Usage
Cefpodoxime Proxetil + Ofloxacin is prescribed for bacterial infections, including:
- Typhoid fever
- Respiratory tract infections (e.g., pneumonia, bronchitis, sinusitis)
- Urinary tract infections (e.g., cystitis)
- Sexually transmitted infections (e.g., gonorrhea)
- Skin and soft tissue infections
- Ear infections (e.g., otitis media)
Pharmacological Classification: Antibiotic (combination of a third-generation cephalosporin and a fluoroquinolone)
Mechanism of Action: Cefpodoxime inhibits bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs), leading to bacterial cell lysis and death. Ofloxacin inhibits bacterial DNA gyrase and topoisomerase IV, enzymes essential for bacterial DNA replication, transcription, and repair, disrupting bacterial DNA synthesis and inhibiting growth.
Alternate Names
No widely recognized alternate names exist for this combination. Brand names may vary regionally. Some examples of brand names include: Zetacef O, Linidox-O.
How It Works
Pharmacodynamics: Cefpodoxime exerts a bactericidal effect by disrupting cell wall synthesis. Ofloxacin inhibits DNA replication and transcription, leading to bacterial cell death.
Pharmacokinetics:
- Absorption: Cefpodoxime proxetil is an oral prodrug that is hydrolyzed to cefpodoxime. Absorption is enhanced when taken with food. Ofloxacin is well-absorbed orally.
- Metabolism: Cefpodoxime is not extensively metabolized. Ofloxacin undergoes some hepatic metabolism.
- Elimination: Cefpodoxime is primarily excreted unchanged in the urine. Ofloxacin is eliminated via both renal and hepatic routes.
Mode of Action: Cefpodoxime targets PBPs, leading to cell wall disruption. Ofloxacin targets DNA gyrase and topoisomerase IV.
Elimination Pathways: Cefpodoxime is primarily eliminated via renal excretion. Ofloxacin is eliminated via both renal and hepatic pathways.
Dosage
Standard Dosage
Adults:
One tablet (Cefpodoxime 200mg + Ofloxacin 200mg) twice daily. Administer with food to enhance cefpodoxime absorption.
Children:
This combination is generally not recommended for children under 18 years of age due to the risk of cartilage damage. For children older than 6 months, dosing must be determined by a doctor based on the child’s weight, age, and the type and severity of the infection. Cefpodoxime is typically dosed at 5 mg/kg every 12 hours, not exceeding 200 mg per dose.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary in elderly patients with renal impairment.
- Patients with Renal Impairment: Reduce the total daily dose based on creatinine clearance.
- Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments may be needed.
- Patients with Comorbid Conditions: Consider potential drug interactions and adjust dosage accordingly.
Clinical Use Cases
Dosage recommendations for specific clinical use cases, such as intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations, require individual patient assessment and are not standardized for this combination. Consult with a specialist for guidance.
Dosage Adjustments
Dose modification is necessary based on renal function, hepatic function, and other patient-specific factors.
Side Effects
Common Side Effects:
- Nausea
- Vomiting
- Diarrhea
- Headache
- Dizziness
- Abdominal pain
Rare but Serious Side Effects:
- Allergic reactions (e.g., rash, itching, swelling)
- Seizures
- Tendonitis or tendon rupture (associated with ofloxacin)
- QT interval prolongation (associated with ofloxacin)
- Clostridium difficile-associated diarrhea
Long-Term Effects:
Long-term use can lead to antibiotic resistance and C. difficile infection.
Adverse Drug Reactions (ADR):
Severe allergic reactions, seizures, and tendon rupture require immediate intervention.
Contraindications
- Hypersensitivity to cefpodoxime, ofloxacin, or other quinolones/cephalosporins
- Epilepsy or history of seizures
- Myasthenia gravis
- Pregnancy and breastfeeding
- Children and adolescents (due to risk of cartilage damage)
Drug Interactions
- Antacids, sucralfate, and metal cations (reduce absorption of ofloxacin)
- Probenecid (increases serum levels of cefpodoxime)
- Warfarin (ofloxacin may enhance anticoagulant effects)
- Theophylline (ofloxacin may increase theophylline levels)
- Nonsteroidal anti-inflammatory drugs (NSAIDs) (increase risk of seizures with ofloxacin)
Pregnancy and Breastfeeding
Cefpodoxime is Pregnancy Category B, and ofloxacin is Pregnancy Category C. This combination is contraindicated in pregnancy and breastfeeding due to potential risks to the fetus and infant.
Drug Profile Summary
- Mechanism of Action: Cefpodoxime: inhibits cell wall synthesis; Ofloxacin: inhibits DNA gyrase and topoisomerase IV.
- Side Effects: Nausea, vomiting, diarrhea, headache, dizziness, allergic reactions, seizures, tendonitis, QT prolongation.
- Contraindications: Hypersensitivity, epilepsy, myasthenia gravis, pregnancy, breastfeeding, children.
- Drug Interactions: Antacids, probenecid, warfarin, theophylline, NSAIDs.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Adults: 200mg/200mg twice daily with food; children: Consult a doctor.
- Monitoring Parameters: Renal function, liver function, signs of allergic reactions, tendon pain.
Popular Combinations
This combination itself is a popular combination for certain infections.
Precautions
- Assess renal and hepatic function before and during treatment.
- Monitor for signs of allergic reactions and C. difficile infection.
- Avoid alcohol consumption.
- Advise against driving or operating machinery due to potential dizziness.
- Ensure adequate hydration.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cefpodoxime Proxetil + Ofloxacin?
A: Adults: One tablet (200mg/200mg) twice daily with food. Pediatric and special population dosing should be determined by a doctor.
Q2: What are the common side effects?
A: Nausea, vomiting, diarrhea, headache, dizziness, and abdominal pain.
Q3: What are the serious side effects?
A: Allergic reactions, seizures, tendonitis, QT prolongation, and C. difficile infection.
Q4: Can this combination be used in pregnancy?
A: No, it is contraindicated in pregnancy and breastfeeding.
Q5: What are the drug interactions to be aware of?
A: Antacids, probenecid, warfarin, theophylline, and NSAIDs.
Q6: What precautions should be taken?
A: Monitor renal and hepatic function, watch for allergic reactions and C. difficile infection, avoid alcohol, and advise against driving.
Q7: How does food affect the absorption of this medication?
A: Food increases the absorption of cefpodoxime but may decrease the rate of absorption of ofloxacin. It is generally recommended to take the combination with food.
Q8: Can this drug be used in patients with renal impairment?
A: Yes, but dosage adjustment is necessary based on the degree of impairment.
Q9: What should be done if a dose is missed?
A: Take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and continue with the regular schedule. Do not double the dose.
Q10: What is the duration of treatment?
A: The duration of treatment depends on the type and severity of the infection and should be determined by a physician. It’s important to complete the full course of therapy even if symptoms improve.
