cefpodoxime (Vantin)

Introduction

Tradename: Vantin. 2nd generation cephalosporin. (cefpodoxime proxetil)

Indications

• treatment of bacterial infections due to susceptible organisms
  • community acquired pneumonia
  • uncomplicated skin or soft tissue infection
  • acute otitis media
  • pharyngitis
  • uncomplicated urinary tract infection
  • gonorrhea
  • proctitis

Dosage

• 100-400 mg PO BID
• Children: 10 mg/kg/day divided BID
• take with food

Tab:100, 200 mg

Suspension: 50, 100 mg/5 mL

Dosage adjustment in renal failure

• reduce dosing to QD with creatinine clearance < 30 mg/mL

Pharmacokinetics

• absorption rapid, well absorbed (50%), acid stable, enhanced absorption with food and decreased gastric pH
• cefpodoxime proxetil is hydrolyzed in GI tract to cefpodoxime
• distribution: good tissue penetration, including lungs, tonsils & pleural fluid
• protein binding 18-23%
• time to peak serum concentration: 1 hour after oral dose
• elimination 1/2life 2.2 hours, increased with renal insufficiency
• 80% excreted unchanged into the urine

elimination via liver

elimination via kidney

1/2life = 2.2 hours

protein binding = 18-23 %

Antimicrobial activity

Gram positive

• Streptococcus
  • Streptococcus group A
  • Streptococcus group B
  • Streptococcus group C
  • Streptococcus group G
  • Streptococcus pneumonia
  • Streptococcus viridans, milleri
• Staphylococcus aureus (MSSA)
• Staphylococcus epidermidis (+/-)

Gram negative

• Neisseria gonorrhoeae
• Moraxella catarrhalis
• Haemophilus influenzae
• Escherichia coli
• Proteus mirabilis
• Proteus vulgaris (+/-)
• Citrobacter species
• Klebsiella

Adverse effects

• not common (1-10%)
  • diarrhea
• uncommon (< 1%)
  • headache, diaper rash, nausea/vomiting, abdominal pain, pseudomembranous colitis, vaginal fungal infection
• low incidence of cross-sensitivity to penicillins

• drug adverse effects of cephalosporins

Drug interactions

• antacids & H2-receptor antagonists reduces absorption of' cefpodoxime
• probenecid may decrease elimination of cephalosporins

• drug interaction(s) anticonvulsants with anti-bacterial agents
• drug interaction(s) of antibiotics with warfarin

Test interactions

• positive direct antiglobulin test

More general terms

• cephalosporin, 2nd generation

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2645
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=54547
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=123816
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=123815
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=441393
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=2644