CEPOM-200

Indications

• Respiratory tract infections
• Urinary tract infections
• Skin and soft tissue infections
• Otitis media

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing recommendations.

Adults: Refer to the BNF for specific dosing guidelines.

Mechanism of action

Cefpodoxime exerts its bactericidal effect by inhibiting cell wall synthesis. The active metabolite binds preferentially to penicillin-binding protein 3, which leads to the inhibition of peptidoglycan production, the main component of bacterial cell walls. This mechanism is particularly effective against various Gram-positive and Gram-negative bacteria, enhancing its therapeutic utility in treating infections.

Pharmacodynamics

Cefpodoxime demonstrates effectiveness against most Gram-positive and Gram-negative bacteria, with notable exceptions including Pseudomonas aeruginosa, Enterococcus, and Bacteroides fragilis. Its ability to remain stable in the presence of beta-lactamase enzymes allows it to target bacteria that are otherwise resistant to beta-lactam antibiotics.

Pharmacokinetics

Cefpodoxime is well absorbed after oral administration, with its bioavailability enhanced by the presence of food. It is distributed widely in body tissues and fluids, with a significant volume of distribution. Cefpodoxime is primarily eliminated via renal excretion, with a half-life sufficient for twice-daily dosing in most cases. The active metabolite contributes to the antimicrobial activity and is also eliminated through renal pathways.

Adverse effects

• Diarrhea
• Nausea
• Vomiting
• Rash
• Allergic reactions
• Elevated liver enzymes

Precautions

• Use with caution in patients with renal impairment
• Monitor for signs of superinfection
• Assess for history of penicillin allergy

Pregnancy

Cefpodoxime is classified as pregnancy category B. Animal studies have not demonstrated a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if clearly needed.

Breast-feeding

Cefpodoxime is excreted in breast milk. Caution is advised when administering to nursing mothers, as adverse effects on the infant are possible.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Tablets
• Oral suspension

Indications

• Community-acquired pneumonia
• Acute bacterial sinusitis
• Acute exacerbation of chronic bronchitis
• Skin and soft tissue infections
• Urinary tract infections
• Otitis media

Dosage

Children: Refer to the BNF for Children for appropriate dosing information based on the child's age and weight.

Adults: Refer to the BNF for specific dosing guidelines as individual patient factors such as age, weight, and renal function affect dosing.

Mechanism of action

Cepodoxime works by inhibiting bacterial cell wall synthesis. It binds to penicillin-binding proteins (PBPs) located inside the bacterial cell wall, disrupting the cross-linking of peptidoglycan layers. This leads to cell lysis and death, effectively treating the infection by eliminating the bacteria.

Pharmacodynamics

Cepodoxime exhibits time-dependent antibacterial activity, meaning that the duration of time the drug concentration remains above the minimum inhibitory concentration (MIC) is crucial for its effectiveness. It is primarily bactericidal, showing greater efficacy against actively dividing bacteria. The spectrum of activity includes Streptococcus pneumoniae, Escherichia coli, and Haemophilus influenzae.

Pharmacokinetics

After oral administration, cepodoxime is well absorbed from the gastrointestinal tract, with peak plasma concentrations reached within 2 to 3 hours. It is approximately 50% protein-bound and has a half-life of about 2 hours. The drug is primarily excreted unchanged in the urine, making renal function an important consideration in dosing adjustments.

Contra-indications

• Hypersensitivity to cepodoxime or any component of the formulation
• History of severe allergic reactions to cephalosporins or penicillins

Adverse effects

• Diarrhea
• Nausea
• Vomiting
• Rash
• Allergic reactions
• Elevated liver enzymes
• Nephrotoxicity in rare cases

Interactions

• Probenecid may increase the serum levels of cepodoxime
• Anticoagulants may have an altered effect when used concurrently
• Other nephrotoxic drugs may increase the risk of renal impairment

Precautions

• Use with caution in patients with renal impairment
• Monitor for signs of superinfection with prolonged use
• Evaluate for potential cross-reactivity in patients with a history of penicillin allergy

Pregnancy

Category B. Animal reproduction studies have not demonstrated a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women.

Breast-feeding

Cephalosporins are excreted in breast milk, but generally considered safe. Monitor infant for possible effects.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Oral tablets
• Suspension for oral administration

Indications

• Major depressive disorder
• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Panic disorder
• Post-traumatic stress disorder

Dosage

Children: Refer to the BNF for Children for appropriate dosing recommendations, as pediatric dosing may differ significantly from adult dosing.

Adults: Refer to the specific prescribing information for dosing guidance as it may vary based on individual patient factors and clinical judgment.

Mechanism of action

Proxetil functions as a selective serotonin reuptake inhibitor (SSRI), which means it inhibits the reuptake of serotonin (5-HT) in the presynaptic neuron. By blocking the serotonin transporter (SERT), it increases the availability of serotonin in the synaptic cleft, enhancing serotonergic neurotransmission. This mechanism is believed to contribute to its antidepressant effects.

Pharmacodynamics

The pharmacodynamics of proxetil involve the modulation of serotonin levels in the central nervous system. The increase in serotonin availability leads to improved mood, reduction in anxiety, and overall enhancement of emotional well-being. The onset of therapeutic effects may take several weeks, and the drug is generally well tolerated, with common side effects including gastrointestinal disturbances and changes in sexual function.

Pharmacokinetics

Proxetil is absorbed rapidly after oral administration, with peak plasma concentrations occurring within several hours. It undergoes extensive first-pass metabolism, primarily in the liver, which affects its bioavailability. The drug is metabolized by cytochrome P450 enzymes, and its elimination half-life is generally around 24 hours, allowing for once-daily dosing. It is excreted mainly in urine, with a small amount excreted as unchanged drug.

Contra-indications

• Hypersensitivity to proxetil or any of its components
• Severe hepatic impairment
• Concurrent use with monoamine oxidase inhibitors (MAOIs)

Adverse effects

• Nausea
• Diarrhea
• Dizziness
• Somnolence
• Dry mouth
• Insomnia
• Sexual dysfunction

Interactions

• Caution when used with other central nervous system depressants
• May increase the effects of anticoagulants
• Potential interaction with other serotonergic drugs, increasing the risk of serotonin syndrome

Precautions

• Use with caution in patients with a history of seizures
• Monitor for worsening of depression or emergence of suicidal thoughts
• Consider potential for withdrawal symptoms upon discontinuation

Pregnancy

Proxetil should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult clinical guidelines for further information.

Breast-feeding

Proxetil is excreted in breast milk. Caution is advised when administering to nursing mothers.

Storage

Store at room temperature, away from moisture and direct sunlight. Keep out of reach of children.

Formulations

• Oral tablets
• Oral solution

Mechanism of action

Cefpodoxime is active against a wide spectrum of Gram-positive and Gram-negative bacteria. Cefpodoxime is stable in the presence of beta-lactamase enzymes. As a result, many organisms resistant to penicillins and cephalosporins, due to their production of beta-lactamase, may be susceptible to cefpodoxime. Cefpodoxime is inactivated by certain extended spectrum beta-lactamases. The bactericidal activity of cefpodoxime results from its inhibition of cell wall synthesis. The active metabolite of cefpodoxime binds preferentially to penicillin binding protein 3, which inhibits production of peptidoglycan, the primary constituent of bacterial cell walls.

Pharmacodynamics

Cefpodoxime is shown to be effective against most Gram positive and Gram negative bacteria, except <i>Pseudomonas aeruginosa</i>, <i>Enterococcus</i>, and <i>Bacteroides fragilis</i>.