What is the recommended dose of Cefpodoxime (Cefpodoxime proxetil) for treating infections?

Cefpodoxime Dosing Recommendations

For adults, cefpodoxime proxetil is dosed at 100-400 mg orally every 12 hours depending on infection type and severity, with food enhancing absorption of film-coated tablets by 21-33%. 1

Standard Adult Dosing

The FDA-approved dosing for cefpodoxime proxetil varies by indication 1:

• 100 mg every 12 hours: Appropriate for uncomplicated urinary tract infections and mild respiratory infections 1, 2
• 200 mg every 12 hours: Standard dose for most community-acquired infections including respiratory tract infections, skin/soft tissue infections 1, 3
• 400 mg every 12 hours: Reserved for more severe infections or those requiring higher tissue penetration 1

Pharmacokinetic Considerations

• Take with food: Film-coated tablets show 21-33% higher AUC when administered with food, though suspension formulations are less affected 1
• Bioavailability: Only 50% of the administered dose is absorbed systemically, with 29-33% excreted unchanged in urine 1
• Peak concentrations: Occur at 2-3 hours post-dose, with Cmax of 1.4 mcg/mL (100 mg), 2.3 mcg/mL (200 mg), and 3.9 mcg/mL (400 mg) 1
• Half-life: Ranges from 2.09-2.84 hours in patients with normal renal function 1

Pediatric Dosing

Children should receive 8-10 mg/kg/day divided into two doses (every 12 hours) for most infections, with treatment duration of 5-10 days. 4, 5

• Acute otitis media: 8-10 mg/kg/day in 2 divided doses for 5-10 days 4
• Pharyngitis/tonsillitis: 8-10 mg/kg/day in 2 divided doses, with 5-day courses showing similar efficacy to 10-day penicillin V regimens 4
• Lower respiratory tract infections: 8-10 mg/kg/day in 2 divided doses 4, 5

Renal Impairment Adjustments

Dose reduction is mandatory for creatinine clearance <50 mL/min due to significantly prolonged half-life. 1

• Mild impairment (50-80 mL/min CrCl): Half-life increases to 3.5 hours; standard dosing may be used 1
• Moderate impairment (30-49 mL/min CrCl): Half-life increases to 5.9 hours; dose adjustment required 1
• Severe impairment (5-29 mL/min CrCl): Half-life increases to 9+ hours; significant dose reduction necessary 1

Special Populations

Elderly Patients

No routine dose adjustment is needed in elderly patients unless severe renal impairment is present. 6

• Pharmacokinetics in elderly patients (≥70 years) are comparable to younger adults when renal function is preserved 6
• Always assess renal function before dosing, as age-related decline may necessitate adjustment 6

Clinical Context from Guidelines

While cefpodoxime is mentioned in IDSA guidelines, it has important limitations 7, 8:

• Not first-line for gonorrhea: Cefpodoxime proxetil 200 mg PO shows suboptimal efficacy (96.5% cure rate, CI 94.8%-98.9%) and poor pharyngeal coverage (78.9% efficacy) 7
• Alternative for H. influenzae: Recommended as an alternative oral cephalosporin for β-lactamase-producing strains when amoxicillin-clavulanate cannot be used 8
• Not preferred for pneumococcal pneumonia: Listed as an alternative second/third-generation oral option, but amoxicillin remains first-line 8
• Avoid in penicillin-resistant pneumococcus: Respiratory fluoroquinolones or high-dose amoxicillin are preferred over cefpodoxime for high-MIC strains 8

Common Pitfalls

• Forgetting food administration: Film-coated tablets require food for optimal absorption; missing this reduces efficacy by up to 33% 1
• Overlooking renal function: Failure to adjust for moderate-to-severe renal impairment leads to drug accumulation and potential toxicity 1
• Dose-dependent absorption: Higher doses show decreased dose-normalized absorption (up to 32% reduction), meaning doubling the dose does not double the exposure 1
• Tissue penetration variability: While lung tissue levels are adequate (0.63 mcg/g at 3 hours), CSF penetration data are insufficient for CNS infections 1