Cefpodoxime is a third generation semi-synthetic cephalosporin and a beta-lactam antibiotic with bactericidal activity. Cefpodoxime’s effect is dependent on its binding to penicillin-binding proteins (PBPs) located in the bacterial cytoplasmic membrane. Binding results in the inhibition of the transpeptidase enzymes, thereby preventing cross-linking of the pentaglycine bridge with the fourth residue of the pentapeptide and interrupting consequent synthesis of peptidoglycan chains. As a result, cefpodoxime inhibits bacterial septum and cell wall synthesis formation.
Cefpodoxime is an oral third generation cephalosporin antibiotic. It is active against most Gram positive and Gram-negative bacteria. It is commonly used to treat acute otitis media, pharyngitis, and sinusitis. Cefpodoxime proxetil is a prodrug which is absorbed and de-esterified by the intestinal mucosa to Cefpodoxime.
Mechanism of action of cefpodoxime
Cefpodoxime is active against a wide spectrum of Gram-positive and Gram-negative bacteria. Cefpodoxime is stable in the presence of beta-lactamase enzymes. As a result, many organisms resistant to penicillins and cephalosporins, due to their production of beta-lactamase, may be susceptible to cefpodoxime. Cefpodoxime is inactivated by certain extended spectrum beta-lactamases. The bactericidal activity of cefpodoxime results from its inhibition of cell wall synthesis. The active metabolite of cefpodoxime binds preferentially to penicillin binding protein 3, which inhibits production of peptidoglycan, the primary constituent of bacterial cell walls.
Indications of cefpodoxime
- For the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms.
- Bladder infection
- Gonococcal infection,
- Bronchitis
- Gonococcal infection, uncomplicated
- Skin or soft tissue infection
- Kidney infections
- Otitis media
- Pneumonia
- Sinusitis
- Tonsillitis/pharyngitis
- Upper respiratory tract infection
- Acute bacterial exacerbation of chronic bronchitis
- Acute maxillary sinusitis
- Bacterial Infections
- Community acquired pneumonia
- Gonorrhea
- Streptococcal pharyngitis
- Streptococcal tonsillitis
- Uncomplicated urinary uract infections
- Uncomplicated skin and subcutaneous tissue bacterial infections
Contra-Indications of cefpodoxime
- Clostridium difficile infection
- Carnitine Deficiency
- A decrease in the Blood-Clotting Protein Prothrombin
- Moderate to Severe Kidney Impairment
- Antimicrobial resistance, viral infection. …
- Cephalosporin hypersensitivity, penicillin hypersensitivity. …
- Dialysis, renal failure, renal impairment. …
- Colitis, diarrhea, GI disease, inflammatory bowel disease, pseudomembranous colitis, ulcerative colitis.
Allergies
- Cephalosporins
- Beta-lactams
Dosages of cefpodoxime
Strengths: 100 mg; 200 mg; 50 mg/5 mL; 100 mg/5 mL;
Bronchitis
- Acute bacterial exacerbation of chronic bronchitis: 200 mg orally every 12 hours for 10 days
Cystitis
- 100 mg orally every 12 hours for 7 days
Gonococcal Infection
- Uncomplicated urethral, cervical, or female anorectal infections: 200 mg orally one time
Pneumonia
- Community-acquired pneumonia: 200 mg orally every 12 hours for 14 days
Pyelonephritis
- 100 mg orally every 12 hours
- Therapy should be continued for about 14 days, depending on the nature and severity of the infection.
Sinusitis
- 200 mg orally every 12 hours for 10 days
Skin or Soft Tissue Infection
- Uncomplicated infection: 400 mg orally every 12 hours for 7 to 14 days
Tonsillitis/Pharyngitis
- 100 mg orally every 12 hours for 5 to 10 days
- There are insufficient data to establish efficacy in the subsequent prophylaxis of rheumatic fever.
Upper Respiratory Tract Infection
- 100 mg orally every 12 hours
- Therapy should be continued for approximately 10 to 14 days, depending on the nature and severity of the infection.
Pediatric Dose
Bronchitis
Acute bacterial exacerbation of chronic bronchitis
- 12 years or older: 200 mg orally every 12 hours for 10 days
Cystitis
- 12 years or older: 100 mg orally every 12 hours for 7 days
Gonococcal Infection
Uncomplicated urethral, cervical, or female anorectal infections
- 12 years or older: 200 mg orally one time
Side Effects of cefpodoxime
The most common
- allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
- leukopenia/leukemia
- hemolytic anemia
- serum sickness
- agranulocytosis
- pain, swelling, irritation where injected
- stomach upset
- sweating
- skin color change, mild diarrhea
- mild nausea
- loss of appetite
- vaginal discharge and itching
- swelling of feet or legs
- chest pain
- constipation
- cough
- diarrhea or loose stools
- difficulty with breathing
- dizziness
- heartburn
More common
- Abdominal or stomach pain, discomfort, or tenderness
- chills or fever
- difficulty with moving
- headache, severe and throbbing
- joint or back pain
- muscle aching or cramping
- muscle pains or stiffness
- chest pressure or squeezing pain in chest
- excessive sweating
- feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
- sudden tingling or coldness in an arm or leg
- sudden slow or difficult speech
- sudden drowsiness or need to sleep
- fast breathing
- sharp pain when taking a deep breath
- fast or slow heartbeat
- coughing up blood
- rust colored urine
- decreased amount of urine
Rare
- Anxiety
- change in vision
- seizures
- abnormal or fast heart rate
- tremors
- weight loss
- chest pain or tightness
- confusion
- cough
- Agitation
- arm, back, or jaw pain
- blurred vision
- chest pain or discomfort
- convulsions
- extra heartbeats
- fainting
- hallucinations
- headache
- irritability
- muscle pain or cramps
- pale or yellowed skin, dark colored urine, fever, confusion or weakness;
- jaundice (yellowing of the skin or eyes);
- sore throat, and headache with a severe blistering, peeling, and red skin rash;
- swelling, rapid weight gain, feeling short of breath (even with mild exertion); or
- increased thirst, loss of appetite, urinating less than usual or not at all.
Drug Interactions of cefpodoxime
Cefpodoxime may interacts with following drugs, suppliments & change the efficacy of drugs
- methotrexate ;
- antiviral medicines such as adefovir , cidofovir or foscarnet ;
- cancer medicine such as , carmustine , cisplatin , ifosfamide, streptozocin , or tretinoin ;
- a diuretic such as bumetanide , furosemide , indapamide hydrochlorothiazide , metolazone , spironolactone , torsemide , and others;
- a medication that reduces stomach acid, such as an antacid, or cimetidine , famotidine , omeprazole , ranitidine and others;
- IV antibiotics such as amphotericin B , amikacin , bacitracin , capreomycin gentamicin , kanamycin , streptomycin, or vancomycin ;
- medicines used to prevent organ transplant rejection, such as sirolimus or tacrolimus
- medicines used to treat ulcerative colitis, such as or sulfasalazine ; or
- pain or arthritis medicines such as aspirin acetaminophen diclofenac , etodolac , ibuprofen , indomethacin , naproxen , and others.
Pregnancy & Lactation of cefpodoxime
FDA pregnancy category B
Pregnancy
Cefpodoxime proxetil was neither teratogenic nor embryocidal when administered to rats during organogenesis at doses up to 100 mg/kg/day (2 times the human dose based on mg/m²) or to rabbits at doses up to 30 mg/kg/day (1-2 times the human dose based on mg/m²).There are, however, no adequate and well-controlled studies of cefpodoxime proxetil use in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.
Lactation
Limited information indicates that cefpodoxime produces low levels in milk and is not be expected to cause any adverse effects in breastfed infants.
References
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