Middle ear fluid (MEF) levels of cefpodoxime in pediatric patients with acute otitis media (AOM)

The penetration of cefpodoxime into the middle ear of 26 pediatric patients (age, 6 mo to 9 yr) with AOM was evaluated after administration of cefpodoxime proxetil oral suspension 5 mg/kg bid or 10 mg/kg qd. After at least one complete day of treatment, tympanocentesis was performed during a 2-8 hr interval after the morning dose; a blood sample was collected at the same time as the MEF. Drug concentrations in MEF and plasma were determined using a HPLC method with tandem mass selective detection. Median (range) cefpodoxime concentrations in MEF are shown in the following table: 5 mg/kg bid (N=12) 10 mg/kg qd (N=14) Collection Time(hr) n Conc(μg/mL) n Conc (μg/mL) 2-4 4 2.49 (2.0-3.3) 2 1.70 (1.5, 1.9) 4-6 5 0.50 (0.35-1.6) 6 3.24 (2.1-12.2) 6-8 7 0.97 (0.33-1.2) 8 2.21 (0.20-4.1) The MEF/plasma cefpodoxime concentration ratio ranged from 0.25 to 2.6 and from 0.13 to 3.2 in the 5 mg/kg bid and 10 mg/kg qd groups, respectively. MEF cefpodoxime levels ≥0.50 μg/mL were attained in 88% of the patients. These levels exceed the minimum inhibitory concentration for the majority of S pneumoniae, H influenzae, and M catarrhalis isolates, the most common etiological agents of AOM, and thus support cefpodoxime's utility in treating this disease.