Cefpodoxime is an oral, third-generation cephalosporin antibiotic. It is active against most Gram-positive and Gram-negative organisms. Notable exceptions include Pseudomonas aeruginosa, Enterococcus, and Bacteroides fragilis. It is commonly used to treat acute otitis media, pharyngitis, sinusitis, and gonorrhea. It also finds use as oral continuation therapy when intravenous cephalosporins (such as ceftriaxone) are no longer necessary for continued treatment. The dose range in dogs is 5–10 mg/kg body weight, administered orally, twice a day. Cefpodoxime inhibits cell wall synthesis by inhibiting the final transpeptidation step of peptidoglycan synthesis in cell walls. It has well established pharmacokinetic profile with absorption of 50%. It is indicated in community acquired pneumonia, uncomplicated skin and skin structure infections, and uncomplicated urinary tract infections.

For Doctors


CEFORENZ-200 Tablet

 Each Tablet contains:

 Cefpodoxime Proxetil eq. to Cefpodoxime ………………… 500 mg

CEFORENZ-50 Dry syrup

 Each Dry syrup contains:

Cefpodoxime Proxetil eq. to Cefpodoxime   ………………….50 mg

Mechanism of action

Mechanism of action
Cefpodoxime proxetil is a semi-synthetic beta-lactam antibiotic belonging to the third generation oral cephalosporin group. Cefpodoxime proxetil is the prodrug of the bactericidal antibiotic cefpodoxime. The antibacterial action of cefpodoxime is through inhibition of bacterial cell wall synthesis probably by acylation of membrane bound transpeptidase enzymes; this prevents cross linkage of peptidoglycan chains, which is necessary for bacterial cell wall strength and rigidity.
Antibacterial spectrum
In vitro studies have demonstrated the susceptibility of most strains of the following micro-organisms to cefpodoxime proxetil. However, such in vitro activity does not necessarily imply in vivo efficacy.
Gram-positive organisms
Streptococcus pneumoniaeS. pyogenesS. agalactiaeS. mitis, S. sanguis and S. salivariusPropionibacterium acnesCorynebacterium diphtheriae; methicillin-sensitive penicillinase and non-penicillinase producing strains of S. aureus.
Gram negative organisms
Beta-lactamase and non-beta-lactamase producing strains of Haemophilus influenzae, Haemophilus para-influenzae, Moraxella catarrhalis (Branhamella catarrhalis) and Neisseria gonorrhoeaEscherichia coliKlebsiella pneumoniaeKlebsiella oxytocaProteus mirabilis.
The following organisms are not sensitive: Group D streptococci, Methicillin-resistant staphylococci (S. aureus and S. epidermidis), Staphylococcus saprophyticusCorynebacteria, groups J and K, Listeria monocytogenes,Pseudomonas aeruginosa and Pseudomonas spp., Acinetobacter baumaniiClostridium difficileBacteroides fragilis and related species.

Cefpodoxime proxetil is absorbed orally and rapidly hydrolysed by non-specific esterases in the gastro-intestinal wall to cefpodoxime, the active acid. Absorption is decreased in conditions of low gastric acidity. After oral administration of a single dose of 200 mg of cefpodoxime, the maximum plasma concentration (Cmax) obtained is 2,23 mg/L. After oral administration of a single 5 mg/kg (200 mg maximum) dose of cefpodoxime proxetil suspension in children, the maximum plasma concentration (Cmax) obtained is on average 2,6 mg/L. With cefpodoxime proxetil tablets the time taken to reach the maximum concentration (Tmax) is about 2,7 hours. With the suspension the time taken to reach the maximum concentration (Tmax) is about 2 to 4 hours. The drug diffuses well into respiratory tissues. The serum half-life is about 2,46 hours. About 27% of cefpodoxime in the plasma is bound to plasma proteins. The volume of distribution is about 0,46 L/kg and the clearance is around 2,4 mL/min/kg. About 81% of unchanged cefpodoxime is excreted in the urine.

Detail "

Cefpodoxime proxetil is indicated for the treatment of patients with mild to moderate infections caused by susceptible strains of the designated microorganisms in the conditions listed below.

Acute otitis media caused by Streptococcus pneumoniae (excluding -resistant strains),Streptococcus pyogenesHaemophilus influenzae (including beta-lactamase-producing strains), or Moraxella (Branhamella) catarrhalis (including beta-lactamase-producing strains)

Pharyngitis and/or tonsillitis caused by Streptococcus pyogenes.

Community-acquired pneumonia caused by S. pneumoniae or H. Influenzae (including beta-lactamase-producing strains).

Acute bacterial exacerbation of chronic bronchitis caused by S. pneumoniaeH. influenzae (non-beta-lactamase-producing strains only), or M. catarrhalis

Acute, uncomplicated urethral and cervical gonorrhea caused by Neisseria gonorrhoeae (including penicillinase-producing strains).

Acute, uncomplicated ano-rectal infections in women due to Neisseria gonorrhoeae (including penicillinase-producing strains).

Uncomplicated skin and skin structure infections caused byStaphylococcus aureus (including penicillinase-producing strains) or  Streptococcus pyogenes. Abscesses should be surgically drained as clinically indicated.

Acute maxillary sinusitis caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Staphylococcus saprophyticus.

Uncomplicated urinary tract infections (cystitis)

Dosages & Administration
Detail "

Ceforenz should be administered orally with food to enhance absorption. The recommended dosages, durations of treatment, and applicable patient population are as described in the following chart:





Pharyngitis and/or tonsillitis

200 mg

100 mg Q 12 hours

5 to 10 days

Acute community-acquired pneumonia

400 mg

200 mg Q 12 hours

14 days

Acute bacterial exacerbations of chronic bronchitis

400 mg

200 mg Q 12 hours

10 days

Uncomplicated gonorrhea (men and women) and rectal gonococcal infections (women)

200 mg

single dose


Skin and skin structure

800 mg

400 mg Q 12 hours

7 to 14 days

Acute maxillary sinusitis

400 mg

200 mg Q 12 hours

10 days


200 mg

100 mg Q 12 hours

7 days


Adults and Adolescents (age 12 years and older)

Adverse Drug Reaction

Diarrhea, nausea/vomiting, or headache may occur. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur: swelling of the ankles/feet, tiredness, fast/pounding heartbeat, trouble breathing, new signs of infection (e.g., fever, persistent sore throat), dark urine, persistent nausea/vomiting, yellowing eyes/skin, easy bruising/bleeding, change in the amount of urine.

Seek immediate medical attention if any of these rare but very serious side effects occur: vision changes, slurred speech, mental/mood changes (such as confusion).

This medication may rarely cause a severe intestinal condition (Clostridium difficile-associated diarrhea) due to a type of resistant bacteria. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor immediately if you develop: persistent diarrhea, abdominal or stomach pain/cramping, blood/mucus in your stool. Do not use anti-diarrhea products or narcotic pain medications if you have any of these symptoms because these products may make them worse.

Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches in your mouth, a change in vaginal discharge, or other new symptoms.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any of the following symptoms of a serious allergic reaction: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Drug Interaction

The following drugs are found to be interacted with cefpodoxime (CEFORENZ) as it following drug should be  avoided with it.

·         with lithium (Lithobid);

·         probenecid (Benemid);

·         methotrexate (Rheumatrex, Trexall);

·         antiviral medicines such as adefovir (Hepsera), cidofovir (Vistide), or foscarnet (Foscavir);

·         cancer medicine such as aldesleukin (Proleukin), carmustine (BiCNU, Gliadel), cisplatin (Platinol), ifosfamide (Ifex), oxaliplatin (Eloxatin), plicamycin (Mithracin), streptozocin (Zanosar), or tretinoin (Vesanoid);

·         a diuretic (water pill) such as bumetanide (Bumex), furosemide (Lasix), indapamide (Lozol), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactazide, Aldactone), torsemide (Demadex), and others;

·         a medication that reduces stomach acid, such as an antacid, or cimetidine (Tagamet), famotidine (Pepcid), omeprazole (Prilosec), ranitidine (Zantac), and others;

·         IV antibiotics such as amphotericin B (Fungizone, AmBisome, Amphotec, Abelcet), amikacin (Amikin), bacitracin (Baci-IM), capreomycin (Capastat), gentamicin (Garamycin), kanamycin (Kantrex), streptomycin, or vancomycin (Vancocin, Vancoled);

·         medicines used to prevent organ transplant rejection, such as sirolimus (Rapamune) or tacrolimus (Prograf);

·         medicines used to treat ulcerative colitis, such as mesalamine (Pentasa) or sulfasalazine (Azulfidine); or

·         pain or arthritis medicines such as aspirin (Anacin, Excedrin), acetaminophen (Tylenol), diclofenac (Cataflam, Voltaren), etodolac (Lodine), ibuprofen (Advil, Motrin), indomethacin (Indocin), naproxen (Aleve, Naprosyn), and others.

This list is not complete and there may be other drugs that can interact cefpodoxime.

Warning & Precaution
Detail "


Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including CEFORENZ, and may range in severity from mild diarrhea to fatal colitis.

C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.

A concerted effort to monitor for C. difficile in cefpodoxime-treated patients with diarrhea was undertaken because of an increased incidence of diarrhea associated with C. difficile in early trials in normal subjects. C. difficileorganisms or toxin was reported in 10% of the cefpodoxime-treated adult patients with diarrhea; however, no specific diagnosis of pseudomembranous colitis was made in these patients.

In post-marketing experience outside the United States, reports of pseudomembranous colitis associated with the use of cefpodoxime proxetil have been received.



In patients with transient or persistent reduction in urinary output due to renal insufficiency, the total daily dose of cefpodoxime proxetil should be reduced because high and prolonged serum antibiotic concentrations can occur in such individuals following usual doses. Cefpodoxime, like other cephalosporins, should be administered with caution to patients receiving concurrent treatment with potent diuretics.

As with other antibiotics, prolonged use of cefpodoxime proxetil may result in overgrowth of non-susceptible organisms. Repeated evaluation of the patient's condition is essential. If super infection occurs during therapy, appropriate measures should be taken.

Prescribing CEFORENZ in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term animal carcinogenesis studies of cefpodoxime proxetil have not been performed. Mutagenesis studies of cefpodoxime, including the Ames test both with and without metabolic activation, the chromosome aberration test, the unscheduled DNA synthesis assay, mitotic  recombination and gene conversion, the forward gene mutation assay and the in vivo micronucleus test, were all negative. No untoward effects on fertility or reproduction were noted when 100 mg/kg/day or less (2 times the human dose based on mg/m²) was administered orally to rats.


Teratogenic Effects - Pregnancy Category B

Cefpodoxime proxetil was neither teratogenic nor embryocidal when administered to rats during organogenesis at doses up to 100 mg/kg/day (2 times the human dose based on mg/m²) or to rabbits at doses up to 30 mg/kg/day (1–2 times the human dose based on mg/m²).

There are, however, no adequate and well-controlled studies of cefpodoxime proxetil use in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Labor and Delivery

Cefpodoxime proxetil has not been studied for use during labor and delivery. Treatment should only be given if clearly needed.

Nursing Mothers

Cefpodoxime is excreted in human milk. In a study of 3 lactating women, levels of cefpodoxime in human milk were 0%, 2% and 6% of concomitant serum levels at 4 hours following a 200 mg oral dose of cefpodoxime proxetil. At 6 hours post-dosing, levels were 0%, 9% and 16% of concomitant serum levels. Because of the potential for serious reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and efficacy in infants less than 2 months of age have not been established.

Geriatric Use

Of the 3338 patients in multiple-dose clinical studies of cefpodoxime proxetil film-coated tablets, 521 (16%) were 65 and over, while 214 (6%) were 75 and over. No overall differences in effectiveness or safety were observed between the elderly and younger patients. In healthy geriatric subjects with normal renal function, cefpodoxime half-life in plasma averaged 4.2 hours and urinary recovery averaged 21% after a 400 mg dose was given every 12 hours for 15 days. Other pharmacokinetic parameters were unchanged relative to those observed in healthy younger subjects.

Dose adjustment in elderly patients with normal renal function is not necessary.


Ceforenz (Cefpodoxime proxetil) is contra-indicated in patients who are allergic to the cephalosporin group of antibiotics. Safety of cefpodoxime proxetil for use in pregnancy and lactation has not been established.

For Patients
Why is it important for my child to take this medicine?

It is important that your child takes this medicine in the way that your doctor has told you to so that it kills the harmful bacteria and gets rid of their infection.

What is co-amoxiclav available as?
  • Tablets: 250 mg Amoxicillin/125 mg Clavulanic acid and 500/125 mg
  • Dispersible tablets: 250/125 mg
  • Liquid medicine: 125/31 mg (125 mg amoxicillin/31.25 mg clavulanic acid), 250/62 mg or 400/57 mg in 5 mL

Augmentin and Augmentin-Duo contain aspartame.

When should I give co-amoxiclav?

Co-amoxiclav is usually given three times a day. This should be first thing in the morning, early afternoon (or after school) and at bedtime. Ideally, these times are at least 4 hours apart.

Give the medicine at about the same times each day so that this becomes part of your child’s daily routine, which will help you to remember.

How much should I give?

Your doctor will work out the amount of co-amoxiclav (the dose) that is right for your child. The dose will be shown on the medicine label.

It is important that you follow your doctor’s instructions about how much to give.

How should I give it?

This medicine works best when the stomach is empty, so try to give it to your child ½–1 hour before they eat. However, if your child has an upset stomach, you can give it with a small amount of food.

Tablets should be swallowed with a glass of water, milk or juice. Your child should not chew the tablets.

Liquid medicine: Shake the medicine well. Measure out the right amount using an oral syringe or a medicine spoon. You can get these from your pharmacist. Do not use a kitchen teaspoon as it will not give the right amount.

What is cefpodoxime (CEFORENZ)?

Cefpodoxime (ceforenz) is in a group of drugs called cephalosporin (SEF a low spor in) antibiotics. It works by fighting bacteria in your body.

Cefpodoxime is used to treat many different types of infections caused by bacteria.

Cefpodoxime may also be used for other purposes not listed in this medication guide.

What are the possible side effects of cefpodoxime (CEFORENZ)?

Get emergency medical help if you have any of thesesigns of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

·         diarrhea that is watery or bloody;

·         fever, chills, body aches, flu symptoms;

·         unusual bleeding or bruising;

·         cough, wheezing, chest tightness, trouble breathing;

·         fast or pounding heartbeats;

·         feeling like you might pass out;

·         seizure (convulsions);

·         pale or yellowed skin, dark colored urine, fever, confusion or weakness;

·         jaundice (yellowing of the skin or eyes);

·         fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;

·         swelling, rapid weight gain, feeling short of breath (even with mild exertion); or

·         increased thirst, loss of appetite, urinating less than usual or not at all.

Less serious side effects may include:

·         nausea, vomiting, stomach pain, mild diarrhea, bloating, gas, constipation;

·         stiff or tight muscles;

·         back pain, muscle pain;

·         headache, tired feeling;

·         anxiety, nervousness, feeling restless or hyperactive;

·         numbness or tingly feeling, warmth or redness under your skin;

·         dizziness, spinning sensation;

·         strange dreams, nightmares;

·         stuffy nose;

·         dry mouth, unusual or unpleasant taste in your mouth;

·         white patches or sores inside your mouth or on your lips;

·         diaper rash in an infant taking liquid cefpodoxime

·         mild itching or skin rash; or

·         vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

Read the CEFORENZ (cefpodoxmine proxetil) Side Effects Center  for a complete guide to possible side effects

What is the most important information I should know about cefpodoxime (CEFORENZ)?

Do not take this medication if you are allergic to cefpodoxime, or to similar antibiotics, such as Ceftin, Cefzil, Keflex, Omnicef, and others.

Before taking this medication, tell your doctor if you are allergic to any drugs (especially penicillin). Also tell your doctor if you have kidney disease or a history of intestinal problems.

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Cefpodoxime will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

What should I discuss with my healthcare provider before taking cefpodoxime (CEFORENZ)?

Do not take this medication if you are allergic to cefpodoxime or to other cephalosporin antibiotics, such as:

·         cefaclor (Raniclor);

·         cefadroxil (Duricef);

·         cefazolin (Ancef);

·         cefdinir (Omnicef);

·         cefditoren (Spectracef);

·         cefixime (Suprax);

·         cefprozil (Cefzil);

·         ceftibuten (Cedax);

·         cefuroxime (Ceftin);

·         cephalexin (Keflex); or

·         cephradine (Velosef); and others.

Before taking cefpodoxime, tell your doctor if you are allergic to any drugs (especially penicillins) or if you have:

·         kidney disease (or if you are on dialysis); or

·         a history of intestinal problems, such as colitis.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take this medication.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Cefpodoxime passes into breast milk and could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take cefpodoxime (CEFORENZ)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take this medicine with a full glass of water.

The cefpodoxime tablet should be taken with food.

Cefpodoxime oral suspension (liquid) can be taken with or without food.

Shake the liquid well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

This medication can cause you to have false results with certain medical tests, including urine glucose (sugar) tests. Tell any doctor who treats you that you are using cefpodoxime.

Take cefpodoxime for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Cefpodoxime will not treat a viral infection such as the common cold or flu.

Store the tablets at room temperature away from moisture, heat, and light.

Store cefpodoxime oral liquid in the refrigerator. Do not allow it to freeze. Throw away any unused medication that is older than 14 days.

What happens if I miss a dose (CEFORENZ)?

Take the medication as soon as you remember the missed dose. If it is almost time for your next dose, skip the missed dose and use the medicine at your next regularly scheduled time. Do not use extra medicine to make up the missed dose.

What happens if I overdose (CEFORENZ)?

Seek emergency medical attention if you think you have used too much of this medicine.

Overdose symptoms may include nausea, vomiting, stomach pain, and diarrhea.

What should I avoid while taking cefpodoxime (CEFORENZ)?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

What should I avoid while giving cefpodoxime proxetil (CEFORENZ) ?

Do not administer at the same time as giving antacids such as Diagene or other acid reducers such as Rantac, Zintac,Omez.

Where can I get more more information about cefpodoxime (CEFORENZ) ?

Your pharmacist and doctor can provide more information about cefpodoxime.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.