Usage
Cefpodoxime proxetil + clavulanic acid is prescribed for a range of bacterial infections, including:
- Pharyngitis/tonsillitis (throat infections)
- Otitis media (ear infections)
- Sinusitis (sinus infections)
- Community-acquired pneumonia
- Gonorrhea (sexually transmitted disease)
- Anorectal infections in women
- Skin and soft tissue infections
- Urinary tract infections (UTIs)
- Bronchitis
Pharmacological Classification: Antibiotic (Combination of a third-generation cephalosporin and a beta-lactamase inhibitor)
Mechanism of Action: Cefpodoxime inhibits bacterial cell wall synthesis, leading to bacterial cell death. Clavulanic acid inhibits beta-lactamase enzymes produced by bacteria, which would otherwise inactivate cefpodoxime, thereby extending cefpodoxime’s effectiveness against a wider range of bacteria.
Alternate Names
While “cefpodoxime proxetil + clavulanic acid” is the standard generic name, regional variations may exist.
Brand Names: A few examples of brand names include:
- Altipod CV
- Clavuran
- Combocef
- Cedobact CV
- Cepcure CV
- Duo-5
- Jandox-CV
- LiquaCef C (veterinary)
- Podaxef
- Texef Plus
- Trioclav
- Vantin
- Xtabac
How It Works
Pharmacodynamics: Cefpodoxime, a third-generation cephalosporin, exerts bactericidal action by binding to penicillin-binding proteins (PBPs) located inside the bacterial cell wall. This binding disrupts the final stage of bacterial cell wall synthesis, leading to cell lysis and bacterial death. Clavulanic acid, a beta-lactamase inhibitor, protects cefpodoxime from degradation by bacterial beta-lactamase enzymes, thus broadening its antibacterial spectrum.
Pharmacokinetics: Cefpodoxime proxetil, a prodrug, is administered orally and is well-absorbed from the gastrointestinal tract. It’s then de-esterified to the active metabolite, cefpodoxime. The presence of food enhances the bioavailability of cefpodoxime proxetil. Cefpodoxime achieves therapeutic concentrations in various tissues and fluids, including lungs, middle ear fluid, and urine. Cefpodoxime is partially metabolized in the liver and primarily excreted by the kidneys. Clavulanic acid is also well-absorbed orally and exhibits similar pharmacokinetic properties, with renal excretion as the primary elimination route.
Receptor Binding/Enzyme Inhibition: Cefpodoxime binds to PBPs, and clavulanic acid inhibits beta-lactamase enzymes.
Elimination Pathways: Primarily renal excretion for both components.
Dosage
Standard Dosage
Adults: 200 mg every 12 hours. The maximum daily dose is generally 800 mg.
Children: Dosage is weight-based. The usual recommendation is 5 mg/kg of body weight every 12 hours. The maximum daily dose is generally 400 mg. For some infections (pharyngitis, tonsillitis), 200 mg/day may be sufficient. For children younger than 2 months, use and dose must be determined by a doctor. For children less than 8 years old, alternative formulations may be more appropriate.
Special Cases:
- Elderly Patients: Dose adjustment may be necessary in elderly patients with renal impairment.
- Patients with Renal Impairment: Dose reduction is required based on the degree of impairment.
- Patients with Hepatic Dysfunction: Close monitoring is necessary, though dose adjustment is not typically required for cefpodoxime. However, clavulanic acid use should be avoided or cautiously monitored in patients with hepatic impairment, especially those with a history of cholestatic jaundice/hepatitis associated with clavulanate use.
- Patients with Comorbid Conditions: Consider individual patient factors and potential drug interactions when determining the appropriate dosage in patients with comorbidities like diabetes or cardiovascular disease.
Clinical Use Cases
Dosing for conditions such as Intubation, Surgical Procedures, Mechanical Ventilation, Intensive Care Unit (ICU) Use, Emergency Situations would require adjustments based on specific patient conditions and the type and severity of the infection being targeted. Consult infectious disease specialists for guidance. Generally, doses used in these settings would fall within the range of the standard adult doses.
Dosage Adjustments
Adjustments are essential in renal/hepatic impairment and for certain other conditions, including interactions with other medications the patient is taking. Consult dosing guidelines and/or clinical pharmacists when adjusting dosages.
Side Effects
Common Side Effects
- Diarrhea
- Abdominal pain
- Nausea
- Vomiting
- Headache
- Skin rash
Rare but Serious Side Effects
- Clostridium difficile-associated diarrhea (CDAD)
- Allergic reactions (including anaphylaxis)
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Hepatitis
- Cholestatic Jaundice (especially with prior clavulanate associated jaundice/hepatitis)
- Seizures (rare)
Long-Term Effects: With prolonged use, some patients may experience antibiotic-associated colitis or changes in gut microbiota.
Contraindications
- Hypersensitivity to cefpodoxime, clavulanic acid, other cephalosporins, or any component of the formulation
- History of severe allergic reactions to penicillins (due to cross-reactivity)
- Prior clavulanate associated cholestatic jaundice or hepatitis
Drug Interactions
- Anticoagulants (e.g., warfarin): Cefpodoxime may enhance the anticoagulant effect.
- Probenecid: Increases cefpodoxime serum concentrations.
- Nephrotoxic drugs: Monitor renal function closely when used concurrently.
- Oral contraceptives: Efficacy may be reduced.
Pregnancy and Breastfeeding
- Pregnancy: Cefpodoxime is generally considered safe during pregnancy (Pregnancy Category B). However, its use should be reserved for cases where the benefits outweigh the risks. There is no evidence of teratogenicity.
- Breastfeeding: Cefpodoxime is excreted in breast milk in low amounts. While it’s generally considered compatible with breastfeeding, observe the infant for potential adverse effects (e.g., diarrhea, diaper rash). Discuss with the patient to assess if discontinuation of breastfeeding or temporary discontinuation of the drug is warranted.
Drug Profile Summary
- Mechanism of Action: Cefpodoxime inhibits bacterial cell wall synthesis. Clavulanic acid extends the antibacterial spectrum.
- Side Effects: Common: Diarrhea, abdominal pain, nausea, vomiting, headache, skin rash. Serious: CDAD, allergic reactions, Stevens-Johnson syndrome.
- Contraindications: Hypersensitivity to cephalosporins or penicillins, prior clavulanate induced jaundice/hepatitis.
- Drug Interactions: Anticoagulants, probenecid, nephrotoxic drugs.
- Pregnancy & Breastfeeding: Generally safe but weigh the benefits against risks. Monitor for adverse effects in breastfeeding infants.
- Dosage: Adults: 200 mg every 12 hours (up to 800 mg/day). Children: 5 mg/kg every 12 hours (up to 400 mg/day).
- Monitoring Parameters: Renal function (especially in patients with pre-existing renal disease or receiving nephrotoxic drugs), liver function tests (especially in patients with history of liver disease).
Popular Combinations
While not a “combination” drug per se in these cases, cefpodoxime is sometimes used in sequence or in conjunction with other antibiotics depending on the specific infectious organism identified.
Precautions
- General Precautions: Assess for allergies, renal/hepatic function, drug interactions, and history of antibiotic-associated colitis.
- Pregnant Women: Use cautiously if potential benefits outweigh risks.
- Breastfeeding Mothers: Monitor infants for side effects like diarrhea or diaper rash.
- Children & Elderly: Dosage adjustments might be required.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefpodoxime Proxetil + Clavulanic Acid?
A: Adults: 200 mg every 12 hours (up to 800 mg/day). Children: 5 mg/kg every 12 hours (up to 400 mg/day). Special populations: Dose adjustments may be needed. Consult dosing recommendations.
Q2: What infections does this drug treat?
A: Various bacterial infections, including respiratory tract infections (e.g., bronchitis, pneumonia, sinusitis), urinary tract infections, skin infections, otitis media, and some sexually transmitted infections.
Q3: How should this medication be taken?
A: Orally, with or without food. It’s essential to take it at regular intervals and complete the full course of therapy even if symptoms improve.
Q4: What are the common side effects?
A: Diarrhea, nausea, vomiting, abdominal pain, and headache are commonly reported.
Q5: Are there any serious side effects?
A: Rare but serious side effects may include Clostridium difficile-associated diarrhea (CDAD) and allergic reactions.
Q6: Can I take this medication if I am allergic to penicillin?
A: Caution is advised. Cross-reactivity between penicillins and cephalosporins exists. Inform your physician about any penicillin allergies. If a severe reaction has occurred in the past with a penicillin, avoid cefpodoxime.
Q7: Can this drug be used in pregnant or breastfeeding women?
A: Consult with a physician. It’s generally considered safe but must be used cautiously, weighing the benefits against the potential risks.
Q8: What should I do if I miss a dose?
A: Take the missed dose as soon as remembered. However, if it’s close to the time for your next dose, skip the missed dose and return to your regular dosing schedule. Do not double the dose.
Q9: What if I am also taking other medications?
A: Inform your physician about all other medications, including over-the-counter drugs and supplements. Certain medications can interact with cefpodoxime.
Q10: How long does the treatment typically last?
A: The treatment duration depends on the type and severity of infection. Usually it is between 5 and 14 days. Follow the prescribed duration even if symptoms improve earlier.
