Usage
- This combination medication is prescribed for bacterial infections, including respiratory tract infections (pneumonia, bronchitis, pharyngitis, tonsillitis, sinusitis), urinary tract infections (UTIs), skin and soft tissue infections, ear infections, and some sexually transmitted diseases (STDs) like gonorrhea.
- Pharmacological Classification: Antibiotic, Probiotic.
- Mechanism of Action: Cefpodoxime and Cloxacillin are beta-lactam antibiotics that inhibit bacterial cell wall synthesis. Cefpodoxime is a third-generation cephalosporin, while Cloxacillin is a penicillinase-resistant penicillin. They bind to penicillin-binding proteins (PBPs) in the bacterial cell wall, disrupting its formation and leading to bacterial cell death. Lactobacillus, a probiotic, helps restore the gut flora, which may be disrupted by antibiotic use, potentially preventing or alleviating antibiotic-associated diarrhea.
Alternate Names
- Cefoclox, Gudcef XL, Xofex XL
- Brand Names: Cefoclox, Gudcef XL, Xofex XL.
How It Works
- Pharmacodynamics: Cefpodoxime and Cloxacillin exert bactericidal effects by disrupting bacterial cell wall synthesis. Lactobacillus helps maintain a healthy gut microbiome.
- Pharmacokinetics: Cefpodoxime proxetil is an oral prodrug that is hydrolyzed to cefpodoxime after absorption. It has good bioavailability and is distributed widely in the body. Cloxacillin is also well-absorbed orally and is mainly excreted renally. Lactobacillus colonizes the gut.
- Mode of Action: Cefpodoxime and Cloxacillin target PBPs, enzymes essential for bacterial cell wall synthesis. Inhibition of PBPs leads to cell wall instability and bacterial lysis. Lactobacillus competes with pathogenic bacteria for resources and adhesion sites in the gut.
- Elimination Pathways: Cefpodoxime is primarily excreted renally as unchanged drug. Cloxacillin is also primarily excreted renally.
Dosage
Standard Dosage
Adults:
- Cefpodoxime Proxetil 200 mg + Cloxacillin 500 mg + Lactobacillus (90 million spores) every 12 hours for 7-14 days.
Children:
- Dosage should be determined by a pediatrician based on the child’s weight and the severity of the infection. The commercially available combination products might not be suitable for children. Cefpodoxime oral suspension, if used separately, usually given every 12 hours.
Special Cases:
- Elderly Patients: Dosage adjustment may be needed in cases of renal impairment.
- Patients with Renal Impairment: Dosage adjustments may be necessary. Close monitoring of renal function is essential.
- Patients with Hepatic Dysfunction: Dosage adjustments might be needed. Close monitoring of hepatic function is crucial.
- Patients with Comorbid Conditions: Careful evaluation is required, especially with diabetes, cardiovascular disease, or other relevant conditions, potentially modifying the usual dosage.
Clinical Use Cases
The available sources do not give dosage guidelines for this combination in the following clinical cases, however, individual components may be used in these settings with appropriate dosage adjustments:
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations
Dosage Adjustments
Dosage adjustments might be necessary based on renal function, hepatic function, and patient-specific factors. Consult specialized resources for specific guidelines.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Headache
- Indigestion
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling, shortness of breath)
- Clostridium difficile infection
- Seizures (rare)
Long-Term Effects
Data on long-term effects are limited, but chronic complications from prolonged use are possible.
Adverse Drug Reactions (ADR)
- Severe allergic reactions (anaphylaxis)
- Pseudomembranous colitis
Contraindications
- Hypersensitivity to cephalosporins, penicillins, or Lactobacillus.
- History of severe allergic reactions to beta-lactam antibiotics.
Drug Interactions
- Probenecid may decrease the renal excretion of Cefpodoxime.
- Antacids may reduce the absorption of Cefpodoxime.
- Oral contraceptives’ efficacy may be reduced by Cloxacillin.
- Anticoagulants may increase the risk of bleeding when combined with Cloxacillin.
- Alcohol may increase the risk of adverse effects.
Pregnancy and Breastfeeding
- Pregnancy: Consult a physician before use. Safety has not been established.
- Breastfeeding: Consult a physician before use. Excretion in breast milk is not well-established.
Drug Profile Summary
- Mechanism of Action: Inhibition of bacterial cell wall synthesis (Cefpodoxime, Cloxacillin), restoration of gut flora (Lactobacillus).
- Side Effects: Nausea, vomiting, diarrhea, abdominal pain, headache, allergic reactions.
- Contraindications: Hypersensitivity to components, history of severe allergy to beta-lactams.
- Drug Interactions: Probenecid, antacids, oral contraceptives, anticoagulants, alcohol.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: Adults: 200 mg Cefpodoxime + 500 mg Cloxacillin + 90 million spores Lactobacillus every 12 hours; pediatric and renal/hepatic adjustments needed.
- Monitoring Parameters: Renal and liver function, complete blood count, signs of superinfection.
Popular Combinations
This medication is itself a combination product. While individual components are often combined with other drugs (e.g., Cefpodoxime with Clavulanate), the triple combination isn’t routinely combined with other medications.
Precautions
- Assess for allergies to cephalosporins, penicillins, or any component of the formulation.
- Monitor renal and hepatic function, especially in patients with pre-existing dysfunction.
- Pregnant Women: Evaluate risks and benefits carefully.
- Breastfeeding Mothers: Assess for potential risks to the neonate.
- Children & Elderly: Age-specific dosing and monitoring required.
- Lifestyle Considerations: Avoid alcohol during treatment. Driving restrictions may be needed if drowsiness or dizziness occurs.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefpodoxime Proxetil + Cloxacillin + Lactobacillus?
A: The usual adult dose is 200 mg Cefpodoxime Proxetil + 500 mg Cloxacillin + 90 million spores of Lactobacillus every 12 hours for 7-14 days. Pediatric dosages should be determined by a pediatrician.
Q2: What infections can this combination treat?
A: This combination targets a range of bacterial infections, including respiratory tract infections, skin infections, UTIs, and some STDs.
Q3: Is this a fixed-dose combination approved by regulatory authorities?
A: No, this particular combination is not a standard FDA-approved fixed-dose combination. Its use would be considered off-label.
Q4: What are the most common side effects?
A: Common side effects include gastrointestinal issues such as nausea, vomiting, and diarrhea.
Q5: Are there any serious side effects?
A: Although rare, severe allergic reactions and Clostridium difficile infections can occur.
Q6: Can this medication be used during pregnancy or breastfeeding?
A: Safety during pregnancy and breastfeeding hasn’t been definitively established. Consult a physician for risk-benefit assessment.
Q7: How should this medication be taken?
A: The tablet form should be swallowed whole with water, preferably with food.
Q8: Are there any dietary restrictions while taking this medicine?
A: It is advised to avoid alcohol during the treatment course.
Q9: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember, unless it’s almost time for the next dose. Do not double the dose.
Q10: How should this medicine be stored?
A: Store at room temperature, away from moisture and direct sunlight.
