CEFDITOREN PIVOXIL

CEFDITOREN PIVOXIL
(cef-ditor'en)
Spectracef
Classifications: antibiotic; third-generation cephalosporin;
Therapeutic: antibiotic
; cephalosporin
Prototype: Cefotaxime sodium
Pregnancy Category: B

Availability

200 mg tablets

Action

Semisynthetic cephalosporin. Bactericidal activity results from the inhibition of cell wall synthesis through an affinity for penicillin-binding proteins (PBPs). Stable in the presence of a variety of bacterial beta-lactamase enzymes, including penicillinases and some cephalosporinases.

Therapeutic Effect

Antibacterial activity is effective against both aerobic gram-positive and aerobic gram-negative bacteria.

Uses

Acute exacerbation of bacterial chronic bronchitis, pharyngitis, tonsillitis, uncomplicated skin and skin-structure infections.

Contraindications

Known allergy to cephalosporins or any of the components of cefditoren; carnitine deficiency; milk protein hypersensitivity.

Cautious Use

History of hypersensitivity to penicillin or other drugs; renal or hepatic impairment; poor nutritional status; coagulopathy; diabetes mellitus; colitis, GI disease; older adults; concurrent anticoagulant therapy; pregnancy (category B), lactation. Safety and efficacy in children <12 y are not established.

Route & Dosage

Chronic Bronchitis
Adult: PO 400 mg b.i.d. x 10 d

Pharyngitis, Tonsillitis, Skin Infections
Adult: PO 200 mg b.i.d. x 10 d

Renal Impairment
Clcr 30–49 mL/min: 200 mg b.i.d.; <30 mL/min: 200 mg q.d.

Administration

Oral
  • Give with food to enhance absorption.
  • Do not give within 2 h of an antacid or H2-receptor antagonist (such as cimetidine).
  • Verify dose for patients with renal insufficiency. Manufacturer recommends doses not to exceed 200 mg b.i.d. for patients with creatinine clearance of 30–49 mL/min and doses not to exceed 200 mg q.d. for patients with creatinine clearance of <30 mL/min.
  • Store at 15°–30° C (58°–86° F). Protect from light and moisture.

Adverse Effects (≥1%)

GI: Diarrhea, nausea, abdominal pain, dyspepsia, vomiting. Hematologic: Anemia, leukocytosis. CNS: Headache. Urogenital: Vaginal moniliasis, hematuria.

Interactions

Drug: antacids, h2-receptor antagonists may decrease absorption; probenecid will decrease elimination.

Pharmacokinetics

Absorption: 14% reaches systemic circulation. Distribution: 88% protein bound, distributes into blister fluid, tonsils. Metabolism: Hydrolyzed. Elimination: Primarily in urine. Half-Life: 1.6 h.

Nursing Implications

Assessment & Drug Effects

  • Obtain history of hypersensitivity to cephalosporins, penicillins, and other drug allergies.
  • Lab tests: Baseline C&S tests recommended prior to and periodically during therapy. Initiate drug pending results. Baseline and periodic studies of kidney function; frequent PT determinations in patients at risk for increased prothrombin time; as indicated, Hct & Hgb, CBC with differential, urinalysis, serum electrolytes, and liver enzymes.
  • Monitor for manifestations of drug hypersensitivity (see Appendix F). Withhold drug and report promptly to physician if they appear.
  • Monitor for and report promptly manifestations of superinfection (see Appendix F), especially diarrhea. Diarrhea may indicate a change in intestinal flora and development of enterocolitis. If it persists, interruption of therapy may be necessary.
  • Monitor for and report immediately signs of seizure activity or loss of seizure control.

Patient & Family Education

  • Do not take within 2 h of antacids or other drugs used to reduce stomach acids.
  • Discontinue drug and report to physician signs of an allergic reaction (e.g., rash, urticaria, pruritus, fever).
  • Report promptly S&S of superinfection (see Appendix F), especially unexplained diarrhea. Antibiotic-associated colitis is a superinfection that may occur in 4–9 d or as long as 6 wk after drug is discontinued.
  • Use daily yogurt or buttermilk (if allowed) as a prophylactic against intestinal superinfections.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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