What infections is cefpodoxime (cepodoxime cv) used to treat?

Cefpodoxime (Cefpodoxime CV) Clinical Indications

Cefpodoxime is a third-generation oral cephalosporin used primarily for respiratory tract infections (acute otitis media, pharyngitis/tonsillitis, community-acquired pneumonia, acute bacterial sinusitis, acute exacerbations of chronic bronchitis), uncomplicated urinary tract infections, uncomplicated skin and soft tissue infections, and uncomplicated gonorrhea. 1

FDA-Approved Indications

The FDA label specifies the following bacterial infections for cefpodoxime treatment: 1

Respiratory Tract Infections

• Acute otitis media caused by Streptococcus pneumoniae (excluding penicillin-resistant strains), Streptococcus pyogenes, Haemophilus influenzae (including beta-lactamase-producing strains), or Moraxella catarrhalis (including beta-lactamase-producing strains) 1
• Pharyngitis and/or tonsillitis caused by Streptococcus pyogenes 1
• Community-acquired pneumonia caused by S. pneumoniae or H. influenzae (including beta-lactamase-producing strains) 1
• Acute bacterial exacerbation of chronic bronchitis caused by S. pneumoniae, H. influenzae (non-beta-lactamase-producing strains only), or M. catarrhalis 1
• Acute maxillary sinusitis caused by H. influenzae (including beta-lactamase-producing strains), S. pneumoniae, and M. catarrhalis 1

Genitourinary Infections

• Uncomplicated urinary tract infections (cystitis) caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Staphylococcus saprophyticus 1
• Acute uncomplicated urethral and cervical gonorrhea caused by Neisseria gonorrhoeae (including penicillinase-producing strains) 1
• Acute uncomplicated ano-rectal infections in women due to N. gonorrhoeae (including penicillinase-producing strains) 1

Skin and Soft Tissue Infections

• Uncomplicated skin and skin structure infections caused by Staphylococcus aureus (including penicillinase-producing strains) or Streptococcus pyogenes 1

Guideline-Supported Uses

Acute Bacterial Rhinosinusitis

Cefpodoxime proxetil is recommended as an appropriate first-line antimicrobial option for acute bacterial rhinosinusitis in both adults and children by the American Academy of Otolaryngology. 2, 3 The drug demonstrates superior activity against H. influenzae compared to other oral cephalosporins while maintaining adequate coverage of S. pneumoniae. 2

Pediatric Respiratory Infections

French clinical practice guidelines recommend cefpodoxime-proxetil at 8 mg/kg/day divided into two doses for: 2, 3

• Acute bronchiolitis with high fever (≥38.5°C) persisting >3 days, associated purulent acute otitis media, or confirmed pneumonia/atelectasis 2
• Acute maxillary sinusitis in children as first-line therapy 2, 3
• Bronchitis in children under 3 years when fever ≥38.5°C persists >3 days 2

Second-Line Therapy Role

Cefpodoxime proxetil is regarded as the preferred treatment for patients in whom high-dose amoxicillin or amoxicillin/clavulanate fails or is intolerable, due to its superior activity against H. influenzae while maintaining adequate S. pneumoniae coverage. 2

Microbiologic Activity Profile

Cefpodoxime demonstrates the following susceptibility patterns: 3

• ~75% of S. pneumoniae isolates are susceptible at pharmacokinetic/pharmacodynamic breakpoints
• 99.7% of penicillin-susceptible S. pneumoniae strains are covered
• 100% susceptibility against H. influenzae
• ~85% susceptibility against M. catarrhalis

Clinical Efficacy in Pediatric Populations

Randomized controlled trials demonstrate that cefpodoxime 8-10 mg/kg/day (in 2 divided doses) for 5-10 days is at least as effective as standard regimens of amoxicillin/clavulanic acid, cefixime, cefuroxime axetil, or cefaclor for acute otitis media. 4 For pharyngitis/tonsillitis, 5-day cefpodoxime courses show similar clinical efficacy to 10-day penicillin V regimens, with superior bacteriological eradication rates. 4, 5

Critical Limitations and Contraindications

Inappropriate Uses

• Do NOT use for pharyngeal N. gonorrhoeae infections in men or women 1
• Do NOT use for rectal gonorrhea in men (efficacy not established) 1
• Avoid empiric use for suspected Enterobacter infections, especially hospital-acquired or healthcare-associated infections, due to inducible AmpC beta-lactamase production leading to treatment failure 6
• Lower bacterial eradication rates in cystitis compared to some other approved agents should be weighed when selecting therapy 1

Resistance Concerns

• Insufficient data for beta-lactamase-producing H. influenzae in acute bacterial exacerbations of chronic bronchitis 1
• Extended cephalosporin use should be discouraged in settings with high ESBL-producing Enterobacteriaceae prevalence 6
• Enterobacter species can develop inducible resistance during therapy even with initial susceptibility 6

Practical Dosing Considerations

The effective therapeutic dose for skin infections is higher than for other indications, reflecting dose-related efficacy in these infections. 1 Cefpodoxime can be administered without regard to meals in children 6 months to 12 years, as food affects absorption rate but not extent. 7