Cefpodoxime Proxetil: Dosing and Treatment Guidelines
Recommended Dosing
For most common bacterial infections in adults, cefpodoxime proxetil should be dosed at 200 mg orally twice daily for 7-10 days, with higher doses of 400 mg twice daily reserved for severe infections. 1, 2
Adult Dosing by Indication
- Respiratory tract infections (acute/chronic bronchitis, pneumonia): 200 mg twice daily for 5-10 days 3
- Skin and soft tissue infections (mild to moderate): 200 mg twice daily for 7-14 days 2
- Skin and soft tissue infections (severe): 400 mg twice daily for 7-14 days 2
- Urinary tract infections: 100 mg twice daily has shown effectiveness 4
- Acute uncomplicated cystitis: 100 mg twice daily for 3 days (equivalent efficacy to trimethoprim-sulfamethoxazole) 5
Pediatric Dosing
Children should receive 8-10 mg/kg/day divided into two doses for most infections, with treatment duration of 5-10 days. 1, 6
- Acute otitis media: 8-10 mg/kg/day in 2 divided doses for 5-10 days 6
- Pharyngitis/tonsillitis: 8-10 mg/kg/day in 2 divided doses for 5-10 days (5-day courses are as effective as 10-day penicillin V regimens) 6
- Lower respiratory tract infections: 8-10 mg/kg/day in 2 divided doses 6
Clinical Positioning in Guidelines
Cefpodoxime proxetil is recommended as a first-line alternative for respiratory infections when amoxicillin or amoxicillin-clavulanate cannot be used, particularly for β-lactamase-producing organisms. 5, 7, 8
Specific Guideline Recommendations
- Acute bacterial rhinosinusitis: First-line option alongside cefdinir for mild disease (calculated clinical efficacy 87%) 7
- β-lactamase-producing H. influenzae: Alternative when amoxicillin-clavulanate is not suitable 8
- Pneumococcal pneumonia: Alternative second- or third-generation oral cephalosporin, though not first-line (amoxicillin preferred) 8
- Penicillin-allergic patients: Acceptable alternative for respiratory and ear infections 7
Important Limitations
Cefpodoxime should NOT be used for penicillin-resistant pneumococcus with high MICs; respiratory fluoroquinolones or higher-dose amoxicillin are preferred in these cases. 8
- Neither cefpodoxime nor cefdinir should be used as monotherapy for suspected MRSA infections 7
- Not effective against methicillin-resistant staphylococci 1
- Fluoroquinolone resistance exceeding 10% warrants alternative empiric therapy for pyelonephritis 5
Pharmacokinetic Considerations
- Bioavailability: 68% (range 63-73%) after oral administration 4
- Peak plasma concentration: 7.9 mg/L after 500 mg dose with food 4
- Protein binding: 33% 4
- Excretion: Renal, unchanged—dose adjustment required in renal impairment 1
- Food effect: Absorption enhanced when taken with food 1
Safety Profile
Cefpodoxime proxetil is generally well tolerated with adverse events similar to other oral cephalosporins, most commonly involving gastrointestinal disturbances. 1, 6
- Most common adverse reactions: diarrhea (gastrointestinal), vaginitis (female genital tract) 2
- Overall drug-related adverse reaction rate: approximately 8% 2
- Adverse events are mild and transient 1, 6
Clinical Efficacy Data
- Clinical cure rates: 93% for mild-moderate skin infections (200 mg dose), 75.9% for severe infections (400 mg dose) 2
- Pathogen eradication: 97.6-100% in skin/soft tissue infections 2
- Comparative efficacy: Equivalent to amoxicillin-clavulanate, cefixime, cefuroxime axetil, and cefaclor in pediatric otitis media 6
Practical Considerations
The suspension formulation has poor palatability in children, which may limit adherence compared to better-tasting alternatives like cefdinir. 5