Cefpodoxime

• Respiratory Tract Infections
• Urinary Tract Infections
• Ear Infections (Otitis Media)
• Skin and Soft Tissue Infections

Cefpodoxime proxetil is a third-generation oral cephalosporin antibiotic with broad-spectrum activity against many common bacterial pathogens. This medication is widely used for treating respiratory tract infections, urinary tract infections, and skin infections in both adults and children.

Mechanism of Action

Cefpodoxime is administered as the prodrug cefpodoxime proxetil, which is de-esterified in the intestinal wall to release the active cefpodoxime. Like other cephalosporins, cefpodoxime inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), disrupting the transpeptidation step of peptidoglycan synthesis. This results in bacterial cell wall weakness and subsequent cell lysis. Cefpodoxime has good activity against Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and many Enterobacteriaceae. It is stable against many beta-lactamases produced by Gram-negative bacteria.

Available Formulations

Cefpodoxime proxetil is available as oral tablets (100 mg and 200 mg) and as oral suspension (50 mg/5 mL and 100 mg/5 mL). The tablets should be taken with food to enhance absorption. The suspension can be taken with or without food and should be shaken well before each dose. After reconstitution, the suspension should be refrigerated and is stable for 14 days.

Medical Uses

Cefpodoxime is FDA-approved for the treatment of acute bacterial exacerbations of chronic bronchitis, acute community-acquired pneumonia, uncomplicated gonorrhea, acute maxillary sinusitis, pharyngitis/tonsillitis, uncomplicated skin and skin structure infections, and acute uncomplicated urinary tract infections (including cystitis). In pediatric patients, it is approved for acute otitis media, pharyngitis/tonsillitis, and acute maxillary sinusitis. It is often used as a second-line agent in patients who cannot take first-line antibiotics.

Dosing Guidelines

For most adult infections, the typical dose is 100-400 mg every 12 hours for 5-14 days depending on the infection type and severity. For uncomplicated UTI, 100 mg every 12 hours for 7 days is recommended. For gonorrhea, a single 200 mg dose is used. Pediatric dosing is 5 mg/kg (maximum 100-200 mg) every 12 hours. The tablets should be administered with food to increase bioavailability. Dose adjustment is required for patients with renal impairment (CrCl less than 30 mL/min).

Important Safety Information

Cefpodoxime is contraindicated in patients with known hypersensitivity to cephalosporins. Cross-reactivity with penicillins can occur, though the rate is lower than historically believed. Patients with severe penicillin allergy (anaphylaxis) should use with caution. Clostridioides difficile-associated diarrhea may occur during or after antibiotic treatment; patients should be monitored for persistent diarrhea. Superinfection with resistant organisms may develop during prolonged use.

Drug Interactions

High-dose antacids and H2 receptor antagonists can reduce cefpodoxime absorption by increasing gastric pH. Probenecid decreases renal excretion and increases cefpodoxime plasma levels. Cefpodoxime may cause false-positive urine glucose tests with certain reagents (copper reduction tests) and potentially false-positive direct Coombs tests. No significant interactions with warfarin or other commonly used medications have been reported.

Special Populations

Cefpodoxime is pregnancy category B; use during pregnancy only if clearly needed. Small amounts are excreted in breast milk; use with caution during breastfeeding. Safety and efficacy have been established in pediatric patients 2 months and older for otitis media, pharyngitis/tonsillitis, and sinusitis. Elderly patients may require dose adjustment based on renal function. For patients with CrCl less than 30 mL/min, the dose interval should be extended to every 24 hours. Hemodialysis removes cefpodoxime; dosing should be after dialysis sessions.