cefpodoxime
Brand: Vantin
Prototype: ceftriaxone
Drug Class: third-generation cephalosporin
Drug Family: antibiotic
Subclass: oral third-generation cephalosporin (prodrug)
Organ Systems: infectious-disease
Mechanism of Action
A prodrug ester hydrolyzed to active cefpodoxime in the intestinal wall; inhibits bacterial cell wall synthesis. Offers good oral bioavailability and expanded gram-negative spectrum.
penicillin-binding proteins (PBPs)
Indications
- community-acquired pneumonia
- sinusitis
- otitis media
- uncomplicated UTI
- uncomplicated gonorrhea
- pharyngitis/tonsillitis
Contraindications
- cephalosporin hypersensitivity
Adverse Effects
Common
- diarrhea
- nausea
- headache
- vaginal fungal infection
Serious
- anaphylaxis
- C. difficile colitis
- prolonged prothrombin time
Pharmacokinetics (ADME)
| Absorption | 50% bioavailability as prodrug; food increases absorption by 21–33% |
| Distribution | widely distributed; moderate tissue penetration |
| Metabolism | prodrug hydrolyzed to active form in intestinal wall; minimal further metabolism |
| Excretion | renal (29–33% unchanged) |
| Half-life | 2.1–2.8 hours |
| Onset | rapid |
| Peak | 2–3 hours |
| Duration | 12 hours |
| Protein Binding | 18–23% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| antacids/H2 blockers | reduce prodrug activation by raising gastric pH | moderate |
| probenecid | reduces renal excretion | minor |
Nursing Considerations
- Administer with food to improve bioavailability; counsel patients not to take with antacids or H2 blockers simultaneously.
- Monitor for signs of superinfection, particularly vaginal candidiasis in female patients.
- Reduce dose in renal impairment (CrCl <30 mL/min).
- Advise patients to complete the full course even if symptoms resolve.
Clinical Pearls
- Cefpodoxime is one of few oral cephalosporins with reliable activity against gonorrhea and is used for outpatient gonorrhea treatment.
- As a prodrug, its bioavailability depends on adequate gastric acidity for ester hydrolysis; raising gastric pH impairs activation.
Safety Profile
Pregnancy generally-safe
Lactation use-with-caution
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
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