Cefpodoxime is indicated for the treatment of infections caused by susceptible microorganisms, including:

• Acute otitis media caused by Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae, and Moraxella catarrhalis (including β-lactamase–producing strains)
• Pharyngitis and tonsillitis caused by Streptococcus pyogenes
• Acute maxillary sinusitis caused by Haemophilus influenzae (including β-lactamase–producing strains), Streptococcus pneumoniae, and Moraxella catarrhalis
• Community-acquired pneumonia caused by Streptococcus pneumoniae or Haemophilus influenzae (including β-lactamase–producing strains)
• Acute bacterial exacerbation of chronic bronchitis caused by Streptococcus pneumoniae, Haemophilus influenzae (non–β-lactamase–producing strains), or Moraxella catarrhalis
• Skin and skin structure infections caused by Staphylococcus aureus and Streptococcus pyogenes
• Uncomplicated urinary tract infections caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Staphylococcus saprophyticus
• Uncomplicated gonorrhea caused by Neisseria gonorrhoeae (including penicillinase-producing strains)
• Rectal gonococcal infections in women caused by Neisseria gonorrhoeae (including penicillinase-producing strains)

Cefpodoxime is an oral third-generation cephalosporin antibiotic with good stability against β-lactamases and activity against both Gram-positive and Gram-negative organisms. It can be used even before identification of the causative organism. It is administered as a prodrug, cefpodoxime proxetil, which is converted into its active form cefpodoxime after absorption. Approximately 29–33% of cefpodoxime is excreted unchanged in the urine within 12 hours.

Cefpodoxime demonstrates enhanced activity against Gram-positive bacteria compared to some other oral third-generation cephalosporins due to its high stability against β-lactamase enzymes. Susceptible organisms include Gram-positive bacteria such as Staphylococcus aureus (including penicillinase-producing strains), Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, and Streptococcus magnus; and Gram-negative bacteria such as Escherichia coli, Klebsiella pneumoniae, Haemophilus influenzae (including β-lactamase–producing and ampicillin-resistant strains), Moraxella catarrhalis, Neisseria gonorrhoeae (including penicillinase-producing strains), Proteus mirabilis, Citrobacter diversus, Haemophilus parainfluenzae, Klebsiella oxytoca, Proteus vulgaris, and Providencia rettgeri.

Adults and Adolescents (13 years and older)-

• Pharyngitis/tonsillitis: 100 mg 12 hourly, 5 to 10 days
• Acute maxillary sinusitis: 200 mg 12 hourly, 10 day
• Community-acquired pneumonia: 200 mg 12 hourly, 14 days
• Acute bacterial exacerbations of chronic bronchitis: 200 mg 12 hourly, 10 days
• Skin and skin structure: 400 mg 12 hourly, 7 to 14 days
• Uncomplicated urinary tract infection: 100 mg 12 hourly, 7 days
• Uncomplicated gonorrhea: single dose of 200 mg
• Rectal gonococcal infections in women: single dose of 200 mg

Infants and Pediatric Patients (2 months to 12 years)-

• Acute otitis media: 5 mg/kg body weight 12 hourly, 5 days
• Pharyngitis/tonsillitis: 5 mg/kg body weight 12 hourly, 5 to 10 days
• Acute maxillary sinusitis: 5 mg/kg body weight 12 hourly, 10 days

Patients with renal dysfunction: For patients with severe renal impairment (creatinine clearance <30ml/min) the dosing intervals should be increased to 24 hourly.

Patients with liver cirrhosis: Cefpodoxime Proxetil pharmacokinetics in cirrhotic patients are similar to those in healthy subjects. Dose adjustment is not necessary in this population.

Antacids: Concomitant administration of high doses of antacids (such as sodium bicarbonate and aluminium hydroxide) or H₂-receptor blockers reduces the peak plasma concentration by approximately 24%–42% and decreases the extent of absorption by about 27%–32%.

Probenecid: Probenecid inhibits the renal excretion of cefpodoxime, resulting in an approximate 31% increase in systemic exposure (AUC).

Nephrotoxic drugs: Renal function should be closely monitored when cefpodoxime proxetil is used concomitantly with drugs that have known nephrotoxic potential.

Cefpodoxime proxetil is contraindicated in patients with known hypersensitivity to cefpodoxime or other cephalosporin antibiotics.

Cefpodoxime is generally well tolerated with relatively few side effects. Reported adverse effects include diarrhea, nausea, skin and vaginal fungal infections, abdominal pain, headache, chest pain, myalgia, dyspepsia, dizziness, vertigo, and cough. In pediatric patients, fungal skin rashes are reported more frequently than in adults.

Animal studies have not shown teratogenic or embryocidal effects; however, adequate and well-controlled studies in pregnant women are lacking. Therefore, cefpodoxime should be used during pregnancy only if clearly needed. As cefpodoxime is excreted in human milk, a decision should be made whether to discontinue breastfeeding or discontinue the drug.

In patients with reduced urinary output due to renal insufficiency, the total daily dose of cefpodoxime proxetil should be reduced. Like other cephalosporins, it should be used with caution in patients receiving potent diuretics. Prolonged use may lead to overgrowth of non-susceptible organisms; therefore, regular evaluation of the patient’s condition is necessary.

Third generation Cephalosporins

Store in a dry place, away from heat and light. Keep out of reach of children.