A third-generation cephalosporin with broad spectrum activity against numerous gram-positive and gram-negative infections is cefditoren pivoxil (Meiact).

Cefditoren Uses:

• Treatment of:
  • Pharyngitis or tonsillitis (Streptococcus pyogenes); uncomplicated skin and skin-structure infections
  • (Staphylococcus aureus — not MRSA; and Streptococcus pyogenes); and acute bacterial exacerbation of chronic bronchitis or community-acquired pneumonia caused by susceptible organisms such as Haemophilus influenzae, Haemophilus parainflu

Other oral third-generation antibiotics include Cefixime and Cefpodoxime Proxetil. See IDSA Community-acquired Pneumonia Guidelines.

Adult dose:

Dose for treating acute bacterial exacerbation of chronic bronchitis:

• 400 mg orally twice daily for 10 days.

Dose for treating Community-acquired pneumonia:

• 400 mg orally twice daily for 14 days.

Dose for treating Pharyngitis, tonsillitis, and uncomplicated skin & skin structure infections:

• 200 mg orally twice daily for 10 days.

Dose in children:

Cefditoren General dosing in mild to moderate infections susceptible infections:

• Children ≥12 years and Adolescents: 

  • 200 to 400 mg orally, twice day.

Cefditoren Dose in the treatment of acute bacterial exacerbation of Chronic Bronchitis; : 

• Children ≥12 years and Adolescents:

  • 400 mg orally twice daily for 10 days.

Cefditoren Dose in the treatment of Community­-acquired Pneumonia: 

• Children ≥12 years and Adolescents:

  • 400 mg orally twice daily for 14 days.

Cefditoren Dose in the treatment of Pharyngitis and Tonsillitis:

• Manufacturer's labeling:

  • Children ≥12 years and Adolescents:
    • 200 mg orally twice daily for 10 days.

• Alternate dosing:

  • Infants ≥8 months and Children: 
    • 3 mg/kg/dose orally, three times day for five days.

Cefditoren Dose in the treatment of Uncomplicated Skin and skin structure infections:

• Children ≥12 years and Adolescents:

  • 200 mg orally twice daily for 10 days.

Pregnancy Risk Factor B

• Animal reproduction studies have not shown any adverse events.
• After the first-trimester cephalosporin exposure, most birth defects did not increase.

Use during breastfeeding:

• It is unknown if the drug is found in human milk.
• Cefditoren should be used with caution during breastfeeding, according to the manufacturer.
• Cefditoren may be absorbed into breast milk. However, this can reduce the impact on nursing infants.

Cefditoren Dose in Kidney disease:

• CrCl >50 mL/minute/1.73 m²: 

  • No change in dose is required.

• CrCl 30 to 49 mL/minute/1.73 m²:

  • 200 mg twice daily is the maximum dosage.

• CrCl <30 mL/minute/1.73 m²:

  • 200 mg maximum daily dose

• End-stage renal disease (ESRD):

  • The manufacturer's labelling does not disclose any particular dosage modifications.
  • There is no evidence of either safety or effectiveness.

Cefditoren (Meiact) Dose in Liver disease:

• Mild ­to­ moderate impairment (Child-Pugh class A or B):

  • No change in dose is required.

• Severe impairment (Child­-Pugh class C): 

  • The manufacturer's labelling does not mention dosage modifications (has not been studied).

Common Side Effects of Cefditoren (Meiact):

• Gastrointestinal:

  • Diarrhea

Less Common Side Effects of Cefditoren (Meiact):

• Central Nervous System:

  • Headache

• Endocrine & Metabolic:

  • Increased Serum Glucose

• Gastrointestinal:

  • Nausea
  • Abdominal Pain
  • Dyspepsia
  • Vomiting

• Genitourinary:

  • Vulvovaginal Candidiasis
  • Hematuria
  • Urine Abnormality

• Hematologic & Oncologic: 

  • Decreased Hematocrit

Contraindications to Cefditoren (Meiact):

• Other cephalosporins, milk protein Carnitine deficiency, or inborn metabolic abnormalities that could result in clinically severe carnitine deficits are hypersensitivity to any medication component.

Warnings and precautions

• Elevated INR

  • This could be brought on by a rise in INR, especially in patients with dietary deficiencies, a protracted course of therapy, or hepatic and renal illness.

• Penicillin allergy

  • Patients with penicillin allergies should exercise caution, particularly if they have previously experienced IgE-mediated responses such anaphylaxis, urticaria, or angioedema.

• Superinfection

  • Extended use can cause fungal or bacterial overinfections, such as C. difficileassociated diarrhea (CDAD), and pseudomembranous collitis. This has been documented >2 months after antibiotic treatment.

• Carnitine deficiency:

  • Patients with a deficiency in carnitine should not be used.
  • It results in renal excretion.

• Hepatic impairment

  • Patients with hepatic impairment should be cautious.

• Renal impairment

  • Patients with impaired renal function should be cautious.
  • Modify the dosage for moderate or severe renal impairment.

• Seizure disorders:

  • Patients who have a history of epilepsy should exercise caution. The risk can increase if there is severe sepsis, especially if there is renal impairment.

Cefditoren: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Monitor renal function.
• During the initial dose, keep an eye out for any anaphylactic symptoms or signs.

How to administer the drug?

• Administer with meals.

Mechanism of action of Cefditoren (Meiact):

• The final stage of the transpeptidation of peptidoglycan production in bacterial cell walls is inhibited by this protein by binding to one or more penicillin binding proteins (PBPs). Cell wall biosynthesis is hampered by this.
• After stopping the construction of the cell wall, bacteria are destroyed.

Protein binding:

•  88% (in vitro), primarily to albumin

Metabolism:

• Esterases hydrolyze cefditoren pivoxil to produce cefditoren (active) and pivalate; cefditoren itself is not significantly metabolised.

Bioavailability:

• About 14% to 16%, increased by moderate­ to high­fat meal (mean AUC by 70%; maximum plasma concentration by 50%)

Half life elimination:

• 1.6 ± 0.4 hours; increased with moderate (2.7 hours) and severe (4.7 hours) renal impairment

Time to peak:

• 1.5 to 3 hours

Excretion:

•  Urine (as cefditoren and pivaloylcarnitine)

International Brands of Cefditoren:

• Spectracef
• Ceftor
• Ceftoren
• Geralcef
• Giasion
• Hidetron
• Meiact
• Meiacton
• Spacef
• Spektracef
• Telo

Cefditoren Brand Names in Pakistan:

No Brands Available in Pakistan.