Cefpodoxime is an oral
third-generation cephalosporin used for the treatment of acute
upper-respiratory tract infections caused by susceptible bacteria in children. Although not indicated for the treatment of
bacterial meningitis, it is used to treat other
infections produced by organisms associated with
meningitis and may obscure the result of cerebrospinal fluid (CSF) cultures in children who develop
meningitis while receiving oral
antibiotics if sufficient concentrations are achieved in the CSF. This study evaluated the disposition of
cefpodoxime and penetration into CSF in piglets. Fifteen Landacre-Camborough cross piglets (10-20 days old) received
cefpodoxime proxetil oral
suspension (10 mg/kg). Repeated plasma and CSF samples were collected over 24 hours for quantitation of
cefpodoxime by HPLC. Pharmacokinetic analysis was performed on both plasma and CSF data. The plasma concentration versus time data for
cefpodoxime were best characterized using a one-compartment model with first-order absorption. The mean (+/- SD) pharmacokinetic parameters for Cmax, tmax, and AUC0-infinity were 23.3 +/- 12.9 mg/L, 3.9 +/- 1.4 h, and 237 +/- 129 mg/L.h, respectively. CSF/plasma ratios for AUC0-infinity demonstrated a mean
cefpodoxime penetration of approximately 5%. CSF penetration of
cefpodoxime was evident following a single oral dose of
cefpodoxime proxetil suspension. Despite the small percentage of total
cefpodoxime dose distributing into the CSF, the resultant concentrations approached or exceeded the MIC90 for many bacterial pathogens considered susceptible to
cefpodoxime. Accordingly, clinicians should use caution in the interpretation of CSF cultures in patients who develop clinical signs and symptoms consistent with
meningitis and who have been previously treated with
cefpodoxime.