Cefetamet

General

• Type: 3rd generation Cephalosporin
• Dosage Forms: Tablet, Powder for oral suspension
• Dosage Strengths: 250mg, 500mg (dosed as cefetamet pivoxil)
• Routes of Administration: PO
• Common Trade Names: Globor

Adult Dosing

General

• Standard: 500mg PO q12h
• Administer with food (increases bioavailability)
• Max: 2000mg/day

Community Acquired Pneumonia

• 500mg PO q12h x 10 days

Acute Bacterial Exacerbation of Chronic Bronchitis

• 500mg PO q12h x 7 days

Acute Sinusitis / Pharyngitis

• 500mg PO q12h x 7-10 days

UTI, Complicated and Uncomplicated

• 500mg PO q12h x 7-10 days

Uncomplicated Gonorrhea

• 1200-1500mg PO x 1 (Single dose)

Pediatric Dosing

General (>3 Months)

• 10mg/kg PO q12h
• Administer with food
• Max: 1000mg/day (Administer as tablet if child can swallow, or suspension)

Acute Otitis Media

• 10mg/kg PO q12h x 7-10 days

Pharyngitis / Tonsillitis

• 10mg/kg PO q12h x 7-10 days

Special Populations

• Pregnancy: B (Use only if clearly needed)
• Lactation: Excreted in breast milk; caution advised
• Renal
  • Adult
    • CrCl > 40: Standard dose (500mg q12h)
    • CrCl 10-39: 125mg q12h OR 500mg q24h
    • CrCl < 10: 125mg q24h OR 500mg q48h
    • Hemodialysis: Give supplement after dialysis
  • Pediatric
    • CrCl > 40: Standard dose
    • CrCl < 40: Extend interval or reduce dose similar to adult proportions
• Hepatic
  • No adjustment necessary (metabolism is ester hydrolysis in intestinal wall/serum, not hepatic CYP dependent)

Contraindications

• Allergy to class/drug (Cephalosporins)
• History of severe hypersensitivity to Penicillin
• Known Carnitine deficiency (due to pivoxil pivalate liberation)

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Clostridium difficile associated diarrhea
• Hypocarnitinemia (Long term use)
• Angioedema

Common

• Diarrhea
• Nausea and Vomiting
• Abdominal Pain
• Dyspepsia
• Headache
• Fatigue

Pharmacology

• Half-life: 2-3h (Prolonged in renal impairment)
• Metabolism: Cefetamet pivoxil is a prodrug; hydrolyzed by esterases in the intestinal wall to active Cefetamet (and pivalic acid).
• Excretion: Urine (>85% as unchanged active drug)
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
• Notes: Poor activity against Staphylococci compared to other cephalosporins.

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	R
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	R
	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	I
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	I
	Citrobacter freundii	R
	Citrobacter diversus	I
	Citrobacter sp.	R
	Aeromonas sp	S
	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)

References

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