Cefpodoxime

J01D - Other beta-lactam antibacterials ATC J01DD13 Small molecule Natural product

🧬 Cross-allergy: Cephalosporins

JFDA label: Cefodox tab

Mechanism of Action

Inhibitor of Bacterial penicillin-binding protein — Bacterial penicillin-binding protein inhibitor

Target	Action	Gene / class
Bacterial penicillin-binding protein efficacy	INHIBITOR

Indications

Approved

Acute, uncomplicated anorectal infections in women
Acute, uncomplicated urethral and cervical
Chronic bronchitis, acute bacterial exacerbation
Cystitis, acute uncomplicated
Gonorrhea
Otitis media, acute
Pharyngitis or tonsillitis
Pneumonia, community-acquired
Sinusitis, acute maxillary
Skin and skin structure infections, uncomplicated

Antimicrobial Spectrum

Expected / intrinsic spectrum (EUCAST breakpoints & labels) — not local resistance. Source: EUCAST v16 · openfda-label.

Bacteria

Organism	Activity	MIC
Citrobacter diversus	Active	—
Enterobacterales	Susceptible	1.0 mg/L
Escherichia coli	Active	—
Haemophilus influenzae	Susceptible	0.25 mg/L
Haemophilus parainfluenzae	Active	—
Klebsiella oxytoca	Active	—
Klebsiella pneumoniae	Active	—
Moraxella catarrhalis	Active	—
Neisseria gonorrhoeae	Active	—
Peptostreptococcus magnus	Active	—
Proteus mirabilis	Active	—
Proteus vulgaris	Active	—
Providencia rettgeri	Active	—
Staphylococcus aureus	Active	—
Staphylococcus saprophyticus	Active	—
Streptococcus agalactiae	Active	—
Streptococcus pneumoniae	Susceptible	0.25 mg/L
Streptococcus pyogenes	Active	—

Class profile

gramStatus	Both
spectrumBreadth	Broad
atypicalCoverage	No
isBactericidal	1
moaCategory	Cell wall synthesis inhibitor (beta-lactam, 3rd generation cephalosporin, oral)
pdIndex	Time-dependent
postAntibioticEffect	None
mrsaCoverage	0
resistanceMechanisms	ESBL production,AmpC beta-lactamase

Contraindications

Source: Lexicomp

Hypersensitivity to cefpodoxime, any component of the formulation, or other cephalosporins Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Nervous system disorders (1)

Common Headache

Renal and urinary disorders (1)

Common Vaginal infection

Gastrointestinal disorders (4)

Very Common Diarrhea

Common abdominal pain · nausea · vomiting

Skin and subcutaneous tissue disorders (2)

Very Common Diaper rash

Common Skin rash

Dosing

Source: Lexicomp

Bronchitis (chronic), bacterial exacerbation: Oral: 200 mg every 12 hours for 10 days Cystitis, acute uncomplicated (alternative agent): Oral: 100 mg twice daily for 5 to 7 days (Hooton 2018) Pharyngitis/tonsillitis: Oral: 100 mg every 12 hours for 5 to 10 days Pneumonia, community acquired: Oral: 200 mg every 12 hours for 14 days. Note: For outpatient empiric therapy in adults, IDSA guidelines recommend use in combination with a macrolide (preferred) or doxycycline and a shortened duration of treatment (ie, minimum of 5 days [patient should be afebrile for ≥48 hours and clinically stable before discontinuation of therapy]) (Mandell 2007). Rhinosinusitis, acute maxillary: Oral: 200 mg every 12 hours for 10 days Skin and skin structure: Oral: 400 mg every 12 hours for 7 to 14 days

(For additional information see "Cefpodoxime: Pediatric drug information") Usual dosage range: Infants ≥2 months of age and Children Children ≥12 years of age and Adolescents: Oral: 100 to 400 mg every 12 hours. Indication-specific dosing: Bronchitis (chronic), bacterial exacerbation: Children ≥12 years of age and Adolescents: Oral: Refer to adult dosing. Cystitis, acute uncomplicated : Children ≥12 years of age and Adolescents: Oral: Refer to adult dosing. Otitis media, acute: Infants ≥2 months of age and Children Note: AAP guidelines recommend duration based on patient age: If Pharyngitis/tonsillitis: Infants ≥2 months and Children Children ≥12 years of age and Adolescents: Oral: Refer to adult dosing. Pneumonia, community acquired: Children ≥12 years of age and Adolescents: Oral: Refer to adult dosing. Rhinosinusitis, acute maxillary: Infants ≥2 months of age and Children Note: IDSA recommends use in combination with clindamycin for 10 to 14 days in patients with non-type 1 penicillin allergy, after failure of initial therapy or in patients at risk for antibiotic resistance (eg, daycare attendance, age Children ≥12 years of age and Adolescents: Oral: Refer to adult dosing. Skin and skin structure: Children ≥12 years of age and Adolescents: Oral: Refer to adult dosing.

Refer to adult dosing.

CrCl ≥30 mL/minute: No dosage adjustment necessary. CrCl Hemodialysis: Dose 3 times/week following dialysis.

Cirrhosis (with or without ascites): No dosage adjustment necessary.

Warnings & Precautions

Source: Lexicomp

Beta-lactam allergy

Use with caution in patients with a history of beta-lactam allergy, especially IgE-mediated reactions (eg, anaphylaxis, angioedema, urticaria).

Superinfection

Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment. Disease-related concerns:

Renal impairment

Use with caution in patients with renal impairment; modify dosage in severe impairment. Concurrent drug therapy issues:

Drug-drug interactions

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Dosage form specific issues:

Benzyl alcohol and derivatives

Some dosage forms may contain sodium benzoate/benzoic acid; benzoic acid (benzoate) is a metabolite of benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol derivative with caution in neonates. See manufacturer’s labeling.

Pregnancy & Lactation

Pregnancy

FDA category B Teratogenic

Teratogenic events were not observed in animal reproduction studies. An increase in most types of birth defects was not found following first trimester exposure to cephalosporins.

Lactation

Cefpodoxime is excreted in breast milk. The manufacturer recommends discontinuing nursing or discontinuing the medication in breast-feeding women. Nondose-related effects could include modification of bowel flora.

Monitoring

Efficacy	Culture and susceptibility testing; clinical resolution (temperature, WBC, CRP, procalcitonin)
Toxicity	Renal function (dose adjustment in renal impairment); hepatic function for hepatically cleared agents; signs of C. difficile infection (diarrhoea)
Clinical pearl	Culture results guide de-escalation to narrower-spectrum therapy. Review antibiotic appropriateness at 48–72 h (antimicrobial stewardship).
Counseling	Complete the full course. Report persistent diarrhoea, rash, or lack of improvement after 48–72 h.

Chemistry & Properties

Formula	C15H17N5O6S2
Molecular weight	427.46 g/mol
IUPAC name	(6R,7R)-7-[[(2Z)-2-(2-amino-1,3-thiazol-4-yl)-2-methoxyiminoacetyl]amino]-3-(methoxymethyl)-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylic acid
CAS	80210-62-4
PubChem CID	6335986
InChIKey	`WYUSVOMTXWRGEK-HBWVYFAYSA-N`
logP	-0.54 (XLogP -1.4)
Polar surface area	156.44 Å²
H-bond acceptors / donors	10 / 3
Drug-likeness (QED)	0.30
Lipinski violations	0

SMILES

COCC1=C(C(=O)O)N2C(=O)[C@@H](NC(=O)/C(=N\OC)c3csc(N)n3)[C@H]2SC1

Biology & Pharmacokinetics

Pharmacokinetics

BBB penetrant	No

Enzyme interactions

Enzyme	Role	Detail
CYP2B6	Inhibitor	—
CYP2C8	Inhibitor	—
CYP2C9	Substrate	—
CYP2D6	Substrate	—

Transporters

BCRP (Inhibitor)BSEP (Inhibitor)MRP1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)P-gp (Inhibitor)PEPT1 (Inhibitor)PEPT2 (Inhibitor)P-gp (Substrate)PEPT1 (Substrate)

Drug–drug interactions (33, DDInter)

Interacting drug	Severity	Management
Aluminum hydroxide	moderate
Amikacin	moderate
Amikacin (liposome)	moderate
Balsalazide	moderate
Calcium carbonate	moderate
Chloramphenicol	moderate
Cimetidine	moderate
Dexlansoprazole	moderate
Dicoumarol	moderate
Esomeprazole	moderate
Ethinylestradiol	moderate
Famotidine	moderate
Gentamicin	moderate
Kanamycin	moderate
Lansoprazole	moderate
Magaldrate	moderate
Magnesium carbonate	moderate
Magnesium hydroxide	moderate
Magnesium oxide	moderate
Mycophenolic acid	moderate
Neomycin	moderate
Nizatidine	moderate
Omeprazole	moderate
Pantoprazole	moderate
Pemetrexed	moderate
Picosulfuric acid	moderate
Rabeprazole	moderate
Ranitidine	moderate
Ranitidine (bismuth citrate)	moderate
Sodium bicarbonate	moderate
Sodium citrate	moderate
Streptomycin	moderate
Warfarin	moderate

Registered Products (20)

Brand	Form / strength	Pack	Agent	Citizen (JOD)
Cefpo-50mg/5ml suspension	Suspension 50 mg/5 ml	100 ml	Noor Drug Store	5.960
Cefodox susp.	Suspension 50 mg/5 ml	50 ml	Pharma International Company/ Jordan	6.000
Cefpo 100 Tablets	Tablet 100 mg	10 tab pack varies	Noor Drug Store	6.730
CEFPO-100MG/5ML SUSPENSION	Suspension 100 mg/5 ml	100 ml	Noor Drug Store	8.390
Cefodox sus	Suspension 100 mg/5 ml	50 ml pack varies	Pharma International Company/ Jordan	8.570
Podecif	Tablet 100 mg	10 tab	THE JORDANIAN PHARMACEUTICAL MANUFACTURING COMPANY/JORDAN	8.820
Auropodox 100	Tablet 100 mg	10 tab	AL Rahma Drug Store	9.200
Cefodox tab	Tablet 100 mg	10 tab	Pharma International Company/ Jordan	9.200
Cefpo 100 Tablets	Tablet 100 mg	14 tab pack varies	Noor Drug Store	9.940
Cefodox	Suspension 40 mg/5 ml	100 ml	Pharma International Company/ Jordan	11.040
Cefpo 200 Tablets	Tablet 200 mg	10 tab pack varies	Noor Drug Store	11.060
Podecif	Tablet 200 mg	10 tab	THE JORDANIAN PHARMACEUTICAL MANUFACTURING COMPANY/JORDAN	12.600
Auropodox 200	Tablet 200 mg	10 tab	AL Rahma Drug Store	12.900
Cefodox tab	Tablet 200 mg	10 tab pack varies	Pharma International Company/ Jordan	13.200
Metoxim	Tablet 200 mg	10 tab	Nabulsi Drug Store	13.250
Cefodox sus	Suspension 100 mg/5 ml	100 ml pack varies	Pharma International Company/ Jordan	16.280
Cefodox tab	Tablet 200 mg	14 tab pack varies	Pharma International Company/ Jordan	18.480
Cefpo 200 Tablets	Tablet 200 mg	14 tab pack varies	Noor Drug Store	19.490
Cefodox tab	Tablet 200 mg	20 tab pack varies	Pharma International Company/ Jordan	25.080
Cefodox tab	Tablet 200 mg	500 tab pack varies	Pharma International Company/ Jordan	561.000