Cefdaloxime

General

• Type: 4th generation Cephalosporin
• Dosage Forms: Tablet, Granules for suspension
• Dosage Strengths: 100mg, 200mg (as cefdaloxime pentexil)
• Routes of Administration: PO
• Common Trade Names: Cefdal (Investigational/International)

Adult Dosing

General

• Standard: 200mg PO q12h
• Administer with food to increase absorption

Community Acquired Pneumonia

• 200mg PO q12h x 10 days

Acute Bacterial Exacerbation of Chronic Bronchitis

• 200mg PO q12h x 5-10 days

Pharyngitis / Tonsillitis

• 100mg PO q12h x 5-10 days

UTI, Uncomplicated

• 100-200mg PO q12h x 7 days

Pediatric Dosing

General (>6 Months)

• 4mg/kg/dose PO q12h
• Max: 400mg/day

Acute Otitis Media

• 4mg/kg PO q12h x 10 days

Special Populations

• Pregnancy: Category B (Limited data; use only if clearly needed)
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult
    • CrCl > 30: No adjustment required
    • CrCl < 30: Increase dosing interval (q24h) or reduce dose by 50%
    • Hemodialysis: Supplement required after dialysis
  • Pediatric
    • Not fully defined; adjust based on adult GFR principles
• Hepatic
  • No extensive metabolism; specific adjustments not usually required

Contraindications

• Allergy to class/drug (Cephalosporins)
• Prior immediate hypersensitivity reaction to Penicillin

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile associated diarrhea
• Angioedema

Common

• Diarrhea
• Nausea
• Abdominal Pain
• Rash
• Dyspepsia
• Headache

Pharmacology

• Half-life: 5-7h (Long half-life allows for BID dosing)
• Metabolism: Hydrolyzed in intestinal wall from prodrug (pentexil) to active cefdaloxime
• Excretion: Urine (largely unchanged)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis. Notable for stability against beta-lactamases.

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	S
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	I
	Enterobacter sp, AmpC pos	R
	Serratia sp	I
	Serratia marcescens	R
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	R
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	I
	Citrobacter sp.	R
	Aeromonas sp	R
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	I
	Clostridium difficile	X1
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)