Is cefpodoxime an appropriate oral antibiotic substitute for ceftriaxone when treating patients with respiratory tract infections caused by penicillin-resistant Streptococcus pneumoniae (PRSP)?

Short answer: No!

Although cefpodoxime is also a 3rd generation cephalosporin, its invitro activity against PRSP is not comparable to that of ceftriaxone.  In a study of 21,605 strains of S. pneumoniae collected internationally, whereas 89.1% of PRSP isolates were susceptible to ceftriaxone, only 35% were susceptible to cefpodoxime (1).  Among isolates resistant to penicillin and erythromycin, the susceptibility to ceftriaxone was 86.9% compared to that of 22.7% for cefpodoxime.

This information is important since 32%, and 17.6% of all S. pneumoniae isolates tested in this study  were either penicillin-resistant or penicillin- and erythromycin-resistant, respectively.  So, when it comes to the coverage of PRSP, there is no oral cephalosporin “equivalent” to ceftriaxone and that includes cefpodoxime.  In fact, the package insert of cefpodoxime states that cefpodoxime is active against S. pneumoniae “excluding penicillin-resistant strains” (2).

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References

  1. Pottumarthy S. Fritsche TR, Jones RN. Comparative activity of oral and parenteral cephalosporins tested against multidrug-resistant Streptococcus pneumonia: report from SENTRY Antimicrobial Surveillance Program (1997-2003). Diag Microbiol Infect Dis 2005;51:147-150. https://www.sciencedirect.com/science/article/pii/S0732889304002081    
  2. http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/050674s014,050675s017lbl.pdf; accessed June 20, 2016.
Is cefpodoxime an appropriate oral antibiotic substitute for ceftriaxone when treating patients with respiratory tract infections caused by penicillin-resistant Streptococcus pneumoniae (PRSP)?