Cefpodoxime Proxetil

Clinical and Laboratory Standards Institute (CLSI) M100Ed24 (2024) states that Streptococcus pneumoniae susceptible to oral penicillin can be considered susceptible to various β-lactams, including oral cephalosporins. However, surrogacy guidance is not available for isolates nonsusceptible to oral penicillin. Instead, such isolates require specific MIC testing and interpretations for reporting susceptibility to oral cephalosporins, for which susceptibility testing is limited in most automated systems, and consequently restricts information pertaining to oral cephalosporins at an individual institution. This study evaluated the ability of the penicillin breakpoints to predict cefpodoxime and ceftriaxone susceptibilities against a recent collection of S. pneumoniae from United States hospitals according to CLSI guidelines. The susceptible breakpoint for oral penicillin (≤0.06 mg/L) predicted susceptibility to cefpodoxime and ceftriaxone. However, when isolates were nonsusceptible to oral penicillin (MIC, >0.06 mg/L), susceptibility to cefpodoxime could not be predicted due to a low categorical agreement (CA) (78.4%). Parenteral penicillin breakpoints also could not predict cefpodoxime susceptibility due to the elevated number of very major errors and a CA of 76.8%; however, these breakpoints could still be used as a surrogate marker to predict ceftriaxone susceptibility. Finally, ceftriaxone could be used for surrogate testing of cefpodoxime by applying breakpoints (≤0.25 mg/L for susceptible; 0.5 mg/L for intermediate; ≥1 mg/L for resistant) lower than the current clinical cutoffs. These analyses showed that isolates nonsusceptible to oral penicillin cannot be considered susceptible to cefpodoxime, and caution should be used when prescribing oral cephalosporins for the empiric treatment of community-acquired bacterial pneumonia.IMPORTANCESusceptibility results to oral cephalosporins are rarely available to guide therapy due to the limited number of drugs evaluated on common automated antimicrobial susceptibility testing (AST) systems (i.e., Vitek 2, MicroScan, and Phoenix). In addition, disk diffusion methods for determining Streptococcus pneumoniae susceptibility to β-lactam agents are not reliable, and a quantitative method, such as broth microdilution or gradient strips, is required. In addition, the epidemiology and serotypes of S. pneumoniae are constantly evolving; therefore, this work provides a re-evaluation of surrogacy testing for β-lactam agents against S. pneumoniae recently recovered from United States laboratories. The data provide the possible use of ceftriaxone MIC for determining cefpodoxime susceptibility. This should be of interest to microbiology laboratories and the scientific community.

The management of acute cough has a range of treatment strategies, including prescription and nonprescription medicines, which may contain one or more active ingredients such as fixed-dose combinations (FDCs) and potentially the use of antibiotics. This study aims to analyze recommendation and prescription patterns for cough, focusing on the use and/or recommendation of antibiotics, and the single or FDCs of medicines.

Electronic medical records (EMR) data from 2017 to 2023 of the patients of acute cough meeting the study criteria was retrieved and analyzed to understand the types of cough, its treatment pattern, and duration of treatment in Indian adults and elderly.

Antibiotics were frequently prescribed for both the productive cough (adult: 60.33%, elderly: 62.01%) and nonproductive cough (adult: 53.13%, elderly: 52.27%), followed by various FDCs. Overall, dextromethorphan (productive 1.83%, nonproductive 4.37%) and levocloperastine (productive 1.61%, nonproductive 4.31%) were commonly used as monotherapy. Frequent prescriptions of antitussives for nonproductive cough as well as for productive cough were noted both in monotherapy (4.42%) and FDCs (21.84%). Among the antitussive FDCs used for productive cough, chlorpheniramine + dextromethorphan + phenylephrine (38.44%) was the most prescribed, followed by beta-agonists/bronchodilators (18.34%) and antihistamines (4.32%). Antibiotics were prescribed for both the productive (60.33%) and nonproductive (51.93%) cough. Azithromycin (19.10%, 20.65%) and cefpodoxime (5.61%, 6.44%) were the frequently prescribed antibiotic monotherapies for productive and nonproductive cough, respectively. Among the antibiotics, amoxicillin + clavulanic acid and cefpodoxime + clavulanic acid were the commonly prescribed FDCs. The duration of prescription of the cough medications was 3-5 days.

The study gives an overview of current cough management practices in India. The findings highlight the need for educating primary care physicians on the use of standardized guidelines and evidence-based management for common ailments like cough.