Third-generation oral cephalosporin
ATC code: J01DD16 (Cefditoren)
Brand names
Spectracef, Meiact
A bactericidal antibiotic that disrupts bacterial peptidoglycan synthesis by binding penicillin-binding proteins (PBPs). Active against Streptococcus pneumoniae (including penicillin-intermediate strains), Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Stable to most gram-negative beta-lactamases. Cefditoren pivoxil is a prodrug converted by intestinal esterases to active cefditoren. In Spain, it is widely prescribed for respiratory infections under brands Spectracef and Meiact.
Second line
Used in moderate acute bacterial sinusitis as an alternative to amoxicillin/clavulanate when penicillins are intolerable without prior anaphylaxis. Dose 400 mg twice daily for 5–7 days. 2012 and the Spanish SEORL 2023 consensus place cefditoren in the second-line group alongside and . In patients without risk factors, antibiotics for acute sinusitis are often unnecessary – most cases are viral and resolve in 7–10 days.
Second line
Alternative for non-severe outpatient community-acquired pneumonia. Dose 400 mg twice daily for 5 days. SEPAR 2024 first-line is amoxicillin 1 g three times daily, with azithromycin added when atypical pathogens are suspected. Cefditoren is used in confirmed amoxicillin resistance or allergy. Patients with severe pneumonia and risk factors need admission and parenteral therapy.
Second line
Used in bacterial COPD exacerbations meeting two or more Anthonisen criteria (worsening dyspnea, increased sputum volume and purulence). Cefditoren is listed in Spanish GesEPOC 2021 as an alternative to amoxicillin/clavulanate. Dose 400 mg twice daily for 5–7 days. Not used in severe COPD with risk factors for Pseudomonas aeruginosa – ciprofloxacin or levofloxacin is preferred.
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
Not recommended
Cefditoren pivoxil is prescribed for acute pharyngitis and upper respiratory infections without confirmed bacterial etiology. 2024 AWaRe places oral third-generation cephalosporins in the Watch category. NG191 2020 does not recommend antibiotics for acute bronchitis in immunocompetent adults. The AEMPS Ficha Técnica confines cefditoren to confirmed GAS tonsillopharyngitis, chronic bronchitis exacerbation, uncomplicated pneumonia and skin infections.
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FDA category B. Limited pregnancy data. When antibiotic therapy is needed in pregnancy, amoxicillin or cefuroxime with more pregnancy data are preferred.
Milk concentrations are low. Lactation use is acceptable when indicated; transient infant diarrhea is possible.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
Cefditoren pivoxil is evaluated for the following indications with varying evidence strength: Community-acquired pneumonia (evidence tier B), Acute bacterial rhinosinusitis (evidence tier B), COPD exacerbation (evidence tier B). See the full indication matrix with dosing and citations above on this page.
Common side effects of Cefditoren pivoxil (≥ 1 in 100): Diarrhea (8–15%), Nausea, Abdominal pain, Headache, Vaginal candidiasis. See the Safety section for uncommon and serious reactions.
FDA category B. FDA category B. Limited pregnancy data. When antibiotic therapy is needed in pregnancy, amoxicillin or cefuroxime with more pregnancy data are preferred.
Milk concentrations are low. Lactation use is acceptable when indicated; transient infant diarrhea is possible.
Cefditoren pivoxil is contraindicated in: Cephalosporin hypersensitivity; History of penicillin anaphylaxis; Primary carnitine deficiency (pivoxil ester depletes carnitine). Full list in the Safety section.