Periodontal Tissue Distribution of Cefpodoxime Proxetil and Efficacy in Acute Odontogenic Infections

Abstract

The tissue penetration and clinical efficacy of Cefpodoxime proxetil, a third generation cephalosporin, were studied in odontoiatric patients. Drug concentrations in plasma, saliva, gingiva and alveolar bone were evaluated in 15 patients treated with Cefpodoxime proxetil 400mg (expressed as Cefpodoxime equivalents) administered orally as a single dose, and measured microbiologically using Proteus mirabilis ATCC 21100 as the reference organism. The maximum concentration (Cmax) in plasma was 4.80 mg/L, while Cmax values in gingiva and alveolar bone were 1.51 and 0.82 mg/kg, respectively. These values are above the mean inhibitory concentrations for susceptible pathogens responsible for most odontogenic infections. On the other hand, low levels of Cefpodoxime were detected in saliva (Cmax 0.07 mg/L). Values of the area under the concentration-time curve were calculated from mean concentration-time curves of plasma, gingiva, alveolar bone and saliva, and were 10.13 mg/L/h, 3.26 mg/kg/h, 1.52 mg/kg/h and 0.16 mg/L/h, respectively. 31 patients affected by acute odontogenic infections were treated orally with Cefpodoxime proxetil 100mg (expressed as Cefpodoxime equivalents) twice daily for 5 days. An excellent or good clinical response was obtained in 96.7% of patients overall. Cefpodoxime proxetil was well tolerated in almost all patients; 3 subjects reported adverse reactions consisting of mild nausea, diarrhoea and itching of the hands. On the basis of drug distribution and clinical data, it may be concluded that Cefpodoxime proxetil achieves bactericidal levels in oral tissues and is an effective treatment for odontogenic infections.