Cefpodoxime proxetil is an orally administered
prodrug which is converted in vivo to the
third generation cephalosporin cefpodoxime.
Cefpodoxime has a similar spectrum of antibacterial activity to the parenteral
cephalosporins ceftriaxone and
cefotaxime and a long elimination half-life, which allows once- or twice-daily administration.
Cefpodoxime proxetil has proven efficacy in the treatment of community-acquired
pneumonia and upper respiratory tract, skin and soft tissue and
urinary tract infections. It has been evaluated for use in cost-containment programmes, as stepdown (parenteral-to-oral conversion)
therapy in the treatment of community-acquired
pneumonia and as abbreviated
therapy in
upper respiratory tract infections. Substituting oral for parenteral
therapy can achieve considerable savings (in acquisition, delivery and labour costs). Moreover,
oral administration has advantages for the patient in terms of comfort and mobility, avoids the hazards of parenteral delivery and may allow earlier discharge from hospital, or even allow home treatment from the outset in low-risk patients. As hospitalisation is usually the major cost component in treating serious
infections, considerable savings can be made in this way. Pharmacy-driven stepdown programmes in 2 US hospitals have achieved cost savings by targeting patients with community-acquired
pneumonia for early conversion from intravenous
ceftriaxone therapy to oral
cefpodoxime proxetil. Costs were compared with those from a control group of patients who continued to receive intravenous
ceftriaxone until physicians deemed that oral
therapy (with various agents) was appropriate. In one study, duration of parenteral
therapy in the
cefpodoxime proxetil group was reduced from 6.18 to 3.82 days and duration of hospitalisation was reduced from 10.06 to 6.23 days (p < 0.02), with corresponding hospitalisation cost reductions of $US7300 per patient. However, clinical trial data relating to the efficacy of
cefpodoxime proxetil as stepdown
therapy in patients initially requiring parenteral antibacterials are lacking. Abbreviated (4-to 7-day)
cephalosporin regimens appear to be as effective as traditional 10-day
penicillin regimens in the treatment of
upper respiratory tract infections. Short regimens may improve patient compliance and tolerability, thereby reducing the costs of adverse effects and treatment failures. Data from preliminary clinical studies suggest that a 5-day course of
cefpodoxime proxetil is as effective as an 8-day course of
amoxicillin/clavulanic acid in treating either acute
otitis media or
sinusitis, and as effective as a 10-day course of
amoxicillin/ clavulanic acid and more effective than a 10-day course of
phenoxymethyl- penicillin in the treatment of pharyngotonsillitis.
Cefpodoxime proxetil tended to be better tolerated and was associated with better compliance than
penicillin-based regimens. Indeed, a pharmacoeconomic study showed that a 10-day regimen of
cefpodoxime proxetil was associated with lower costs for treating adverse effects and treatment failures than a 10-day regimen of
amoxicillin/clavulanic acid in the treatment of acute
otitis media in children. A 5-day course of
cefpodoxime proxetil had a lower cost per patient treated per month free of recurrence than a 10-day course of
phenoxymethylpenicillin (non-generic) or
amoxicillin/clavulanic acid in the treatment of recurrent pharyngotonsillitis. Thus, evidence to date suggests that
cefpodoxime proxetil has potential for use as stepdown
therapy in community-acquired
pneumonia and in abbreviated
therapy courses in
upper respiratory tract infections. These preliminary observations require confirmation in well designed studies.