When cefpodoxime is used in the treatment of skin and skin structure infections, the fact that abscesses usually require surgical drainage should be considered.Oral cefpodoxime proxetil is used for the treatment of uncomplicated urinary tract infections (cystitis) caused by susceptible Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or S. saprophyticus. Cefpodoxime generally is inactive against enterococci (e.g., Enterococcus faecalis [formerly Streptococcus faecalis], methicillin-resistant staphylococci, Pseudomonas, Enterobacter, and anaerobic bacteria.The National Committee for Clinical Laboratory Standards (NCCLS) states that, if results of in vitro susceptibility testing indicate that a clinical isolate is susceptible to cefpodoxime, then an infection caused by this strain may be appropriately treated with the dosage of the drug recommended for that type of infection and infecting species, unless otherwise contraindicated.If results indicate that a clinical isolate has intermediate susceptibility to cefpodoxime, then the strain has a minimum inhibitory concentration (MIC) that approaches usually attainable blood and tissue drug concentrations and response rates may be lower than for strains identified as susceptible.Therefore, the intermediate category implies clinical applicability in body sites where the drug is physiologically concentrated (e.g., urine) or when a high dosage of the drug can be used. Systemic adverse reactions to cefotaxime have been rare. Results of a study in healthy adults who received single 100-mg doses of cefpodoxime as cefpodoxime proxetil film-coated tablets or cefpodoxime proxetil oral suspension indicate that these formulations are bioequivalent.Cefpodoxime exhibits linear pharmacokinetics over the oral dosage range of 100-400 mg; however, the drug exhibits nonlinear, dose-dependent pharmacokinetics at doses exceeding 400 mg. In pediatric patients 1-17 years of age who receive a single 5-mg/kg dose of cefpodoxime as cefpodoxime proxetil oral suspension, plasma concentrations of cefpodoxime average 1.4, 2.1, 1.7, 0.9, and 0.4 mcg/mL at 1, 2, 4, 6, and 8 hours, respectively, after the dose.The apparent volume of distribution of cefpodoxime ranges from 0.7-1. Initial treatment of CAP generally involves use of an empiric anti-infective regimen based on the most likely pathogens; therapy may then be changed (if possible) to a pathogen-specific regimen based on results of in vitro culture and susceptibility testing, especially in hospitalized patients.The most appropriate empiric regimen varies depending on the severity of illness at the time of presentation and whether outpatient treatment or hospitalization in or out of an intensive care unit (ICU) is indicated and the presence or absence of cardiopulmonary disease and other modifying factors that increase the risk of certain pathogens (e.g., penicillin- or multidrug-resistant Streptococcus pneumoniae, enteric gram-negative bacilli, Pseudomonas aeruginosa).Most experts recommend that an empiric regimen for the outpatient treatment of CAP include an anti-infective active against S. pneumoniae since this organism is the most commonly identified cause of bacterial pneumonia and causes more severe disease than many other common CAP pathogens; some other pathogens often involved in outpatient CAP are Mycoplasma pneumoniae, Chlamydia pneumoniae, respiratory viruses, and Haemophilus influenzae (especially in cigarette smokers).For empiric outpatient treatment of acute CAP in immunocompetent adults, the IDSA recommends monotherapy with an oral macrolide (azithromycin, clarithromycin, erythromycin), oral doxycycline, or an oral fluoroquinolone active against S. pneumoniae (e.g., gatifloxacin, levofloxacin, moxifloxacin) and states that alternative empiric regimens include oral amoxicillin and clavulanate or certain oral cephalosporins (cefpodoxime, cefprozil, cefuroxime axetil).For outpatient treatment of CAP in immunocompetent adults without cardiopulmonary disease or other modifying factors that would increase the risk of multidrug-resistant S. pneumoniae or gram-negative bacteria, the ATS recommends an empiric regimen of monotherapy with azithromycin or clarithromycin or, alternatively, doxycycline.
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