Cefditoren  (PDF Version)

Antibiotic Class:

Third-Generation Cephalosporin

Antimicrobial Spectrum:

Staphylococcus aureus (methicillin susceptible), Coagulase negative Staphylococci, Streptococcus pneumoniae (penicillin susceptible), Streptococcus spp., Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitides, Neisseria gonorrhoeae, Enterobacteriaceae, E. coli

Mechanism of Action:

Cephalosporins exert bactericidal activity by interfering with bacterial cell wall synthesis and inhibiting cross-linking of the peptidoglycan. The cephalosporins are also thought to play a role in the activation of bacterical cell autolysins which may contribute to bacterial cell lysis.

Pharmacodynamics:

Cephalosporins exhibit time-dependent killing (T > MIC)

Pharmacokinetics:

Dose of 200mg: Cmax: 3.4 mcg/L; Tmax: 2.0 hour; Half-life: 1.1 hours; Table 10

Adverse Effects:

Hypersensitivity: Maculopapular rash, Urticaria, Pruritis, Anaphylaxis/angioedema, eosinophilia

Hematologic: Hypoprothrombinemia, Neutropenia, Leukopenia, Thrombocytopenia

GI: Diarrhea, C. difficile disease

Renal: Interstitial nephritis

Table 14 

Dosage:

PO: 200mg tablets

Dosing in adults:

Acute exacerbation of chronic bronchitis: 400 mg PO q12h x 10 days

Pharyngitis: 200mg PO q12h x 10 days  

Community acquired pneumonia: 400 mg PO q12h x 14 days

Tonsillitis: 200mg PO q12h x 10 days

Dosing in pediatrics:

Not recommended

Disease state based dosing:

Renal failure:  CrCl 30-49 mL/min:  200 mg q12h

                        CrCl < 30 mL/min: 200 mg q24h

Hepatic failure:  No dosing changes recommended at this time.

Contraindications/Warnings/Precautions:

Contraindications: Carnitine deficiency or inborn errors of metabolism that may result in significant carnitine deficiency, Milk protein hypersensitivity

Precautions: hypersensitivity to penicillins, history of gastrointestinal disease, particularly colitis, renal impairment

Drug Interactions:

Antacids: decreased cefditoren effectiveness

Cimetidine: decrease cefditoren serum concentrations

Famotidine: decrease cefditoren serum concentrations

Live Typhoid Vaccine: decreased immunological response to the typhoid vaccine

Nizatidine: decrease cefditoren serum concentrations

Probenecid: increased cefditoren serum concentrations and bioavailabity

Ranitidine: decrease cefditoren serum concentrations

Pregnancy:

Category B: No evidence of risk in humans but studies inadequate.

Monitoring Requirements:

Therapeutic: Culture and sensitivities, serum levels, signs and symptoms of infection, white blood cell count

Toxic: Urinalysis, BUN, SCr, AST and ALT, skin rash, Neutropenia and leukopenia, Prothrombin time in patients with renal or hepatic impairment or poor nutritional state, as well as patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy.

Brand names/Manufacturer: 

SpectracefÒ/Purdue