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Therapeutics Snapshot: Cefpodoxime

Therapeutics Snapshot: Cefpodoxime

Jennifer Schissler Pendergraft, DVM, MS, DACVD, Colorado State University

Pharmacology & Medications

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November 2014
|
Peer Reviewed

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Cefpodoxime proxetil is an oral third-generation cephalosporin approved for treatment of skin infections in dogs.

Clinical Applications

The bactericidal spectrum for cefpodoxime proxetil involves both gram-positive cocci and gram-negative bacilli.

  • Spectrum for gram-positive cocci includes methicillin-susceptible Staphylococcus spp and group G β-hemolytic Streptococcus canis.1
  • Spectrum for gram-negative bacilli includes Proteus mirabilis, Pasteurella multocida, and Escherichia coli.1

In dogs, cefpodoxime treatment is most commonly prescribed for regional or generalized Staphylococcus pseudintermedius bacterial folliculitis.

  • Staphylococcal pyoderma is most commonly observed in patients with cutaneous hypersensitivity disorders.

Given the gram-negative spectrum of cefpodoxime, its use as a first-tier antimicrobial for cutaneous staphylococcal infections is controversial.

  • Individual and population selection for antimicrobial-resistant flora may occur, particularly extended-spectrum β-lactamase–resistant E coli.2
  • In the author’s opinion, administration of cefpodoxime should be limited to cases that require less frequent dosing to ensure compliance or in patients with mixed infections that require the extended gram-negative spectrum of cefpodoxime.

The bactericidal spectrum for cefpodoxime treatment of skin infections in dogs ranges from gram-positive cocci to gram-negative bacilli.

Protocol & Side Effects

Cefpodoxime is dosed at 5–10 mg/kg PO q24h.1

  • Once-daily dosing promotes client compliance.
    • Can administer with food to ease patient dosing
  • Treatment for 1 week beyond clinical resolution, along with adjunct topical antimicrobial therapy, is recommended for patients with staphylococcal bacterial folliculitis.2,3

The most commonly observed side effects—vomiting and diarrhea—reportedly occur in less than 5% of patients.4

  • β-lactams have been implicated in canine cutaneous drug eruptions5 that may occur up to 2 weeks after treatment initiation.
    • The true prevalence of cutaneous adverse drug reactions in dogs (and cats) is presently unknown for any antibiotic, as it is likely that these drug eruptions are underreported.6

Precautionary Measures

Conducting bacterial culture and sensitivity testing is recommended before cefpodoxime administration to patients that

  • Failed to respond to empiric antimicrobial therapy
  • Have an extensive antimicrobial history
  • Had a previous multidrug-resistant infection
  • Cohabitate with an individual (human, animal) that has a confirmed multidrug-resistant infection
  • Have a clinical diagnosis of deep pyoderma

In consideration of the worldwide presence of canine methicillin-resistant staphylococci, a recheck examination must be performed in all patients before discontinuation of cefpodoxime.

  • Lack of improvement or development of new cutaneous lesions during cefpodoxime therapy should prompt examination and consideration for the presence of resistant infection or cutaneous drug eruption.

References and Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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