Indications and Dosing Guidelines for Cefpodoxime
Cefpodoxime proxetil is indicated for the treatment of mild to moderate infections caused by susceptible organisms, with specific dosing regimens based on infection type, severity, and patient characteristics.
FDA-Approved Indications
Cefpodoxime proxetil is FDA-approved for the following conditions 1:
- Acute otitis media caused by Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae (including beta-lactamase-producing strains), or Moraxella catarrhalis
- Pharyngitis/tonsillitis caused by Streptococcus pyogenes
- Community-acquired pneumonia caused by S. pneumoniae or H. influenzae
- Acute bacterial exacerbation of chronic bronchitis caused by S. pneumoniae, H. influenzae (non-beta-lactamase-producing strains), or M. catarrhalis
- Uncomplicated gonorrhea (urethral, cervical, and ano-rectal infections in women)
- Uncomplicated skin and skin structure infections caused by Staphylococcus aureus or Streptococcus pyogenes
- Acute maxillary sinusitis caused by H. influenzae, S. pneumoniae, and M. catarrhalis
- Uncomplicated urinary tract infections caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Staphylococcus saprophyticus
Dosing Guidelines by Indication
Adults and Adolescents (≥12 years)
| Infection | Dosage | Duration |
|---|---|---|
| Pharyngitis/Tonsillitis | 100 mg twice daily | 5-10 days |
| Acute Sinusitis | 200 mg twice daily | 10 days |
| Community-acquired Pneumonia | 200 mg twice daily | 14 days |
| Acute Bacterial Exacerbation of Chronic Bronchitis | 200 mg twice daily | 10 days |
| Uncomplicated Gonorrhea (men and women) | 200 mg single dose | One time |
| Rectal Gonococcal Infections (women) | 200 mg single dose | One time |
| Skin and Skin Structure Infections | 400 mg twice daily | 7-14 days |
| Uncomplicated UTI | 100 mg twice daily | 7 days |
Pediatric Patients
For children, the recommended dose is 8-10 mg/kg/day divided into two doses 2, 3:
| Infection | Dosage | Duration |
|---|---|---|
| Acute Otitis Media | 5 mg/kg twice daily (max 200 mg/dose) | 5-10 days |
| Pharyngitis/Tonsillitis | 5 mg/kg twice daily (max 100 mg/dose) | 5-10 days |
| Acute Sinusitis | 5 mg/kg twice daily (max 200 mg/dose) | 10 days |
Clinical Considerations and Limitations
Efficacy in Specific Infections
Urinary Tract Infections: Cefpodoxime proxetil (100 mg twice daily for 7 days) has demonstrated bacteriological cure rates of approximately 80% in uncomplicated UTIs, comparable to cefaclor (82%) and superior to amoxicillin (70%) 4. However, the IDSA guidelines note that cefpodoxime has lower bacterial eradication rates compared to other agents for UTIs 5.
Gonorrhea: While effective for uncomplicated urethral and cervical gonorrhea, cefpodoxime proxetil 200 mg is less active against N. gonorrhoeae than cefixime and does not quite meet minimum efficacy criteria for pharyngeal infection (78.9% cure rate) 5.
Respiratory Infections: Cefpodoxime demonstrates good efficacy in respiratory tract infections, with clinical success rates similar to other commonly used antibiotics 2, 6.
Special Populations
- Renal Impairment: Dosage adjustment is required in patients with impaired renal function 3.
- Children <12 years: Weight-based dosing at 8-10 mg/kg/day divided into two doses 2, 3.
Antimicrobial Considerations
- Cefpodoxime is stable against most common plasmid-mediated beta-lactamases 6.
- For bacterial rhinosinusitis, cefpodoxime is recommended for children with mild disease who have received antibiotics in the previous 4-6 weeks or children with moderate disease 5.
Clinical Pitfalls and Caveats
Pharyngitis/Tonsillitis: While effective for streptococcal pharyngitis, cefpodoxime has not been proven effective for the prevention of rheumatic fever 1.
Gonorrhea: Not recommended for pharyngeal infections due to N. gonorrhoeae in men or women due to insufficient efficacy data 1.
Urinary Tract Infections: Consider the lower bacterial eradication rates compared to other agents 1. Beta-lactams generally have inferior efficacy and more adverse effects compared to other UTI antimicrobials 5.
Bacterial Exacerbation of Chronic Bronchitis: Insufficient data to establish efficacy against beta-lactamase-producing strains of H. influenzae 1.
Skin Infections: Higher doses (400 mg twice daily) are required for skin and soft tissue infections compared to other indications 1.
Cefpodoxime proxetil offers the advantage of twice-daily dosing due to its extended plasma half-life (1.9-3.7 hours), making it convenient for outpatient treatment 6.