Cefodizime: safety profile in patients with comorbidities

The aim. To evaluate the safety profile of cefodizime in comparison with ceftriaxone and amoxicillin/clavulanic acid based on an analysis of current literature data.

Materials and methods. A literature search was conducted among randomized controlled trials, cohort studies, meta-analyses, and clinical guidelines for the period from 2021 to 2026 in the PubMed database.

Results. The analysis of publications and one clinical guideline revealed that the safety profile of cefodizime in comorbid patients is more favorable compared to ceftriaxone and amoxicillin / clavulanic acid. The use of ceftriaxone is associated with a dose-dependent and duration-dependent risk of developing biliary pseudolithiasis, cholestatic hepatitis, nephrolithiasis, and crystalluria, especially in patients with risk factors such as decompensated comorbidities, dehydration, starvation, and polypharmacy. Amoxicillin/clavulanic acid remains one of the leading causes of drug-induced liver injury, including cholestatic forms, and also demonstrates clinically significant interactions with vitamin K antagonists and direct oral anticoagulants. No convincing data on hepatotoxicity or nephrotoxicity or clinically significant interactions with oral anticoagulants were found for cefodizime, including in patients with hepatobiliary and urinary system pathology. However, the limited volume of clinical studies requires further investigation of its safety in larger cohorts.

Conclusion. Cefodizime, ceftriaxone, and amoxicillin / clavulanic acid are effective in comorbid patients; however, their safety profiles differ. Cefodizime is characterized by a lack of data on hepatotoxicity and nephrotoxicity and does not demonstrate clinically significant drug interactions with oral anticoagulants, unlike ceftriaxone and amoxicillin / clavulanic acid. At the same time, the limited number of clinical studies on cefodizime requires further investigation of its safety profile in larger cohorts of comorbid patients.

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