cefpodoxime

[sef″po-dok´sēm] a broad-spectrum, β-lactamase–resistant, third-generation cephalosporinantibiotic effective against a wide range of gram-positive and gram-negative bacteria; used as cefpodoxime proxetil.

cefpodoxime

(sef-poe-dox-eem) cefpodoxime,

Vantin

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: third generation cephalosporins
Pregnancy Category: B

Indications

Treatment of the following infections caused by susceptible organisms:

Skin and skin structure infections,

Uncomplicated urinary tract infections,

Uncomplicated gynecological infections including gonorrhea,

Respiratory tract infections,

Otitis media.

Action

Binds to the bacterial cell wall membrane, causing cell death.

Therapeutic effects

Bactericidal action against susceptible bacteria.Similar to that of second-generation cephalosporins, but activity against staphylococci is less, whereas activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents.Notable is increased action against:

Haemophilus influenzae (including β-lactamase-producing strains),

Escherichia coli,

Klebsiella pneumoniae,

Neisseria gonorrhoeae,

Proteus.

Not active against methicillin-resistant staphylococci or enterococci.

Pharmacokinetics

Absorption: Cefpodoxime proxetil is a prodrug that is converted to cefpodoxim (the active component) in GI tract during absorption; 50% absorbed after oral administration; absorption of tablets increased with food.Distribution: Widely distributed. Crosses the placenta; enters breast milk.Metabolism and Excretion: 29–33% excreted unchanged in urine.Half-life: 2–3 hr (increased in renal impairment).

Time/action profile (blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	2–3 hr	12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins; Lactation: Lactation.Use Cautiously in: Renal impairment (↑ dosing interval recommended if CCr <30 mL/min); History of GI disease, especially colitis; Geriatric: Dose adjustment due to age-related ↓ in renal function may be necessary; Obstetric / Pediatric: Pregnancy and infants <2 mo (safety not established).

Adverse Reactions/Side Effects

Central nervous system

seizures (very high doses) (life-threatening)
headache

Gastrointestinal

pseudomembranous colitis (life-threatening)
diarrhea (most frequent)
abdominal pain
nausea
vomiting

Dermatologic

rashes
urticaria

Genitourinary

vaginal moniliasis

Hematologic

bleeding
blood dyscrasias
hemolytic anemia

Miscellaneous

allergic reactions including anaphylaxis (life-threatening)
superinfection

Interactions

Drug-Drug interaction

Probenecid ↓ excretion and increases blood levels.Concurrent use of loop diuretics or nephrotoxic agents including aminoglycosides may ↑ risk of nephrotoxicity.Antacids or histamine H2 receptor antagonists ↓ absorption of cefpodoxime (take 2 hr before or after).

Route/Dosage

Oral (Adults and Children ≥12 yr) Most infections—200 mg every 12 hr; Skin and skin structure infections—400 mg every 12 hr; Urinary tract infections/pharyngitis—100 mg every 12 hr; Gonorrhea—200 mg single dose.Oral (Children 2 mo–12 yr) Pharyngitis/tonsillitis/otitis media/acute maxillary sinusitis—5 mg/kg every 12 hr (not to exceed 200 mg/dose).

Renal Impairment

Oral (Adults) CCr <30 mL/min—Increase dosing interval to every 24 hr.

Availability (generic available)

Tablets: 100 mg, 200 mg Oral suspensionlemon creme flavor: 50 mg/5 mL, 100 mg/5 mL

Nursing implications

Nursing assessment

Assess patient for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
Lab Test Considerations: May cause positive results for Coombs' test.
- May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and creatinine.
- May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, lymphocytosis, and thrombocytosis.

Potential Nursing Diagnoses

Risk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

Oral: Administer around the clock. Administer tablets with meals to enhance absorption. Suspension may be administered without regard to meals. Shake oral suspension well before administering. Suspension is stable for 14 days after reconstitution in refrigerator.
- Do not administer concurrently with antacids or other drugs taken to reduce stomach acid.

Patient/Family Teaching

Instruct patient to take medication at evenly spaced times and to finish the medication completely, even if feeling better. Take missed doses as soon as possible unless almost time for next dose; do not double doses. Instruct patient to use calibrated measuring device with suspension. Advise patient that sharing of this medication may be dangerous.
Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.

Evaluation/Desired Outcomes

Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.