Usage
- This combination medication is prescribed for bacterial infections of the respiratory tract (bronchitis, pneumonia), skin and soft tissue, urinary tract, ear, throat (tonsillitis, pharyngitis), sinuses (sinusitis), and sexually transmitted infections like gonorrhea.
- Pharmacological classification: Antibiotic, Probiotic. It combines two beta-lactam antibiotics (a cephalosporin and a penicillin) with a probiotic.
- Mechanism of Action: Cefpodoxime and Dicloxacillin inhibit bacterial cell wall synthesis, leading to bacterial cell death. Cefpodoxime is a third-generation cephalosporin that targets penicillin-binding proteins, while Dicloxacillin, a penicillinase-resistant penicillin, targets transpeptidases. Lactobacillus, a probiotic, helps maintain or restore the balance of gut flora, which can be disrupted by the antibiotics.
Alternate Names
- No widely recognized alternate names exist for this specific combination.
- Brand Names: Cefoclox XL, Ceedoric DX (Cefpodoxime + Dicloxacillin only).
How It Works
- Pharmacodynamics: Cefpodoxime and Dicloxacillin exert bactericidal effects by disrupting bacterial cell wall formation. Lactobacillus helps repopulate the gut with beneficial bacteria, minimizing antibiotic-associated diarrhea.
- Pharmacokinetics: Cefpodoxime proxetil is an ester prodrug hydrolyzed to cefpodoxime after oral administration. Absorption is improved with food. Dicloxacillin is acid-stable and well-absorbed orally, but food may slightly reduce its bioavailability. Both antibiotics are eliminated via renal and hepatic pathways. Lactobacillus, being a live organism, colonizes the gut.
- Mode of Action: Both antibiotics target the final transpeptidation step of peptidoglycan synthesis, a crucial component of bacterial cell walls. This leads to cell wall instability and lysis.
- Receptor Binding/Enzyme Inhibition: Cefpodoxime binds to penicillin-binding proteins (PBPs), while dicloxacillin binds to and inhibits transpeptidases, both of which are essential for bacterial cell wall synthesis.
- Elimination Pathways: Cefpodoxime is primarily excreted unchanged in urine. Dicloxacillin is partially metabolized in the liver and excreted in both urine and bile.
Dosage
Standard Dosage
Adults:
- Cefpodoxime: 200 mg every 12 hours.
- Dicloxacillin: 500 mg every 6 hours.
- Lactobacillus: As per the specific product formulation (e.g., Cefoclox XL contains 90 million spores).
Children:
- Consult a pediatrician. Dosage is dependent on weight and age. Dicloxacillin (alone): <40 kg: 3.125 to 6.25 mg/kg every 6 hours; >40 kg: 125 to 250 mg every 6 hours. Cefpodoxime (alone): For ear infections (2 months to 12 years): 5 mg/kg every 12 hours.
Special Cases:
- Elderly Patients: Dose adjustment may be necessary based on renal function.
- Patients with Renal Impairment: Dose adjustment of Cefpodoxime is needed for creatinine clearance <30 mL/min. No adjustment is typically needed for Dicloxacillin.
- Patients with Hepatic Dysfunction: Caution and potential dose adjustments are needed, especially for dicloxacillin.
- Patients with Comorbid Conditions: Careful monitoring is necessary for patients with gastrointestinal issues (e.g., colitis).
Clinical Use Cases Dosage is determined by the specific infection and patient characteristics. These recommendations are for the individual components, and adjustment may be needed for combination products.
- Intubation/Surgical Procedures/Mechanical Ventilation/ICU Use/Emergency Situations: No specific dosage modifications exist for these clinical scenarios; standard or adjusted doses are based on the infection being treated.
Dosage Adjustments
Adjustments are necessary for renal or hepatic impairment.
Side Effects
Common Side Effects
- Nausea, vomiting, diarrhea, abdominal pain, indigestion, flatulence, headache, rash, vaginal itching.
Rare but Serious Side Effects
- Allergic reactions (rash, itching, swelling, shortness of breath, anaphylaxis), seizures, Clostridium difficile-associated diarrhea.
Long-Term Effects
- Potential for antibiotic resistance with prolonged or inappropriate use.
Adverse Drug Reactions (ADR)
- Stevens-Johnson Syndrome (rare), pseudomembranous colitis, hepatotoxicity (rare).
Contraindications
- Hypersensitivity to cefpodoxime, dicloxacillin, any cephalosporin, penicillin, or any component of the formulation.
- History of severe allergic reaction (e.g., anaphylaxis) to beta-lactam antibiotics.
Drug Interactions
- Antacids: May reduce the absorption of cefpodoxime.
- Anticoagulants (e.g., warfarin): Dicloxacillin may enhance anticoagulant effects.
- Probenecid: May increase serum cefpodoxime concentrations.
- Oral Contraceptives: Dicloxacillin may reduce their effectiveness.
- Other antibiotics (e.g., penicillin, tetracyclines), proton pump inhibitors (e.g., omeprazole), aminoglycosides (e.g., gentamicin), vitamin K antagonists (e.g., warfarin), furosemide, and azithromycin.
- Alcohol may potentiate drowsiness.
Pregnancy and Breastfeeding
Consult a physician. Safety during pregnancy and breastfeeding is not fully established. Dicloxacillin may reduce the effectiveness of birth control pills.
Drug Profile Summary
Refer to earlier sections for details.
Precautions
- Assess for allergies.
- Evaluate renal and hepatic function.
- Monitor for signs of superinfection.
- Caution with patients with bleeding disorders or gastrointestinal diseases.
- Pregnant and breastfeeding women should consult a doctor.
- Avoid alcohol while driving.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefpodoxime Proxetil + Dicloxacillin + Lactobacillus?
A: Adult dosage is typically Cefpodoxime 200 mg every 12 hours, Dicloxacillin 500 mg every 6 hours, and Lactobacillus as per the specific product formulation. Pediatric and special population dosing requires adjustments.
Q2: What infections does this combination treat?
A: Respiratory tract infections, skin infections, urinary tract infections, ear infections, throat infections, sinusitis, and gonorrhea.
Q3: What are the common side effects?
A: Nausea, vomiting, diarrhea, and rash.
Q4: Are there any serious side effects?
A: Yes, although rare, serious side effects include allergic reactions (including anaphylaxis) and Clostridium difficile infection.
Q5: Can this combination be used in pregnancy?
A: Consult a physician. The safety during pregnancy and breastfeeding is not well established.
Q6: Does it interact with other medications?
A: Yes, clinically significant interactions can occur with antacids, anticoagulants, probenecid, oral contraceptives, and several other medications.
Q7: What precautions should I take when prescribing this combination?
A: Evaluate patients for allergies to cephalosporins and penicillins, assess renal and hepatic function, and monitor for signs of superinfection.
Q8: Should I stop taking it if I feel better?
A: No. Completing the full course of antibiotics, even if symptoms improve, is important to prevent recurrence and resistance development.
Q9: What should I do if my symptoms don’t improve?
A: Inform your doctor if symptoms don’t improve or worsen after completing the prescribed course.
