Ceftibuten

General

  • Type: Third generation cephalosporin
  • Dosage Forms: capsule, oral suspension
  • Dosage Strengths: capsule: 400mg; oral suspension: 90mg/5mL, 180mg/5mL
  • Routes of Administration: PO
  • Common Trade Names: Cedax

Adult Dosing

Chronic bronchitis, acute exacerbation

  • 400mg PO qd x10 days

Otitis media, acute

  • 400mg PO qd x10 days

Pharyngitis/Tonsillitis, streptococcal

  • 400mg PO qd x10 days

Pediatric Dosing

Otitis media, acute

  • 6 mo - 11 yo, <45kg
    • 9 mg/kg PO qd x10 days
    • Max: 400 mg/day
  • 12+ yo, >45kg
    • 400mg PO qd x10 days

Pharyngitis/Tonsillitis, streptococcal

  • 6 mo - 11 yo, <45kg
    • 9 mg/kg PO qd x10 days
    • Max: 400 mg/day
  • 12+ yo, >45kg
    • 400mg PO qd x10 days

Pneumonia, Community-acquired

  • 6 mo - 11 yo, <45kg
    • 9 mg/kg PO qd x10 days
    • Max: 400 mg/day
  • 12+ yo, >45kg
    • 400mg PO qd x10 days

Special Populations

  • Pregnancy Rating: B
  • Lactation: Probably safe
  • Renal Dosing
    • Adult
      • CrCl 30-49: 200mg qd
      • CrCl 5-29: 100mg qd
      • CrCl <5: Not defined
      • HD: 400mg after each dialysis
      • PD: No supplement
    • Pediatric
      • CrCl 30-49: 4.5 mg/kg qd, max 200mg/day
      • CrCl 5-29: 2.25 mg/kg qd, max 100mg/day
      • CrCl <5: Not defined
      • HD: 9mg/kg after each dialysis, max 400mg;day
      • PD: No supplement
  • Hepatic Dosing
    • Adult
      • Not defined
    • Pediatric
      • Not defined

Contraindications

  • Hypersensitivity to class/drug
  • Caution:
    • Hypersensitivity to PCN
    • Renal impairment
    • Concurrent nephrotoxic agent
    • Seizure disorder
    • Recent antibiotic-associated colitis

Adverse Reactions

Serious

  • Allergy to class/drug
  • Serum sickness-like reaction
  • Stevens-Johnson syndrome
  • Exfoliative dermatitis
  • Erythema multiforme
  • Toxic epidermal necrolysis
  • Interstitial nephritis
  • Superinfection
  • C. difficile associated diarrhea
  • Seizure
  • Pancytopenia

Common

Pharmacology

  • Half-life: 2-2.5 hr; 13.4 hr if CrCl 5-29
  • Metabolism: Other
  • Excretion: Urine 56%, Feces 39%
  • Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis

Antibiotic Sensitivities[1]

Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GS
Strep. PneumoniaeI
Viridans strepR
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumX1
MSSAR
MRSAR
CA-MRSAR
Staph. EpidermidisR
C. jeikeiumR
L. monocytogenesR
Gram NegativesN. gonorrhoeaeI
N. meningitidisI
Moraxella catarrhalisS
H. influenzaeS
E. coliS
Klebsiella spS
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negI
Enterobacter sp, AmpC posR
Serratia spI
Serratia marcescensX1
Salmonella spS
Shigella spS
Proteus mirabilisS
Proteus vulgarisS
Providencia sp.S
Morganella sp.R
Citrobacter freundiiR
Citrobacter diversusS
Citrobacter sp.S
Aeromonas spS
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaS
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaS
Francisella tularensisX1
Brucella sp.X1
Legionella sp.R
Pasteurella multocidaX1
Haemophilus ducreyiX1
Vibrio vulnificusX1
MiscChlamydophila spX1
Mycoplasm pneumoniaeX1
Rickettsia spX1
Mycobacterium aviumX1
AnaerobesActinomycesX1
Bacteroides fragilisR
Prevotella melaninogenicaX1
Clostridium difficileX1
Clostridium (not difficile)X1
Fusobacterium necrophorumX1
Peptostreptococcus sp.X1

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014
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