Usage
This combination medication is prescribed for various bacterial infections, including respiratory tract infections (sinusitis, bronchitis, pneumonia), skin and soft tissue infections, urinary tract infections, and acute otitis media (middle ear infection). Saccharomyces boulardii is included to prevent or treat antibiotic-associated diarrhea.
Pharmacological Classification:
- Azithromycin: Macrolide antibiotic
- Cefpodoxime Proxetil: Cephalosporin antibiotic
- Saccharomyces boulardii: Probiotic yeast
Mechanism of Action:
- Azithromycin: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit.
- Cefpodoxime: Interferes with bacterial cell wall synthesis by binding to penicillin-binding proteins.
- Saccharomyces boulardii: Restores the balance of gut flora, which can be disrupted by antibiotic use.
Alternate Names
How It Works
Pharmacodynamics:
- Azithromycin: Bacteriostatic (inhibits bacterial growth) at lower concentrations; bactericidal (kills bacteria) at higher concentrations for some susceptible bacteria.
- Cefpodoxime: Bactericidal against a wide range of gram-positive and gram-negative bacteria.
- Saccharomyces boulardii: Produces metabolites that inhibit the growth of certain pathogenic bacteria and yeasts, such as Clostridium difficile. It also enhances intestinal barrier function and modulates immune responses.
Pharmacokinetics:
- Azithromycin: Well-absorbed orally, long half-life (68 hours), distributes widely into tissues. Metabolized in the liver and excreted primarily in bile.
- Cefpodoxime Proxetil: Converted to the active cefpodoxime after absorption. Excreted primarily by the kidneys.
- Saccharomyces boulardii: Not absorbed systemically; acts locally in the gut and is eliminated in the stool.
Dosage
Standard Dosage
Adults: One tablet twice daily for 5-7 days. The exact dose and duration depend on the specific infection being treated.
Children: Pediatric dosage is based on the child’s weight and the specific infection. Consult a pediatrician for appropriate dosing guidelines and safety considerations.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary due to age-related decline in renal and hepatic function.
- Patients with Renal Impairment: Dose modifications are necessary depending on the degree of impairment (creatinine clearance or glomerular filtration rate).
- Patients with Hepatic Dysfunction: Dose reduction may be necessary for patients with moderate to severe liver disease, especially for azithromycin. Cefpodoxime dosage adjustments are not typically necessary.
Clinical Use Cases
This combination is generally not specifically indicated for use in settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations. Dosages for acute infections are as listed above.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Stomach pain
- Headache
- Dizziness
- Indigestion
- Loss of appetite
- Flatulence
Rare but Serious Side Effects
- Severe allergic reactions (anaphylaxis, angioedema)
- Clostridium difficile-associated diarrhea (pseudomembranous colitis)
- Hepatotoxicity (liver damage), especially with azithromycin
- QT interval prolongation (a heart rhythm problem) with azithromycin
Contraindications
- Hypersensitivity to azithromycin, cefpodoxime, other macrolides, cephalosporins, or any component of the formulation.
- History of cholestatic jaundice or hepatic dysfunction associated with prior azithromycin use.
Drug Interactions
- Antacids (containing aluminum or magnesium): Can reduce the absorption of both azithromycin and cefpodoxime. Take antacids at least 2 hours before or after these antibiotics.
- Warfarin and other anticoagulants: Azithromycin can increase the effects of warfarin, leading to an increased risk of bleeding. Monitor the international normalized ratio (INR) closely.
- Digoxin: Azithromycin can increase digoxin levels. Monitor digoxin levels.
Pregnancy and Breastfeeding
Azithromycin is generally considered safe during pregnancy. Cefpodoxime’s safety profile during pregnancy is less well-established. Consult a physician before use during pregnancy. It is advisable to use only if the potential benefits outweigh the risks.
For breastfeeding, both medications are excreted in breast milk in small amounts. Azithromycin is considered compatible with breastfeeding, but cefpodoxime should be used with caution. Monitor the infant for any adverse effects.
Drug Profile Summary
- Mechanism of Action: Azithromycin inhibits bacterial protein synthesis. Cefpodoxime inhibits bacterial cell wall synthesis. Saccharomyces boulardii restores gut flora.
- Side Effects: Nausea, vomiting, diarrhea, stomach pain, headache, dizziness; rarely, severe allergic reactions, C. difficile infection.
- Contraindications: Hypersensitivity; history of cholestatic jaundice/hepatic dysfunction with azithromycin.
- Drug Interactions: Antacids, warfarin, digoxin.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: Adults: Typically, one tablet twice daily for 5-7 days. Pediatric and special populations: Dosage adjustments needed.
- Monitoring Parameters: Liver function tests, renal function tests, complete blood count (CBC), electrolyte levels.
Popular Combinations
This specific combination is not commonly used with other drugs.
Precautions
- General Precautions: Evaluate for allergies, assess liver and kidney function before administration.
- Pregnant Women: Consult a physician before use.
- Breastfeeding Mothers: Consult a physician before use. Monitor the infant for side effects.
- Children & Elderly: Dose adjustments may be necessary.
- Lifestyle Considerations: Limit alcohol intake during therapy.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Azithromycin + Cefpodoxime Proxetil + Saccharomyces boulardii?
A: The typical adult dose is one tablet twice daily for 5-7 days. Pediatric and special populations require individualized dosing.
Q2: What are the common side effects?
A: Common side effects include nausea, vomiting, diarrhea, stomach pain, headache, and dizziness.
Q3: What are the serious side effects?
A: Serious side effects, though rare, can include severe allergic reactions, C. difficile infection, liver damage (with azithromycin), and QT prolongation (with azithromycin).
Q4: Are there any contraindications to using this medication?
A: Yes. Contraindications include hypersensitivity to any of the components and a history of cholestatic jaundice/hepatic dysfunction with azithromycin use.
Q5: Can this medication be used during pregnancy and breastfeeding?
A: Azithromycin is generally safe during pregnancy. Cefpodoxime has a less-established safety profile; consult a physician before using it. During breastfeeding, use with caution and monitor the infant for side effects.
Q6: What are the potential drug interactions?
A: Drug interactions can occur with antacids, warfarin, digoxin and alcohol.
Q7: How does Saccharomyces boulardii help in this combination?
A: Saccharomyces boulardii is a probiotic that helps prevent or treat antibiotic-associated diarrhea by restoring the balance of gut flora.
Q8: What should I monitor in patients taking this medication?
A: Monitor liver and renal function, complete blood count, and electrolyte levels, especially with prolonged use. Monitor for signs of allergic reactions.
Q9: What precautions should I take when prescribing this medication?
A: Assess for allergies and existing liver or kidney problems. Adjust dosage accordingly for children, elderly, and patients with organ dysfunction. Advise patients to limit alcohol. Monitor INR if co-prescribed with warfarin.
