthesis in bacterial cell wall.

Pharmacokinetics

Absorption

About 50% absorbed.

Tablets

C _max is 1.4 to 3.9 mcg/mL (100 to 400 mg dose). T _max is about 2 to 3 h.

Suspension

C _max is about 1.5 mcg/mL (100 mg dose).

Food

AUC and C _max are increased when tablets are taken with food. T _max is increased 48% when suspension is taken with food.

Distribution

21% to 29% plasma protein bound.

Metabolism

Cefpodoxime proxetil is a prodrug and de-esterified to cefpodoxime (active).

Elimination

About 29% to 33% of the absorbed dose is excreted unchanged in the urine in 12 h. The t _½ is 2.09 to 2.84 h.

Special Populations

Renal Function Impairment

Elimination is reduced in those with CrCl less than 50 mL/min. Dosage adjustment is recommended.

Elderly

The t _½ is increased to about 4.2 h. Dosage adjustment is recommended in those with diminished renal function.

Indications and Usage

Treatment of infections of respiratory tract, urinary tract, skin and skin structures; treatment of STDs caused by susceptible strains of specific microorganisms.

Contraindications

Hypersensitivity to cephalosporins.

Dosage and Administration

Adults

PO 100 to 400 mg every 12 h.

Children 6 mo to 12 yr of age

PO 10 mg/kg/day in divided doses every 12 h (max 200 mg/dose).

General Advice

Administer with food to enhance absorption.

Storage/Stability

Store tablets at controlled room temperature (68° to 77°F). Store unsuspended granules at controlled room temperature (68° to 77°F). Store reconstituted suspension in refrigerator (36° to 46°F); discard any unused portion after 14 days.

Drug Interactions

Probenecid

Inhibition of renal excretion of cefpodoxime.

Laboratory Test Interactions

May cause false-positive urine glucose test results with Benedict solution, Fehling solution, or Clinitest tablets but not with enzyme-based tests (eg, Clinistix , Tes-tape ); false-positive test results for proteinuria with acid and denaturization-precipitation tests; false-positive direct Coombs test result in certain patients (eg, those with azotemia); false elevations in urinary 17-ketosteroid values.

Adverse Reactions

GI

Nausea; vomiting; diarrhea; anorexia; abdominal pain or cramps; flatulence; colitis, including pseudomembranous colitis.

Genitourinary

Pyuria; renal function impairment; dysuria; reversible interstitial nephritis; hematuria; toxic nephropathy.

Hematologic

Eosinophilia; neutropenia; lymphocytosis; leukocytosis; thrombocytopenia; decreased platelet function; anemia; aplastic anemia; hemorrhage.

Hepatic

Hepatic function impairment; abnormal LFT results.

Miscellaneous

Hypersensitivity, including Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis; serum sickness–like reactions (eg, skin rashes, polyarthritis, arthralgia, fever); candidal overgrowth.

Precautions

Monitor Response to therapy Monitor patient's response to therapy. Notify health care provider if infection does not appear to improve or worsens. Adverse reactions Monitor patient for GI, DERM, and general body adverse reactions, and signs of superinfection. Inform health care provider if noted and significant. Immediately report severe diarrhea, diarrhea containing blood or pus, or severe abdominal cramping.

Pregnancy

Category B .

Lactation

Excreted in breast milk.

Children

Consider benefits relative to risks. Safety and efficacy in children younger than 6 mo of age not established.

Hypersensitivity

Reactions range from mild to life-threatening. Administer drug with caution to penicillin-sensitive patients because of possible cross-reactivity.

Renal Function

Use drug with caution in patients with renal function impairment. Dosage adjustment based on renal function may be required.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

Pseudomembranous colitis

Consider in patients in whom diarrhea develops.

Overdosage

Symptoms

Seizures.

Patient Information

• Instruct patient to complete full course of therapy.
• Advise patient to take with food to enhance absorption.
• Remind patient to check body temperature daily. If fever persists for more than a few days or if high fever (higher than 102°F) or shaking chills are noted, notify health care provider immediately.
• Advise patient to maintain normal fluid intake while using this medication.
• Advise diabetic patient to use enzyme-based tests (eg, Clinistix , Testape ) for monitoring urine glucose because drug may give false results with other tests.
• Instruct patient to report these symptoms to health care provider: nausea, vomiting, diarrhea, skin rash, hives, muscle or joint pain.
• Instruct patient to report signs of superinfection: black “furry” tongue, white patches in mouth, foul-smelling stools, vaginal itching or discharge.
• Warn patient that diarrhea that contains blood or pus may be a sign of serious disorders. Tell patient to seek medical care and not to treat at home.
• Instruct patient to seek emergency care immediately if wheezing or difficulty breathing occurs.

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