Swich Special Precautions

Cefpodoxime is not a preferred antibiotic for the treatment of staphylococcal pneumonia and should not be used in the treatment of atypical pneumonia caused by organisms such as Legionella, Mycoplasma and Chlamydia.
In cases of severe renal insufficiency it may be necessary to reduce the dosage regimen dependent on the creatinine clearance (see Dosage & Administration).
As with all beta-lactam antibiotics, neutropenia and more rarely agranulocytosis may develop particularly during extended treatment. For cases of treatment lasting longer than 10 days, the blood count should be monitored and treatment discontinued if neutropenia is found. Cephalosporins may be absorbed onto the surface of red cell membranes and react with antibodies directed against the drug. This can produce a positive Coomb's test and very rarely, haemolytic anaemia. Cross reactivity may occur with penicillin for this reaction. Changes in renal function have been observed with cephalosporin antibiotics, particularly when given concurrently with potentially nephrotoxic drugs such as aminoglycosides and/or potential diuretics. In such cases renal function should be monitored.
Tablet: Cefpodoxime is not recommended for the treatment of pneumonia due to S.pneumoniae (see Pharmacology: Pharmacodynamics under Actions).
As with all beta-lactam antibacterial agents serious and occasionally fatal hypersensitivity reactions have been reported. In case of severe hypersensitivity reactions, treatment with cefpodoxime must be discontinued immediately and adequate emergency measures must be initiated. Before beginning treatment, it should be established whether the patient has a history of severe hypersensitivity reactions to cefpodoxime, to other cephalosporins or to any other type of beta-lactam agent. Caution should be used if cefpodoxime is given to patients with a history of non-severe hypersensitivity to other beta-lactam agents. Antibacterial agent-associated colitis and pseudo-membranous colitis have been reported with nearly all anti-bacterial agents, including cefpodoxime, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea during or subsequent to the administration of cefpodoxime (see Overdosage).
Discontinuation of the therapy with cefpodoxime and the administration of specific treatment for Clostridium difficile should be considered.
Medicinal products that inhibit peristalsis should not be given. Cefpodoxime should always be prescribed with caution in patients with a history of gastrointestinal disease, particularly colitis. As with other antibiotics, prolonged use of cefpodoxime may result in the overgrowth of non-susceptible organisms (candida and Clostridium difficile), which may require interruption of treatment.
Interactions with Laboratory Tests: A false positive reaction for glucose in the urine may occur with Benedict's or Fehling's solution or with copper sulphate test tablets, but not with tests based on enzymatic glucose oxidase reactions. Patients with rare hereditary problems of galactose malabsorption should not take this medicine. Sunset yellow (E110) may cause allergic reactions.
Suspension: Preliminary enquiry about allergy to penicillin is necessary before prescribing cephalosporins since cross allergy to penicillins occurs in 5-10% of cases.
Particular care will be needed in patients sensitive to penicillin: strict medical surveillance is necessary from the very first administration. Where there is doubt, medical assistance should be available at the initial administration, in order to treat any anaphylactic episode. In patients who are allergic to other cephalosporins, the possibility of cross allergy to Cefpodoxime, should be borne in mind. Cefpodoxime should not be given to those patients with a previous history of immediate type hypersensitivity to cephalosporin.
Hypersensitivity reactions (anaphylaxis) observed with beta-lactam antibiotics can be serious and occasionally fatal.
The onset of any manifestation of hypersensitivity indicates that treatment should be stopped.
Possible side effects include gastrointestinal disorders such as nausea, vomiting and abdominal pain. Antibiotics should always be prescribed with caution in patients with a history of gastrointestinal disease, particularly colitis. Cefpodoxime may induce diarrhoea, antibiotic associated colitis and pseudomembranous colitis. These side-effects, which may occur more frequently in patients receiving higher doses for prolonged periods, should be considered as potentially serious. The presence of C. difficile should be investigated. In all potential cases of colitis, the treatment should be stopped immediately. The diagnosis should be confirmed by sigmoidoscopy and specific antibiotic therapy (vancomycin) substituted if considered clinically necessary. The administration of products which cause faecal stasis must be avoided. Although any antibiotic may cause pseudomembranous colitis, the risk may be higher with broad-spectrum drugs, such as the cephalosporin.