What is the recommended dosage of cefpodoxime (Cefpodoxime proxetil) for various infections?

Cefpodoxime Dosing Recommendations

Cefpodoxime proxetil should be dosed at 200-400 mg orally every 12 hours for adults (depending on infection severity) and 5-10 mg/kg/dose every 12 hours for pediatric patients, with food enhancing absorption in adults but not required in children. 1

Adult Dosing by Indication

Respiratory Tract Infections

• Community-acquired pneumonia: 200 mg every 12 hours for 14 days (total daily dose 400 mg) 1
• Acute bacterial exacerbations of chronic bronchitis: 200 mg every 12 hours for 10 days 1
• Acute maxillary sinusitis: 200 mg every 12 hours for 10 days 1

Upper Respiratory Infections

• Pharyngitis/tonsillitis: 100 mg every 12 hours for 5-10 days (total daily dose 200 mg) 1

Urinary Tract Infections

• Uncomplicated UTI: 100 mg every 12 hours for 7 days 1

Skin and Soft Tissue Infections

• Skin and skin structure infections: 400 mg every 12 hours for 7-14 days (total daily dose 800 mg) 1

Sexually Transmitted Infections

• Uncomplicated gonorrhea (men and women) and rectal gonococcal infections (women): 200 mg as a single dose 1

Pediatric Dosing (Ages 2 Months to 12 Years)

All pediatric dosing is based on 5 mg/kg per dose every 12 hours, with maximum doses not exceeding adult equivalents: 1

• Acute otitis media: 5 mg/kg every 12 hours for 5 days (maximum 200 mg/dose, total daily dose 10 mg/kg up to 400 mg/day) 1
• Pharyngitis/tonsillitis: 5 mg/kg every 12 hours for 5-10 days (maximum 100 mg/dose, total daily dose 10 mg/kg up to 200 mg/day) 1
• Acute maxillary sinusitis: 5 mg/kg every 12 hours for 10 days (maximum 200 mg/dose, total daily dose 10 mg/kg up to 400 mg/day) 1

Special Populations

Renal Impairment

• Severe renal impairment (creatinine clearance <30 mL/min): Extend dosing interval to every 24 hours 1
• Hemodialysis patients: Administer dose 3 times per week after hemodialysis 1

Hepatic Impairment

• Cirrhotic patients (with or without ascites): No dose adjustment necessary, as pharmacokinetics remain similar to healthy subjects 1

Administration Considerations

Food Effects

• Adults and adolescents ≥12 years: Film-coated tablets should be administered with food to enhance absorption 1, 2
• Pediatric patients 2 months to 12 years: Oral suspension may be given without regard to food 1

Drug Interactions

• Antacids and H2-receptor antagonists: Avoid concomitant use as raising gastric pH reduces cefpodoxime absorption 2

Clinical Context and Alternative Positioning

Cefpodoxime is positioned as an alternative oral cephalosporin for β-lactamase-producing Haemophilus influenzae when amoxicillin-clavulanate cannot be used. 3 The 2011 PIDS/IDSA pediatric pneumonia guidelines list cefpodoxime alongside cefdinir, cefixime, and ceftibuten as alternatives for β-lactamase-producing H. influenzae infections 3. For pneumococcal pneumonia, cefpodoxime is listed as an alternative second- or third-generation oral cephalosporin option 3.

Important Caveats

• Cefpodoxime is not a first-line agent for pneumococcal pneumonia; amoxicillin remains preferred for susceptible strains 3
• For penicillin-resistant pneumococcus with high MICs, respiratory fluoroquinolones or higher-dose amoxicillin are preferred over cefpodoxime 3
• The drug demonstrates enhanced antistaphylococcal activity compared to other oral third-generation cephalosporins like cefixime, making it useful for skin infections 4

Pharmacokinetic Properties Supporting Dosing

• Half-life: 1.9-3.7 hours, permitting twice-daily administration 4, 2
• Bioavailability: 50% for tablets, enhanced by food 2
• Protein binding: Low (18-23%), facilitating tissue penetration 2
• Excretion: Primarily renal, unchanged 5, 2