What is the recommended dosage of cefpodoxime (oral) for a patient with a bacterial infection, considering factors such as severity, type of infection, and renal function?

Cefpodoxime Oral Dosing for Bacterial Infections

Cefpodoxime proxetil should be administered orally with food at doses ranging from 100-400 mg every 12 hours in adults (or 8-10 mg/kg/day in children), with specific dosing determined by infection type, severity, and renal function. 1

Adult Dosing by Infection Type

The FDA-approved dosing regimens for adults and adolescents (≥12 years) are infection-specific 1:

Respiratory Tract Infections

• Pharyngitis/tonsillitis: 100 mg every 12 hours for 5-10 days 1
• Acute bacterial exacerbations of chronic bronchitis: 200 mg every 12 hours for 10 days 1
• Community-acquired pneumonia: 200 mg every 12 hours for 14 days 1
• Acute maxillary sinusitis: 200 mg every 12 hours for 10 days 1

Skin and Soft Tissue Infections

• Mild to moderate infections: 400 mg every 12 hours for 7-14 days 1

Urinary Tract Infections

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

Sexually Transmitted Infections

• Uncomplicated gonorrhea and rectal gonococcal infections: 200 mg as a single dose 1

Pediatric Dosing

For children, the recommended dose is 8-10 mg/kg/day, administered either as a single daily dose or divided into two doses 2:

• Cefpodoxime for pediatric UTI: 10 mg/kg/day divided into 2 doses 3
• Treatment duration for pediatric UTIs should be 7-14 days 3

Renal Impairment Adjustments

Dose modifications are critical in renal dysfunction 1:

• Severe renal impairment (CrCl <30 mL/min): Increase dosing interval to every 24 hours 1
• Hemodialysis patients: Administer 3 times per week after dialysis 1
• Cirrhotic patients: No dose adjustment necessary 1

To estimate creatinine clearance when only serum creatinine is available 1:

• Males: CrCl = [Weight (kg) × (140 - age)] / [72 × serum creatinine (mg/dL)]
• Females: CrCl = 0.85 × male calculation

Administration Considerations

Cefpodoxime proxetil must be administered with food to enhance absorption, as the prodrug is absorbed from the proximal intestine and converted to active cefpodoxime by intestinal esterases 1, 4. The extended plasma half-life of 1.9-3.7 hours permits convenient twice-daily dosing 4.

Clinical Efficacy Context

Cefpodoxime demonstrates broad-spectrum activity against both gram-positive and gram-negative bacteria 4:

• Effective against beta-lactamase-producing strains of H. influenzae and M. catarrhalis 5
• Active against penicillin-resistant S. pneumoniae 5
• Enhanced antistaphylococcal activity compared to other oral third-generation cephalosporins like cefixime 4

Clinical trials demonstrate equivalence to parenteral ceftriaxone for community-acquired pneumonia in hospitalized patients 4, 5, making it a viable step-down option from intravenous therapy 2.

Safety Profile

Adverse events are generally mild to moderate, occurring in 4-15% of patients 4:

• Most common: gastrointestinal disturbances (diarrhea) and vaginitis 6
• Drug-related adverse reactions reported in approximately 8% of patients 6
• Safety profile similar to other beta-lactam antibiotics 5

Common Pitfalls to Avoid

• Do not administer without food: Absorption is significantly enhanced with food intake 1, 4
• Do not use standard dosing in severe renal impairment: Failure to adjust for CrCl <30 mL/min risks drug accumulation 1
• Do not underdose severe infections: Use 400 mg every 12 hours for severe skin/soft tissue infections rather than 200 mg 1, 6