cefpodoxime-proxetil and Pneumonia

To evaluate the economic benefit associated with the early conversion of therapy from intravenous ceftiaxone to the comparable oral third-generation cephalosporin, cefpodoxime proxetil.. Open-label, unblind, nonrandomized clinical trial.. A 360-bed Veterans Affairs Medical Center.. Forty patients who began receiving intravenous ceftriaxone for either a community-acquired pneumonia or a complicated urinary tract infection.. twenty patients were selected, based on clinical assessment, to be converted from intravenous ceftriaxone to oral cefpodoxime proxetil. Twenty other comparable patients who would have been appropriate for step-down therapy, did not receive pharmacy intervention and were used as a control group.. Both groups were assessed and compared for length of ceftiaxone therapy, length of oral follow-up therapy (if any), length of hospitalization, results of culture and sensitivity testing, treatment success and readmissions, and cost of respective therapeutic regimens.. In the cefpodoxime study group, the average time receiving intravenous and oral antibiotics was 9.1 days at a total cost of $3040.26 for the 20 patients. In the control group, the average time receiving intravenous and oral antibiotics was 11.9 days at a total cost of $3961.26. A savings of $46.05 per patient was achieved. Patients receiving step-down therapy averaged 1 fewer day of hospitalization.. Pharmacist intervention and cefpodoxime step-down therapy were associated with decreased overall antibiotic costs in our intravenous-to-oral program.

Topics: Administration, Oral; Aged; Bacterial Infections; Cefpodoxime Proxetil; Ceftizoxime; Ceftriaxone; Colorado; Community-Acquired Infections; Costs and Cost Analysis; Drug Costs; Female; Hospital Bed Capacity, 300 to 499; Hospitals, Veterans; Humans; Injections, Intravenous; Male; Middle Aged; Pharmacy Service, Hospital; Pneumonia; Prodrugs; Urinary Tract Infections

The clinical usefulness of cefpodoxime proxetil (CPDX-PR) was investigated in the treatment of pneumonia and chronic airway infections occurring in patients first visiting our outpatient clinic or those being treated at the outpatient clinic. CPDX-PR was orally administered twice a day after meals at a dose of 100-200 mg for acute respiratory tract infections and at a dose of 200 mg for chronic respiratory tract infections. Excellent, good, fair, and poor responses were observed in 20, 33, 10, and 3 of 66 patients (4 with acute bronchitis, 27 with pneumonia, and 35 with acute exacerbation of chronic airway infection), respectively, demonstrating an 80.3% efficacy rate (53/66). Causative organisms, including Streptococcus pneumoniae, were all eradicated from the patients whose causative organisms were examined over time, although 2 of the patients were superinfected with Pseudomonas aeruginosa. There were no serious adverse reactions or abnormal changes in laboratory test results. It was concluded that CPDX-PR could be used as a first-choice drug for the treatment of respiratory tract infections at an outpatient clinic, and that this drug should acquire greater importance in particular consideration of recent increases in infections with S. pneumoniae.

Topics: Adult; Aged; Aged, 80 and over; Cefpodoxime Proxetil; Ceftizoxime; Chronic Disease; Female; Humans; Male; Middle Aged; Pneumococcal Infections; Pneumonia; Respiratory Tract Infections

Topics: Adolescent; Adult; Aged; Bacterial Infections; Cefaclor; Cefpodoxime Proxetil; Ceftizoxime; Cephalexin; Cephalosporins; Chemical Phenomena; Chemistry; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Multicenter Studies as Topic; Pneumonia

We diagnosed a 41-year-old female patient to be suffering from Chlamydia pneumoniae (C. pneumoniae) by using PCR and culture methods. She had a prolonged dry cough and slight fever. Her chest roentgenogram showed a segmental infiltration in the middle of the right lung field. We treated her with 400 mg of cefpodoxime proxetil (CPDX-PR) per day. On the 4th day after beginning the treatment with CPDX-PR, she still complained of a productive cough. We changed the treatment by using 300 mg of roxithromycin per day and these symptoms disappeared. To diagnose C. pneumoniae early, PCR, MIF and culture methods are very useful diagnostic tools.

Topics: Adult; Cefpodoxime Proxetil; Ceftizoxime; Chlamydia Infections; Chlamydophila pneumoniae; Female; Humans; Pneumonia; Roxithromycin

Clinical studies of cefpodoxime proxetil (CPDX-PR), a new cephem antibiotic, were carried out in 60 patients in the pediatric field. The overall efficacy rate on 54 patients with various infections was 98.1%, and few side effects, all of them very mild, were developed in 6 of 60 patients (10%). It was concluded that CPDX-PR was one of the most useful antibiotics in the pediatric field because of the high efficacy rate and the safety.

Topics: Acute Disease; Administration, Oral; Adolescent; Bacteria; Bacterial Infections; Cefpodoxime Proxetil; Ceftizoxime; Chemical Phenomena; Chemistry; Child; Child, Preschool; Drug Evaluation; Female; Humans; Infant; Male; Microbial Sensitivity Tests; Pneumonia; Tonsillitis; Urinary Tract Infections

In bacteriological, pharmacokinetic and clinical studies of cefpodoxime proxetil (CPDX-PR, CS-807), the following results were obtained: 1. Antibacteriological activity Antibacteriological activity of R-3746 (Na-salt of cefpodoxime), cefaclor (CCL), cephalexin, cefroxadine (CXD), cefazolin (CEZ), cephalothin (CET) and amoxicillin (AMPC) were studied against clinical isolated bacteria following as: Staphylococcus aureus (resistant or sensitive of methicillin), Escherichia coli (resistant or sensitive to CEZ), Klebsiella pneumoniae (resistant or sensitive to CEZ), Proteus mirabilis and Enterobacter cloacae. Antibacterial activities of CXD and CET, however, were not tested against methicillin resistant S. aureus (MRSA) or CEZ resistant E. coli and K. pneumoniae. R-3746 showed stronger activities than any of the other oral antibiotics against these strains except S. aureus against which it showed slightly less activity than AMPC. Most frequent MIC values of R-3746 to S. aureus, E. coli, K. pneumoniae and P. mirabilis were 1.56, 0.39, less than or equal to 0.10 and less than or equal to 0.10 microgram/ml, respectively. Against isolated strains of MRSA, MICs of R-3746 were higher than 25 micrograms/ml with 23 strains (77%), which were similar to MIC values of CCL and AMPC against these organisms. MIC values of R-3746 against CEZ resistant E. coli and K. pneumoniae were superior to MICs of other antibiotics, and the MIC50 value was 0.20 micrograms/ml. Against many isolated strains of E. cloacae MIC values of R-3746 were relatively high ranging 0.78 to greater than 100 micrograms/ml. MIC50 of R-3746 against E. cloacae was 12.5 micrograms/ml. 2. Absorption and excretion Serum concentration and urinary excretion of CPDX (the active form of CPDX-PR) were studied upon single oral administration of CPDX-PR at 3 mg/kg, 6 mg/kg (dry syrup) or 100 mg (tablet). The peak of serum concentration of CPDX was attained in 1-6 hours 1-4 hours and 2-6 hours after administration of CPDX-PR at the 3 different dosage levels, and they were 0.99-2.99 micrograms/ml, 4.30-7.05 micrograms/ml and 1.65-2.93 micrograms/ml, respectively. At 8 hours after administration, mean concentrations of CPDX for the 3 groups were 0.31, 0.83 and 0.66 micrograms/ml, respectively. As the average AUC's for the 3 groups were 8.16, 25.97 and 10.79 micrograms.hr/ml, respectively. Urinary recovery rates of CPDX for the 3 groups were 20.9-56.2, 28.3-49.7 and 35.1-50.4%, respectively in the first 8 hours after a

Topics: Absorption; Adolescent; Bacteria; Bacterial Infections; Cefpodoxime; Cefpodoxime Proxetil; Ceftizoxime; Cephalosporins; Chemical Phenomena; Chemistry; Child; Child, Preschool; Drug Evaluation; Drug Resistance, Microbial; Female; Humans; Infant; Male; Pneumonia; Tonsillitis