Ceftibuten

General

• Type: Third generation cephalosporin
• Dosage Forms: capsule, oral suspension
• Dosage Strengths: capsule: 400mg; oral suspension: 90mg/5mL, 180mg/5mL
• Routes of Administration: PO
• Common Trade Names: Cedax

Adult Dosing

Chronic bronchitis, acute exacerbation

• 400mg PO qd x10 days

Otitis media, acute

• 400mg PO qd x10 days

Pharyngitis/Tonsillitis, streptococcal

• 400mg PO qd x10 days

Pediatric Dosing

Otitis media, acute

• 6 mo - 11 yo, <45kg
  • 9 mg/kg PO qd x10 days
  • Max: 400 mg/day
• 12+ yo, >45kg
  • 400mg PO qd x10 days

Pharyngitis/Tonsillitis, streptococcal

• 6 mo - 11 yo, <45kg
  • 9 mg/kg PO qd x10 days
  • Max: 400 mg/day
• 12+ yo, >45kg
  • 400mg PO qd x10 days

Pneumonia, Community-acquired

• 6 mo - 11 yo, <45kg
  • 9 mg/kg PO qd x10 days
  • Max: 400 mg/day
• 12+ yo, >45kg
  • 400mg PO qd x10 days

Special Populations

• Pregnancy Rating: B
• Lactation: Probably safe

• Renal Dosing
  • Adult
    • CrCl 30-49: 200mg qd
    • CrCl 5-29: 100mg qd
    • CrCl <5: Not defined
    • HD: 400mg after each dialysis
    • PD: No supplement
  • Pediatric
    • CrCl 30-49: 4.5 mg/kg qd, max 200mg/day
    • CrCl 5-29: 2.25 mg/kg qd, max 100mg/day
    • CrCl <5: Not defined
    • HD: 9mg/kg after each dialysis, max 400mg;day
    • PD: No supplement
• Hepatic Dosing
  • Adult
    • Not defined
  • Pediatric
    • Not defined

Contraindications

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

Adverse Reactions

Serious

• Allergy to class/drug
• Serum sickness-like reaction
• Stevens-Johnson syndrome
• Exfoliative dermatitis
• Erythema multiforme
• Toxic epidermal necrolysis
• Interstitial nephritis
• Superinfection
• C. difficile associated diarrhea
• Seizure
• Pancytopenia

Common

• Nausea
• Diarrhea
• Elevated BUN
• Headache
• Eosinophilia
• Dyspepsia
• Vomiting
• Abdominal pain
• Anemia

Pharmacology

• Half-life: 2-2.5 hr; 13.4 hr if CrCl 5-29
• Metabolism: Other
• Excretion: Urine 56%, Feces 39%
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	I
	Viridans strep	R
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	X1
	MSSA	R
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	R
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	I
	N. meningitidis	I
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	I
	Enterobacter sp, AmpC pos	R
	Serratia sp	I
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	S
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	S
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	X1
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	X1
	Clostridium difficile	X1
	Clostridium (not difficile)	X1
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	X1

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)