CEFPODOXIME

CEFPODOXIMe (cef-po-dox'eem) Vantin Classifications: antibiotic; third-generation cephalosporin; Therapeutic: antibiotic; cephalosporin Prototype: Cefotaxime sodium Pregnancy Category: B

Availability

100 mg, 200 mg tablets; 10 mg/mL, 20 mg/mL suspension

Action

Semisynthetic beta-lactam cephalosporin antibiotic. It inhibits the third and final stage of bacterial cell wall synthesis by preferentially binding to specific penicillin-binding proteins (PBPs) within the bacterial cell wall.

Therapeutic Effect

Has antibacterial activity resembling that of other third-generation cephalosporins. Stable in the presence of beta-lactamases. Highly active against gram-negative bacteria.

Uses

Gonorrhea, otitis media, lower and upper respiratory tract infections, urinary tract infections.

Unlabeled Uses

Skin and soft tissue infections.

Contraindications

Hypersensitivity to cephalosporins and other beta-lactam antibiotics.

Cautious Use

Renal impairment, history of type I hypersensitivity reactions to penicillins; coagulopathy; history of colitis or other GI disease; lactation, pregnancy (category B).

Route & Dosage

Respiratory Tract, Skin, and Soft Tissue Infections Adult: PO 200 mg q12h for 10 d Child: PO 10 mg/kg/d divided q12h Urinary Tract Infections Adult: PO 100 mg q12h Gonorrhea Adult: PO 200 mg as single dose Otitis Media Child (5 mo–12 y): PO 10 mg/kg/d divided q12–24h

Administration

Oral

• Give with food to enhance absorption.
• Give 1 h before or 2 h after an antacid.
• Consult physician regarding patients with renal impairment (i.e., creatinine clearance less than 30 mL/min); dosage intervals should be every 12 h.
• Patients on hemodialysis should be given usual dose 3 times weekly after hemodialysis.
• Preparation of suspension: To either the 50 mg/5 mL strength or the 100 mg/5 mL strength, add 25 mL of distilled water, then shake vigorously for 15 seconds. Next, to the 50 mg/5 mL strength add 33 mL, or to the 100 mg/5 mL strength add 32 mL, of distilled water, and shake for at least 3 minutes.
• Store suspension for up to 14 d in a refrigerator [2°–8° C (36°–46° F)]. Shake well before using.

Adverse Effects (≥1%)

Body as a Whole: Eye itching, cough, epistaxis, fever, decreased appetite, malaise. GI: Diarrhea, nausea, vomiting, abdominal pain, soft stools, flatulance, pseudomembranous colitis (rare). CNS: rare: Headache, asthenia, dizziness, fatigue, anxiety, insomnia, flushing, nightmares, weakness. Urogenital: Vaginal candidiasis. Skin: Urticaria, rash, scaling, peeling.

Interactions

Drug: antacids, ranitidine may decrease absorption. Food: Food may increase the absorption.

Pharmacokinetics

Absorption: 40–50% absorbed from GI tract. Onset: Therapeutic effect in 3 d. Distribution: Distributes well into inflammatory, pulmonary, and pleural fluid, and tonsils. Some distribution into prostate. 40% bound to plasma proteins. Distributed into breast milk. Elimination: 80% in urine. Half-Life: 2–3 h.

Nursing Implications

Assessment & Drug Effects

• Determine history of hypersensitivity reactions to cephalosporins and penicillins, and history of allergies, particularly to drugs, before therapy is initiated.
• Lab tests: Perform culture and sensitivity tests before initiation of therapy and periodically during therapy, if indicated. Therapy may be instituted pending test results.
• Report onset of loose stools or diarrhea. Although pseudomembranous enterocolitis (see Appendix F) rarely occurs, this potentially life-threatening complication should be ruled out as the cause of diarrhea during and after antibiotic therapy.
• Monitor for manifestations of hypersensitivity (see Appendix F). Discontinue drug and report S&S of hypersensitivity promptly.
• Monitor I&O rates and pattern: Especially important with high doses; report any significant changes.

Patient & Family Education

• Report any signs or symptoms of hypersensitivity immediately.
• Report loose stools, or diarrhea, especially if containing blood, mucus, or pus.
• Complete the full course of drug therapy even if symptoms improve.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug