What is the treatment regimen for Vantin (Cefpodoxime)?

Vantin (Cefpodoxime) Treatment Regimens

Cefpodoxime proxetil is administered orally at 100-400 mg twice daily for adults (or 8-10 mg/kg/day divided into two doses for children), with specific dosing and duration varying by infection type, ranging from single-dose therapy for gonorrhea to 5-14 days for respiratory and skin infections. 1

Dosing by Indication

Respiratory Tract Infections

Upper Respiratory Infections:

• Pharyngitis/Tonsillitis: 100 mg twice daily for 5-10 days in adults; 5 mg/kg twice daily (maximum 100 mg/dose) for 5-10 days in children 1
• Acute Maxillary Sinusitis: 200 mg twice daily for 10 days in adults; 5 mg/kg twice daily (maximum 200 mg/dose) for 10 days in children 1
• Acute Otitis Media (children): 5 mg/kg twice daily (maximum 200 mg/dose) for 5 days 1

Lower Respiratory Infections:

• Community-Acquired Pneumonia: 200 mg twice daily for 14 days 1
• Acute Bacterial Exacerbation of Chronic Bronchitis: 200 mg twice daily for 10 days 1

Genitourinary Infections

• Uncomplicated Gonorrhea (urethral/cervical): Single 200 mg dose 1
• Uncomplicated Anorectal Gonorrhea (women only): Single 200 mg dose 1
• Uncomplicated Urinary Tract Infections (Cystitis): 100 mg twice daily for 7 days 1

Skin and Soft Tissue Infections

• Uncomplicated Skin/Skin Structure Infections: 400 mg twice daily for 7-14 days 1
• Note: This indication requires higher dosing than other infections due to dose-related efficacy in clinical trials 1

Important Clinical Considerations

Limitations and Contraindications

Gonorrhea Treatment Restrictions:

• Cefpodoxime 200 mg does NOT meet minimum efficacy criteria (>95% cure rate) for urogenital/rectal gonorrhea (96.5% cure rate, CI 94.8%-98.9%) 2
• Efficacy for pharyngeal gonorrhea is unacceptable at 78.9% (CI 54.5%-94%) 2
• Not established for male rectal gonorrhea infections 1
• Should only be considered as an alternative when preferred agents (ceftriaxone, cefixime) are not feasible 2

Comparative Efficacy:

• Cefpodoxime is less active against N. gonorrhoeae than cefixime 2
• For cystitis, cefpodoxime has lower bacterial eradication rates compared to some other approved agents, which should be weighed in treatment selection 1

Spectrum of Activity

Strong Activity:

• Streptococcus pneumoniae (including some penicillin-resistant strains) 2
• Haemophilus influenzae (including beta-lactamase producers) - superior to cefuroxime axetil and cefdinir 2
• Moraxella catarrhalis (including beta-lactamase producers) 1
• Staphylococcus aureus (including penicillinase producers) 1
• Streptococcus pyogenes 1

Positioning in Therapy:

• Often regarded as preferred treatment when high-dose amoxicillin or amoxicillin/clavulanate fails or is intolerable, due to its enhanced activity against H. influenzae 2
• Structural analog of ceftriaxone with similar activity against respiratory pathogens 2

Administration and Pharmacokinetics

Absorption Considerations:

• Cefpodoxime proxetil is a prodrug converted to active cefpodoxime in the intestinal mucosa 3, 4
• Food enhances absorption; should be taken with meals when possible 3
• Peak plasma levels occur 2-3 hours after administration 3
• Elimination half-life of 1.9-3.7 hours allows twice-daily dosing 4

Drug Interactions:

• Antacids and H2 blockers reduce peak plasma levels by 24-42% and absorption by 27-32% 1
• Probenecid increases AUC by 31% and peak levels by 20% 1
• Anticholinergics (e.g., propantheline) delay peak levels by 47% but don't affect total absorption 1

Renal Dosing Adjustments

Required dose reductions: 1

• CrCl <30 mL/min: Administer every 24 hours instead of every 12 hours
• Hemodialysis patients: Administer 3 times weekly after dialysis

Pediatric Considerations

Standard pediatric dosing: 8-10 mg/kg/day divided into two doses 3, 5

• Maximum single dose varies by indication (100-200 mg) 1
• 5-day courses demonstrate similar efficacy to 10-day penicillin regimens for pharyngotonsillitis 5
• Suspension formulation has poor palatability, which may limit adherence in children 2

Safety Profile

Common Adverse Events (>1%): 1

• Diarrhea: 7% (dose-related: 10.4% at 800 mg/day vs 5.7% at 200 mg/day)
• Nausea: 3.3%
• Vaginal fungal infections: 1-1.3%
• Abdominal pain: 1.2%
• Headache: 1%

Serious Adverse Events (post-marketing): 1

• Pseudomembranous colitis (10% of patients with diarrhea had C. difficile in stool)
• Stevens-Johnson syndrome, toxic epidermal necrolysis
• Anaphylactic shock
• Acute liver injury

Discontinuation rates: 2.7% discontinued due to adverse events, with 52% of discontinuations due to gastrointestinal disturbances 1

Clinical Pearls

Abbreviated Therapy Evidence:

• 5-day courses are as effective as 8-10 day courses of comparators for acute otitis media and sinusitis, with improved compliance and tolerability 6, 5
• Short courses may reduce costs associated with adverse effects and treatment failures 6

Stepdown Therapy:

• Can be used for parenteral-to-oral conversion in community-acquired pneumonia, though formal clinical trial data are limited 6
• Twice-daily dosing and broad spectrum make it suitable for outpatient transition 6, 4