Cefpodoxime

General

• Type: 3rd generation cephalosporin
• Dosage Forms: tablet, oral suspension
• Dosage Strengths: tablet: 100mg, 200mg; oral suspension: 50mg/5mL, 100mg/5mL
• Routes of Administration: PO
• Common Trade Names: Vantin, Cefopodoxine Proxetil

Adult Dosing

Indications by Disease

Disease	Dose	Context
Acute cystitis	200 mg BID x10-14d	Outpatient, Women Complicated
Acute cystitis	200 mg BID x10-14d	Men
COPD exacerbation	200mg q 12 h for 10 days	Bronchitis (chronic)
Periorbital cellulitis	400mg BID	Outpatient
Pharyngitis	100mg q 12 h for 5-10 days	Pharyngitis/Tonsillitis
Pneumonia (main)	200 mg BID	Outpatient, Unhealthy
Pyelonephritis	200mg PO BID x 10 days	Outpatient
Skin and soft tissue infections	400mg q 12 h for 14 days	Skin and soft tissue infection

Pediatric Dosing

General

• Infant ≥2 months to children <12 years: 10mg/kg/day (maximum 200mg/dose) q 12 h
• Children >12 years to adolescent: 100 to 400mg q 12 h

Specific indication

• Bronchitis (chronic), acute bacterial infection
  • Adult dosing for Infant ≥2 months to children <12 years
• Acute otitis media
  • Infant ≥2 months to children <12 years: 5mg/kg/dose (maximum 200mg/dose) q 12 h for 5 days, duration according to AAP recommendation : for children < 2 years or any age with sever symptoms; 10 day-course, age 2-**5 years with mild to moderate symptoms: 7 day-course; age ≥ 6 years with mild to moderate symptoms: 5 day-course
• Pharyngitis/tonsillitis:
  • Infant ≥2 months to children <12 years: 5mg/kg/dose (maximum 100mg/dose) q 12 h for 5-10 days
  • Children >12 years to adolescent: adult dosing
• Acute sinusitis
  • Infant ≥2 months to children <12 years: 5mg/kg/dose (maximum 200mg/dose) q 12 h for 10 days, ISDA recommend adding Clindamycin for 10-14 days in patients with failed initial therapy or at risk of antibiotic resistance (attending daycare, age <2 years, recently hospitalised, antibiotic used with in 1 month)
  • Children >12 years to adolescent: adult dosing
• Skin soft tissue infection and uncomplicated urinary tract infection
  • Children >12 years to adolescent: adult dosing

Indications by Disease

Disease	Dose	Context
Acute cystitis	10mg/kg/day PO divided BID (max 200mg/dose)	Pediatric
Acute otitis media	10mg/kg PO daily x7-10 days	Prior Month Treatment
Periorbital cellulitis	10 mg/kg per day divided every 12 hours, max 200 mg	Outpatient
Pyelonephritis	10mg/kg/day PO divided BID x 10 days (max 200mg/dose)	Pediatric Outpatient
Sinusitis	5mg/kg/dose (max 200mg/dose) q12h x 10 days	Acute sinusitis

Special Populations

• Pregnancy Rating: B
• Lactation: excreted in breast milk, not recommended for nursing women
• Renal Dosing
  • Adult
    • CrCl >30 mL/minute: dosage adjustment not needed
    • CrCl <30 mL/minute: administer q 24 h
    • Hemodialysis: 3 times/week following dialysis
  • Pediatric: not defined
• Hepatic Dosing: dosage adjustment not nescessary

Contraindications

• Allergy to class/drug
• Caution:
  • Hypersensitivity to penicillin
  • Renal impairment
  • Concurrent nephrotoxic agent
  • Seizure disorder
  • Recent antibiotic-associated colitis

Adverse Reactions

Serious (<1%)

• Anaphylaxis
• Hypotension
• Nephritis
• Pseudomembranous colitis
• Seizures
• Leukopenia
• Thrombocytopenia
• Anemia
• Exfoliative dermatitis
• Stevens-Johnson Syndrome
• C. diff associated diarrhea

Common

• Diaper rash
• Diarrhea
• Nausea/vomiting
• Abdominal pain
• Dyspepsia
• Headache
• Candidiasis, vulvovaginal

Pharmacology

• Half-life: 2-3 h, prolonged to ~10 h if CrCl <30 mL/minute
• Metabolism: De-esterified in GI tract to active metabolite
• Excretion: Urine
• Mechanism of Action: Inhibit bacterial cell walls synthesis (binding to penicillin-binding proteins (PBPs)