cefditoren
Fuentes regulatorias consultadas
Indicaciones aprobadas
- Faringoamigdalitis, sinusitis maxilar, exacerbación de bronquitis crónica, neumonía adquirida en la comunidad e infecciones cutáneas no complicadas.
Contraindicaciones
Absolutas
- Hipersensibilidad a cefditoreno, a otras cefalosporinas o antecedente de reacción inmediata y grave a otro betalactámico.
- Deficiencia primaria de carnitina.
- Hipersensibilidad a proteínas de la leche, porque la presentación contiene caseinato sódico.
Advertencias clínicas
- Advertencia mayor · Puede causar hipersensibilidad grave o anafilaxia; revisa los antecedentes de alergia a betalactámicos y suspende ante una reacción alérgica. — CIMA/AEMPS, ficha técnica 65943
- Advertencia mayor · Puede causar diarrea y colitis por Clostridioides difficile durante o después del tratamiento; evalúa la diarrea importante. — CIMA/AEMPS, ficha técnica 65943
- Advertencia mayor · La sobredosis de cefalosporinas puede causar irritación cerebral y convulsiones; evita la sobredosificación y proporciona tratamiento de soporte si ocurre. — CIMA/AEMPS, ficha técnica 65943
- Advertencia mayor · El grupo pivoxilo reduce la carnitina; está contraindicado en deficiencia primaria de carnitina y no se recomienda el uso prolongado. — CIMA/AEMPS, ficha técnica 65943
Interacciones medicamentosas
- ModeradaProbenecid
Mecanismo: Reduce la eliminación renal y aumenta la exposición a cefditoreno.
Recomendación: Evita la combinación o vigila reacciones adversas.
CIMA/AEMPS, ficha técnica 65943
- SeveraAnticoagulantes orales
Mecanismo: Puede aumentar el tiempo de protrombina y el riesgo de sangrado.
Recomendación: Controla INR o tiempo de protrombina y ajusta el anticoagulante.
CIMA/AEMPS, ficha técnica 65943
- ModeradaAntagonistas de receptores H2
Mecanismo: El aumento del pH gástrico reduce la absorción de cefditoreno.
Recomendación: No se recomienda la administración concomitante.
CIMA/AEMPS, ficha técnica 65943
Eventos adversos
Comunes (≥1%)
Náuseas, diarrea y erupción cutánea
Raros pero graves
Anafilaxia, colitis por C. difficile y citopenias graves
Embarazo y lactancia
Durante el embarazo, usar solo cuando esté clínicamente indicado. Valora la lactancia según la exposición en leche y el estado del lactante descritos en la ficha técnica.
Bibliografía reciente (PubMed)
Cefditoren is an oral third-generation cephalosporin with a large spectrum activity against Gram-negative and Gram-positive bacteria which are reported to be responsible for respiratory tract and skin and skin structure infections. In this work we reviewed the pharmacodynamics, pharmacokinetics, and the main clinical indications of cefditoren. Similarly to other beta-lactams, cefditoren is a time-dependent antibiotic, and its "best" PK/PD target is probably 40% dosing interval time > 4- 5-fold MIC and 40-70% dosing interval time > 4- 5-fold MIC for bacteriostatic and bactericidal effect, respectively. In fasting patients oral bioavailability is low and increases when the drug is taken with food. This cephalosporin has significant bactericidal activity against S. pneumoniae (both penicillin-susceptible and penicillin-resistant strains), S. pyogenes, H. Influenzae and M. catarrhalis, as well as methicillin-susceptible S. aureus (MSSA). Regarding Enterobacterales, cefditoren has very low MICs90 against K. pneumoniae andE. coli but is not active against AmpC-, ESBL- and carbapenemase-producer' strains. Licensed indications are treatment of exacerbations of chronic bronchitis,acute rhinosinusitis, otitis media, upper respiratory tract infections (pharyngitis/tonsillitis), lower community-acquired respiratory tract infections (LRTIs), and skin and skin-structure infections (SSTI). Cefditoren might have a role in switching from parenteral to oral therapy in acute pyelonephritis and LRTIs. with a reduction of adverse effects and hospital costs. Eventually, due to its supposed binding to enterococcal penicillin binding proteins (PBPs) cefditoren, in combination with other beta-lactams, might have a role in partial oral enterococcal endocarditis treatment..
The 2011 Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases guidelines recommend ciprofloxacin or sulfamethoxazole-trimethoprim (SMX-TMP) as first-line agents to treat uncomplicated acute pyelonephritis (APN). With increasing antimicrobial resistance rates and recent changes in practice patterns, the objective of this systematic review was to describe the effectiveness of cephalosporins for uncomplicated APN in more recently published literature. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting. We searched PubMed, Embase, and Scopus for publications between January 2010 and September 2022. Eligible articles detailed patients with uncomplicated APN, treated with first- to fourth-generation cephalosporins, and identified a clinical, microbiological, or health care utilization outcome. Studies with more than 30% of complicated APN patients, non-English-language studies, case reports, case series, pharmacodynamic or pharmacokinetic studies, and in vitro laboratory or animal studies were excluded. Screening, review, and extraction were performed independently by 2 researchers, plus a third for conflict resolution. Critical appraisal of studies was performed using Joanna Briggs Institute checklists. Eight studies met inclusion, including 5 cohort studies (62.5%), 2 randomized controlled trials (25%), and 1 nonrandomized experimental study (12.5%). Cephalosporins most used across the studies included cefazolin, cephalexin, cefuroxime, cefotaxime, cefdinir, cefditoren, and ceftriaxone. Outcomes assessed were diverse, including clinical or microbiological success and time to defervescence or symptom resolution. Cephalosporins displayed effectiveness for the treatment of acute uncomplicated APN regardless of study design or the presence of a comparison group. No trials reported inferiority of clinical treatment outcomes compared with a fluoroquinolone or SMX-TMP. Ce
Lower respiratory tract infections, including chronic obstructive pulmonary disease exacerbations (COPD-E) and community acquired pneumonia (CAP), are one of the most frequent reasons for consultation in primary care and hospital emergency departments, and are the cause of a high prescription of antimicrobial agents. The selection of the most appropriate oral antibiotic treatment is based on different aspects and includes to first consider a bacterial aetiology and not a viral infection, to know the bacterial pathogen that most frequently cause these infections and the frequency of their local antimicrobial resistance. Treatment should also be prescribed quickly and antibiotics should be selected among those with a quicker mode of action, achieving the greatest effect in the shortest time and with the fewest adverse effects (toxicity, interactions, resistance and/or ecological impact). Whenever possible, antimicrobials should be rotated and diversified and switched to the oral route as soon as possible. With these premises, the oral treatment guidelines for mild or moderate COPD-E and CAP in Spain include as first options beta-lactam antibiotics (amoxicillin and amoxicillin-clavulanate and cefditoren), in certain situations associated with a macrolide, and relegating fluoroquinolones as an alternative, except in cases where the presence of Pseudomonas aeruginosa is suspected. Las infecciones del tracto respiratorio inferior, incluyendo las exacerbaciones de la enfermedad pulmonar obstructiva crónica (EPOC) y la neumonía adquirida en la comunidad (NAC), son uno de los motivos de consulta más frecuentes en atención primaria y los servicios de urgencias hospitalarios, y son la causa de una elevada prescripción de antimicrobianos. La selección del tratamiento oral más adecuado con antibióticos se basa en diferentes aspectos e incluye considerar en primer lugar una etiología bacteriana y no una infección vírica, conocer los patógenos bacterianos que más frecuentemente ca
COPD (chronic obstructive pulmonary disease) includes patients with chronic bronchitis and / or emphysema who have in common the presence of a chronic and progressive airflow obstruction, with symptoms of dyspnea and whose natural history is modified by acute episodes of exacerbations. Exacerbation (EACOPD) is defined as an acute episode of clinical instability characterized by a sustained worsening of respiratory symptoms. It is necessary to distinguish a new EACOPD from a previous treatment failure or a relapse. EACOPD become more frequent and intense over time, deteriorating lung function and quality of life. The diagnosis of EACOPD consists of 3 essential steps: a) differential diagnosis; b) establish the severity, and c) identify its etiology. The main cause of exacerbations is infection, both bacterial and viral. Antibiotics are especially indicated in severe EACOPD and the presence of purulent sputum. Beta-lactams (amoxicillin-clavulanate and cefditoren) and fluoroquinolones (levofloxacin) are the most widely used antimicrobials. This review updates the problem of acute exacerbation with infectious origin from the perspective of etiology, antimicrobial resistance, microbiological studies, risk stratification, and antimicrobial management. The risk, prognosis and characteristics of COPD patients who develop COVID19 are analyzed. La enfermedad pulmonar obstructiva crónica (EPOC) incluye a los pacientes con bronquitis crónica y/o enfisema que tienen en común a presencia de una obstrucción crónica y progresiva al flujo aéreo, con clínica de disnea y cuya historia natural se ve modificada por episodios agudos de exacerbaciones. La exacerbación (EAEPOC) se define como un episodio agudo de inestabilidad clínica caracterizado por un empeoramiento mantenido de síntomas respiratorios. Es necesario distinguir una nueva EAEPOC de un fracaso terapéutico previo o de una recaída. Las EAEPOC se hacen con el tiempo más frecuentes e intensas deteriorando la función pulmonar y