Cefpodoxime
Beta-lactams
Beta-lactams
Oral third-generation cephalosporin, given as a prodrug (proxetil), for otitis, pharyngitis, sinusitis, mild pneumonia and lower urinary infection.
Also called: cefpodoxime proxetil
Quick facts
- Group
- Beta-lactams
- Target
- Penicillin-binding proteins (bacterial transpeptidases)
- Used for
- Acute otitis media · Streptococcal pharyngitis
- Key effects
- Diarrhoea · Vaginal yeast infection · Abdominal pain
- Monitor
- Signs of allergy with the first doses
- ATC
- J01DD13
No doses: the clinician sets them by the current guideline.
Mechanism of action
No structure of cefpodoxime bound to a PBP is published; the figure shows cefotaxime, a third-generation cephalosporin with the same aminothiazole-methoxyimino side chain, acylating Streptococcus pneumoniae PBP1b.
Cefpodoxime proxetil is a prodrug: esterases in the gut wall remove the ester and release active cefpodoxime. It acylates the PBPs, blocks peptidoglycan cross-linking and is bactericidal. It covers penicillin-susceptible pneumococci and streptococci, H. influenzae, Moraxella catarrhalis, methicillin-susceptible S. aureus and some Enterobacterales.
- Absorbed as an ester (proxetil) in the gut
- Esterases release active cefpodoxime
- Acylates the PBPs and halts wall synthesis
- The bacterium lyses (bactericidal)
Indications
- Acute otitis media Acute otitis media →
- Streptococcal pharyngitis and tonsillitis Streptococcal pharyngitis →
- Mild to moderate community-acquired pneumonia and flares of chronic bronchitis Community-acquired pneumonia →
- Acute maxillary sinusitis Acute rhinosinusitis →
- Uncomplicated cystitis Urinary tract infection (acute cystitis) →
- Uncomplicated gonorrhoea (urethral, cervical, and anorectal in women) Gonorrhoea →
- Uncomplicated skin and soft-tissue infections
Adverse effects
Common
- Diarrhoea (the most common) and nausea
- Vaginal yeast infection and vulvovaginitis
- Abdominal pain
- Headache
Contraindications
- Allergy to cefpodoxime or other cephalosporins
Key interactions
- High-dose antacids and H2 blockers
- Reduce cefpodoxime absorption.
- Probenecid
- Reduces its renal excretion and raises its levels.
- Nephrotoxic drugs
- Kidney function is watched closely.
What is monitored
- Signs of allergy with the first doses
- Diarrhoea during and after treatment
- Kidney function in kidney failure or with nephrotoxic drugs
Administration and safety
- Tablets are given with food; the suspension with or without food
- Separate from antacids and H2 blockers
- The suspension is shaken and measured with an oral syringe
Pregnancy and breastfeeding
Animal studies showed no harm, but there are no adequate studies in pregnant women; it is used only when clearly needed.
Nursing care
- Ask about penicillin and cephalosporin allergy
- Teach to finish the course even when symptoms improve
- Ask the patient to report watery or bloody diarrhoea
- Urine glucose is checked with enzymatic strips, not copper-reduction tests
Pharmacokinetics
- Absorption
- Oral; about half of the dose is absorbed. Tablets are absorbed better with food; antacids and H2 blockers reduce absorption.
- Elimination
- Renal, unchanged; prolonged in kidney failure.
- Half-life
- About 2 to 3 hours with normal kidney function.
Test yourself
Think of the answer, then tap the question to see it.
Why is oral cefpodoxime called «proxetil»?
It is an ester prodrug; gut esterases hydrolyse it and release active cefpodoxime.
Which commonly used drugs reduce cefpodoxime absorption?
High-dose antacids and H2 blockers, because the prodrug is absorbed less well with lower stomach acidity.
Which generation is cefpodoxime, and which outpatient infections does it treat?
Oral third generation; it treats otitis media, pharyngitis, sinusitis, mild pneumonia, cystitis and uncomplicated skin infections.
Connections
← Back to the class: Beta-lactams
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - CEFPODOXIME PROXETIL tablet, film coated (DailyMed (U.S. National Library of Medicine), 2026); Cefpodoxime: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ACTIVE SITE RESTRUCTURING REGULATES LIGAND RECOGNITION IN CLASS A PENICILLIN-BINDING PROTEINS (RCSB Protein Data Bank, 2026).
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Representative model, for educational purposes only.