What is the dosage and treatment duration of Cepodoxime (Cefpodoxime) for bacterial infections?

Cefpodoxime Dosing and Treatment Duration for Bacterial Infections

For most bacterial infections, cefpodoxime (cefpodoxime proxetil) should be dosed at 200 mg orally twice daily for adults, with treatment duration ranging from 5-14 days depending on the specific infection type. 1

Adult Dosing by Indication

Respiratory Tract Infections

• Community-acquired pneumonia: 200 mg twice daily for 14 days 1, 2
• Acute bacterial exacerbation of chronic bronchitis: 200 mg twice daily for 10 days 1, 2
• Acute maxillary sinusitis: 200 mg twice daily for 10 days 1
• Pharyngitis/tonsillitis: 100 mg twice daily for 5-10 days 1

Urinary Tract Infections

• Uncomplicated cystitis: 100 mg twice daily for 7 days 1, 3
• Uncomplicated pyelonephritis: 200 mg twice daily for 10 days 4
  • Note: An initial intravenous dose of a long-acting parenteral antimicrobial (e.g., ceftriaxone) should be administered before transitioning to oral cefpodoxime 4

Genitourinary Infections

• Uncomplicated gonorrhea (urethral/cervical): 200 mg as a single dose 1
• Uncomplicated anorectal infections in women: 200 mg as a single dose 1

Skin and Soft Tissue Infections

• Uncomplicated skin and skin structure infections: 400 mg twice daily for 7-14 days 1
  • Higher doses are required for skin infections compared to other indications 1

Ear Infections

• Acute otitis media: 200 mg twice daily for 5-10 days 1

Pediatric Dosing

For children, the recommended dose is 8-10 mg/kg/day divided into one or two doses, with specific schedules varying by infection type. 5

• Maximum daily dose should not exceed adult dosing on a per-kilogram basis 4
• Twice-daily dosing improves compliance and is generally preferred 5

Key Clinical Considerations

Spectrum of Activity

Cefpodoxime demonstrates excellent activity against:

• Gram-positive organisms: Streptococcus pneumoniae, Streptococcus pyogenes, Staphylococcus aureus (including penicillinase-producing strains) 1, 6
• Gram-negative organisms: Haemophilus influenzae (including beta-lactamase producers), Moraxella catarrhalis, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Neisseria gonorrhoeae 1, 6

Important Limitations

• Insufficient data for treating beta-lactamase-producing H. influenzae in acute bacterial exacerbations of chronic bronchitis 1
• Not effective for pharyngeal gonorrhea 1
• Not established for rectal gonorrhea in men 1
• Lower bacterial eradication rates in cystitis compared to some other approved agents should be considered 1

Pharmacokinetic Advantages

• Extended plasma half-life (1.9-3.7 hours) permits twice-daily dosing 6
• Stable against most plasmid-mediated beta-lactamases 6
• Adequate tissue penetration in most body fluids 5

Safety Profile

Cefpodoxime is generally well tolerated, with mild to moderate gastrointestinal disturbances occurring in 4-15% of patients 6. Adverse events are similar to other beta-lactam antibiotics 2.

Renal Adjustment

Dose adjustment is required in patients with compromised renal function 5.

Treatment Duration Principles

While specific durations are provided above, treatment duration should be individualized based on infection site, source control, underlying comorbidities, and initial response to therapy 4. Infectious disease specialist consultation is suggested for complex cases 4.