Dose range The dose range of Cefpodoxime Proxetil Tablets is 5-10 mg/kg (2.3-4.5 mg/lb) body weight, administered orally, once a day. The dose may be given with or without food. The determination of dosage for any particular patient must take into consideration such factors as the severity and nature of the infection, the susceptibility of the causative organisms, and the integrity of the patient's host-defense me...
Federal law restricts this drug to use by or on the order of a licensed veterinarian.
DESCRIPTION
DESCRIPTION SECTION
Cefpodoxime proxetil is an orally administered, extended spectrum, semi-synthetic cephalosporin antibiotic. The chemical name is: (+/-)-1-Hydroxyethyl(+)-(6R,7R)-7-[2-(2-amino-4-thiazolyl) glyoxylamido]-3-methoxymethyl)-8-oxo-5-thia-1-azabicyclo[4.2.0]oct-2-ene-2-carboxylate, 72-(Z)- (O-methyloxime), isopropyl carbonate (ester) [87239-81-4].
Cefpodoxime proxetil Chemical Structure:
structure
Cefpodoxime proxetil is a prodrug; its active metabolite is cefpodoxime. All doses of Cefpodoxime Proxetil Tablets are expressed in terms of the active cefpodoxime moiety. Cefpodoxime Proxetil Tablets are available as:
100 mg Tablet, each red-colored, oval-shaped, film-coated, scored tablet contains cefpodoxime proxetil equivalent to 100 mg of cefpodoxime.
200 mg Tablet, each orange-colored, oblong-shaped, film-coated, scored tablet contains cefpodoxime proxetil equivalent to 200 mg of cefpodoxime.
INDICATION
INDICATIONS & USAGE SECTION
Cefpodoxime Proxetil Tablets are indicated for the treatment of skin infections (wounds and abscesses) in dogs caused by susceptible strains of Staphylococcus pseudintermedius, Staphylococcus aureus, Streptococcus canis (group G, ß hemolytic), Escherichia coli, Pasteurella multocida, and Proteus mirabilis.
DOSAGE AND ADMINISTRATION
DOSAGE & ADMINISTRATION SECTION
Dose range
The dose range of Cefpodoxime Proxetil Tablets is 5-10 mg/kg (2.3-4.5 mg/lb) body weight, administered orally, once a day. The dose may be given with or without food. The determination of dosage for any particular patient must take into consideration such factors as the severity and nature of the infection, the susceptibility of the causative organisms, and the integrity of the patient's host-defense mechanisms. Obtain a sample of the pathogenic organism for culture and sensitivity testing prior to beginning antimicrobial therapy. Once results become available, continue with appropriate therapy.
Duration
Cefpodoxime Proxetil Tablets should be administered once daily for 5-7 days or for 2-3 days beyond the cessation of clinical signs, up to a maximum of 28 days. Treatment of acute infections should not be continued for more than 3-4 days if no response to therapy is seen.
Dosing Charts
For daily oral administration of Cefpodoxime Proxetil Tablets at 5 mg/kg (Table 1) and 10 mg/kg (Table 2).
Table 1. Dose Table for Cefpodoxime Proxetil Tablets at 5 mg/kg Total Daily Dosage
Weight of Dog (lbs)
Daily Dose
22
44
66
88
132
No. of 100 mg tablets
0.5
1
1.5
1
No. of 200 mg tablets
1
1
Weight of Dog (kgs)
Daily Dose
10
20
30
40
60
No. of 100 mg tablets
0.5
1
1.5
1
No. of 200 mg tablets
1
1
Table 2. Dose Table for Cefpodoxime Proxetil Tablets at 10 mg/kg Total Daily Dosage
Weight of Dog (lbs)
Daily Dose
11
22
44
66
88
132
No. of 100 mg tablets
0.5
1
1
No. of 200 mg tablets
1
1
2
3
Weight of Dog (kgs)
Daily Dose
5
10
20
30
40
60
No. of 100 mg tablets
0.5
1
1
No. of 200 mg tablets
1
1
2
3
CONTRAINDICATIONS
CONTRAINDICATIONS SECTION
Cefpodoxime proxetil is contraindicated in dogs with known allergy to cefpodoxime or to the ß-lactam (penicillins and cephalosporins) group of antibiotics.
WARNINGS
WARNINGS SECTION
Not for human use. Keep this and all drugs out of reach of children. Antimicrobial drugs, including penicillins and cephalosporins, can cause allergic reactions in sensitized individuals. To minimize the possibility of allergic reactions, those handling such antimicrobials, including cefpodoxime, are advised to avoid direct contact of the product with the skin and mucous membranes.
PRECAUTIONS
PRECAUTIONS SECTION
The safety of cefpodoxime proxetil in dogs used for breeding, pregnant dogs, or lactating bitches has not been demonstrated. As with other cephalosporins, cefpodoxime proxetil may occasionally induce a positive direct Coombs' test.
ADVERSE REACTIONS
ADVERSE REACTIONS SECTION
A total of 216 dogs of various breeds and ages ranging from 2 months to 15 years were included in the field study safety analysis. The following table shows the number of dogs displaying each clinical observation.
Table 3. Abnormal Health Findings in the U.S. Field Study*
Clinical Observation
cefpodoxime proxetil tablets (n=118)
Active Control (n=98)
Vomiting
2
4
Diarrhea
1
1
Increased water drinking
0
2
Decreased appetite
1
1
*Dogs may have experienced more than one of the observations during the study.
CONTACT INFORMATION
SPL UNCLASSIFIED SECTION
To report suspected adverse drug events, for technical assistance or to obtain a copy of the Safety Data Sheet, contact Covetrus® North America at (855) 724-3461 or covetrus.com.
For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888- FDA-VETS or www.fda.gov/reportanimalae
CLINICAL PHARMACOLOGY
CLINICAL PHARMACOLOGY SECTION
Pharmacokinetics/Pharmacodynamics
Cefpodoxime proxetil is a prodrug that is absorbed from and de-esterified in the gastrointestinal tract to its active metabolite, cefpodoxime. Following oral administration to fasting Beagles, oral bioavailability was 63.1 ± 5.3%.
Figure 1. Canine Plasma Concentration of Cefpodoxime After a Single Oral Dose of 10 mg/kg cefpodoxime proxetil tablets
graph
Cefpodoxime is distributed in the body with an apparent volume of distribution of 151 ± 27 mL/kg. Like other β-lactam antibiotics, cefpodoxime is eliminated from the body primarily in the urine, with an apparent elimination half-life of approximately 5-6 hours after oral administration. This is similar to the 4.7 hour apparent elimination half-life observed after intravenous dosing. Following intravenous administration of 10 mg/kg, the average total body clearance (CIB) was 22.7 ± 4.19 mL/hr/kg.
Table 4. Summary of Pharmacokinetic Parameters Obtained after a Single Oral Dose of 10 mg Cefpodoxime/kg BW, Administered as a Tablet
PK Parameter
Unit
Tablet (SD)
AUC0-∞
mcg•hr/mL
145 (77.6)
AUC0-LOQ
mcg•hr/mL
142 (77.5)
Maximum concentration (Cmax)
mcg/mL
16.4 (11.8)
Terminal plasma elimination half-life (t1/2,Z)
hr
5.61 (1.15)
Time of maximum concentration (tmax)
hr
2.21 (0.542)
Mean residence time (MRT0-∞)
hr
9.21 (1.97)
Microbiology
Like other β-lactam antibiotics, cefpodoxime exerts its inhibitory effect by interfering with bacterial cell wall synthesis. This interference is primarily due to its covalently binding to the penicillin-binding proteins (PBPs) (i.e. transpeptidase and/or carboxypeptidase), which are essential for synthesis of the bacterial cell wall. Therefore, cefpodoxime is bactericidal. Cefpodoxime is stable in the presence of many common β-lactamase enzymes. As a result, many organisms resistant to other β-lactam antibiotics (penicillins and some cephalosporins) due to the production of β-lactamases may be susceptible to cefpodoxime.
Cefpodoxime has a broad spectrum of clinically useful antibacterial activity that includes staphylococci, streptococci, and Gram-negative species (including Pasteurella, Escherichia, and Proteus). The compound is not active against most obligate anaerobes, Pseudomonas spp., or enterococci. The minimum inhibitory concentrations (MICs) for cefpodoxime against Gram-positive and Gram-negative pathogens isolated from canine skin infections (wounds and abscesses) in a 2002 U.S. field study are presented in Table 5. All MICs were determined in accordance with the National Committee for Clinical Laboratory Standards (NCCLS). Appropriate quality control (QC) ranges for in vitro susceptibility testing are presented in Table 6.
Table 5. Cefpodoxime Minimum Inhibitory Concentration Values (mcg/mL) from a 2002 Field Study Evaluating Skin Infections (wounds and abscesses) of Canines in the United States.
Organism*
# of Isolates
MIC50
MIC90
Range
Staphylococcus pseudintermedius
118
0.12
0.50
0.12->32.0
Streptococcus canis (group G, β hemolytic)
33
≤0.03
≤0.03
≤0.03†
Escherichia coli
41
0.25
0.50
0.12->32.0
Pasteurella multocida
32
≤0.03
≤0.03
≤0.03-0.12
Proteus mirabilis
14
≤0.03
0.06
≤0.03-0.06
Staphylococcus aureus
19
2.0
2.0
0.12-2.0
* Veterinary specific interpretive criteria have not been established for the above listed canine pathogens by the NCCLS at this time.
† No Range, all isolates yielded the same value.
Table 6. Acceptable Quality Control Ranges for Cefpodoxime
QC ATCC strain
KB Disk Diffusion Method
Broth Micro-dilution Method
Drug concentration
Zone diameter
MIC
Escherichia coli 25922
10 mcg
23-28 mm*
0.25-1 mcg/mL*
Staphylococcus aureus 25923
10 mcg
19-25 mm*
Staphylococcus aureus 29213
1-8 mcg/mL*
Streptococcus pneumoniae 49619
10 mcg
28-34 mm†
0.03-0.12 mcg/mL†
*These ranges are for quality control strains used to monitor accuracy of minimum inhibitory concentrations (MICs) of non-fastidious organisms using cation-adjusted Mueller-Hinton agar or broth medium. The dilution range should encompass the QC ranges of these strains in the broth micro-dilution method.
†These ranges are for quality control strains used to monitor accuracy of minimum inhibitory concentrations (MICs) of fastidious organisms. When susceptibility testing is performed for Streptococcus canis (group G, β hemolytic), Streptococcus pneumoniae ATCC 49619 should be included as a QC strain in the presence of 5% lysed sheep blood (KB disk diffusion method) or 2.5% lysed horse blood (broth micro-dilution method).
EFFECTIVENESS
SPL UNCLASSIFIED SECTION
The clinical effectiveness of cefpodoxime proxetil tablets was established in a multi-location (23 site) field study. In this study, 216 dogs with infected wounds or abscesses were treated with either cefpodoxime proxetil tablets (n=118) once daily at 5 mg/kg (2.3 mg/lb) body weight or with an active control antibiotic (n=98) administered twice daily for 5-7 days. In this study, cefpodoxime proxetil tablets were considered noninferior to the active control (88.7% versus 88.4% respectively) in the treatment of canine skin infections (wounds and abscesses) caused by susceptible strains of Staphylococcus pseudintermedius, Staphylococcus aureus, Streptococcus canis (group G, β hemolytic), Escherichia coli, Pasteurella multocida, and Proteus mirabilis.
ANIMAL SAFETY
SPL UNCLASSIFIED SECTION
In target animal safety studies, cefpodoxime was well tolerated at exaggerated daily oral doses of 100 mg/kg/day (10 times the maximum label dose) for 13 weeks in adult dogs and for 28 days in puppies (18-23 days of age). Therefore, once daily administration of cefpodoxime oral tablets at the maximum labeled dose of 10 mg/kg for up to 28 days was shown to be safe in adult dogs and puppies.
Blood dyscrasia including neutropenias, may be seen following high doses of cephalosporins. Cephalosporin administration should be discontinued in such cases.
STORAGE INFORMATION
SPL UNCLASSIFIED SECTION
Store at 20° to 25°C (68° to 77°F); excursions permitted between 15° and 30°C (between 59° and 86°F) [see USP Controlled Room Temperature]. Dispense in tight, light-resistant container. Replace cap securely after each opening.
HOW SUPPLIED
HOW SUPPLIED SECTION
Cefpodoxime Proxetil Tablets are available in the following strengths (cefpodoxime equivalent), colors, and sizes:
100 mg (Red-colored, oval-shaped, film-coated tablet, debossed with "F" & "3" on either side of score line on one side of tablets and "1" & "00" on either side of score line on other side of the tablet.)
Bottles of 100
NDC 11695-7040-2
Bottles of 250
NDC 11695-7040-1
200 mg (Orange-colored, oblong-shaped, film-coated tablet, debossed with "F" & "3" on either side of score line on one side of tablets and "2" & "00" on either side of score line on other side of the tablet.)
Bottles of 100
NDC 11695-7041-2
Bottles of 250
NDC 11695-7041-1
SPL UNCLASSIFIED SECTION
Approved by FDA under ANADA # 200-815
Questions? (855) 724-3461
Distributed by: Covetrus® North America 400 Metro Place North Dublin, OH 43017 covetrus.com
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