Cefteram

General

• Type: 3rd generation Cephalosporin
• Dosage Forms: Tablet, Fine Granules
• Dosage Strengths: 50mg, 100mg; 10% Granules
• Routes of Administration: PO
• Common Trade Names: Tomiron

Adult Dosing

General

• Standard: 50-100mg PO q8h (TID)
• Severe/Refractory: 200mg PO q8h (TID)
• Administration: Take after meals to improve absorption
• Max: 600mg/day

Respiratory Tract Infections (Pneumonia, Bronchitis)

• 100mg PO q8h

UTI, Uncomplicated (Cystitis)

• 50-100mg PO q8h

Pharyngitis / Tonsillitis

• 100mg PO q8h

Acute Otitis Media

• 100mg PO q8h

Pediatric Dosing

General

• Standard: 3mg/kg/dose PO q8h (TID)
• Severe/Refractory: May increase to 6mg/kg/dose PO q8h (TID)
• Administration: Take after meals
• Max: 600mg/day (or adult maximum)

Special Populations

• Pregnancy: Safety not established; use only if benefit outweighs risk
• Lactation: Excreted in breast milk; use with caution
• Renal
  • Adult & Pediatric
    • Renal impairment delays excretion.
    • Severe impairment (CrCl < 30): Reduce dose or extend interval (e.g., q12h or q24h)
    • Hemodialysis: Supplement likely required after dialysis
• Hepatic
  • No specific adjustment defined

Contraindications

• Allergy to class/drug (Cephalosporins)
• History of anaphylactic shock
• Primary Carnitine deficiency (due to pivoxil group)

Adverse Reactions

Serious

• Anaphylaxis
• Stevens-Johnson Syndrome
• Toxic Epidermal Necrolysis
• Clostridium difficile / Pseudomembranous colitis
• Hypocarnitinemia (Associated with hypoglycemia and encephalopathy, particularly in children)
• Renal failure

Common

• Diarrhea
• Abdominal Pain
• Nausea
• Rash
• Elevation of LFTs (ALT/AST)
• Eosinophilia

Pharmacology

• Half-life: ~1 hour
• Metabolism: Hydrolyzed in the intestinal wall/serum from prodrug (cefteram pivoxil) to active cefteram
• Excretion: Urine (approx 30%) and Bile
• Mechanism of Action: Bactericidal; inhibits cell wall mucopeptide synthesis.
• Notes: The pivoxil moiety is eliminated as pivalic acid, which conjugates with carnitine, potentially leading to carnitine depletion with long-term use.

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	R
	MSSA	S
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	I
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	S
	N. meningitidis	S
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	I
	Enterobacter sp, AmpC pos	R
	Serratia sp	I
	Serratia marcescens	I
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	S
	Citrobacter freundii	R
	Citrobacter diversus	I
	Citrobacter sp.	R
	Aeromonas sp	I
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	X1
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	R
	Mycoplasm pneumoniae	R
	Rickettsia sp	R
	Mycobacterium avium	R
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	I
	Clostridium difficile	R
	Clostridium (not difficile)	I
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

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

• Antibiotics (Main)