Cefixime is an oral broad-spectrum third-generation cephalosporin available by the brand name of Cefim, Cefspan, and Suprax among others. It treats most urinary, respiratory, and abdominal infections.

Cefixime Indications:

• Treatment of uncomplicated urinary tract infections caused by:

  • Escherichia coli
  • Proteus mirabilis

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• Treatment of otitis media caused by

  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Streptococcus pyogenes

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• Pharyngitis and tonsillitis caused by:

  • Streptococcus pyogenes

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• Acute exacerbations of chronic bronchitis caused by:

  • Streptococcus pneumoniae
  • Haemophilus influenzae

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• Uncomplicated cervical & urethral gonorrhea caused by:

  • Penicillinase- and non-penicillinase-producing N. gonorrhea.

Note: Ceftriaxone in combination with azithromycin is the preferred cephalosporin for gonorrhea.

• Off Label Use of Cefixime in Adults include:

  • Uncomplicated Gonococcal infection of the rectum;
  • Acute bacterialRhinosinusitis
  • Typhoid fever

Cefixime Dose in Adults 

• The usual Cefixime dosage range in adults:

  • 400 mg orally daily in one or two divided doses.

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• Cefixime dose for uncomplicated Gonococcal infection of the cervix, urethra or rectum:

  • 400 mg orally (as a single dose) in combination with oral azithromycin.

• Cefixime dose in the treatment of expedited partner therapy of Gonococcal infection:

  • 400 mg orally (as a single dose) in combination with oral azithromycin.

• For penicillin-allergic patients who can tolerate cephalosporins, cefixime dose is an alternate treatment for acute bacterial rhinosinusitis.:

  • For 5–7 days, take 400 mg orally once every day. If pneumococcal resistance is thought to exist, clindamycin may be added.

• Cefixime dose in Group A Streptococcal pharyngitis as an alternative agent:

  • 400 mg orally once a day for 10 days.

• Cefixime dosage in the treatment of Typhoid fever:

  • For 7 to 14 days, take 100 to 200 mg orally twice daily (WHO 2003). Higher rates of medication failure were, however, observed [Ref].
  • The majority of specialists advise giving a dosage of 15–20 mg/kg in two evenly spaced doses for at least 10 days.
     

Although the maximum recommended daily dose is 400 mg, most patients in Pakistan receiving cefixime treatment for typhoid fever are given an 800 mg daily dose due to the drug's dubious efficacy at lower levels.

• Cefixime as a substitute medication for treating urinary tract infections:

  • Use in treatment of acute uncomplicated Cystitis:

    • 400 mg orally once a day for 7 days

  • Use in treatment of Complicated Urinary Tract Infection including pyelonephritis:

    • 400 mg orally once a day for 10 - 14 days.

Cefixime Dose in Children

• Cefixime general dosing in susceptible mild to moderate infections:

  • Infants, Children, and Adolescents:
    • 8 mg/kg/day orally in one or two divided doses to a maximum daily dose of 400 mg/day.

• Cefixime dose in the treatment of low-risk Febrile neutropenia:

  • Infants, Children, and Adolescents:
    • 8 mg/kg/day orally in one or two divided doses to a maximum daily dose of 400 mg/day.
    • Oral cefixime therapy should be started when the patient is afebrile for 48 - 72 hours while on empiric parenteral therapy.
    • The first dose of oral cefixime should be administered at the end of the last injection/ infusion.
    • If the patient vomits within two hours of receiving oral cefixime, the dose should be repeated.

• Cefixime dose in the treatment of uncomplicated Gonococcal infection of the cervix, urethra, or rectum:

  • Children more than 45 kgs and Adolescents:
    • 400 mg orally as a single dose in combination with a single dose of oral azithromycin

• Cefixime dose in the prophylaxis of Irinotecan-associated diarrhea:

  • Infants, Children, and Adolescents:
    • 8 mg/kg orally once a day.
    • Therapy should begin 5 days before oral irinotecan therapy and continue throughout the course.

• Cefixime dose in the treatment of acute Otitis media:

  • Infants, Children, and Adolescents:
    • 8 mg/kg/day orally in one or two divided doses to a maximum daily dose of 400 mg/day.

• Cefixime dose in the treatment of Pharyngitis or tonsillitis caused by Strep. pyogenes:

Note: Not a preferred therapy as per IDSA Guidelines

• Infants, Children, and Adolescents:
  • 8 mg/kg/day orally in one or two divided doses for 10 days or more to a maximum daily dose of 400 mg/day.

• Cefixime dose in the treatment of mild community-acquired Pneumonia caused by Haemophilus influenza types A-F or non-typeable or as step-down therapy after parenteral antibiotics:

  • Infants older than 3 months, Children, and Adolescents:
    • 8 mg/kg/day orally in one or two divided doses to a maximum daily dose of 400 mg/day.

• Cefixime dose in the treatment of acute bacterial Rhinosinusitis:

  • Infants, Children, and Adolescents:
    • 4 mg/kg/dose orally twice daily with concomitant clindamycin for 10 -14 days to a maximum daily dose of 400 mg/day.

• Cefixime dose in the treatment of Typhoid fever caused by Salmonella typhi:

  • Infants, Children, and Adolescents:
    • 15 - 20 mg/kg/day in two divided doses for 7 - 14 days.

• Cefixime dose in the treatment of acute Urinary tract infection:

  • Manufacturer's labeling:

    • Infants older than 6 months, Children, and Adolescents:
      • 8 mg/kg/day in one or two divided doses to a maximum daily dose of 400 mg/day.

  • Alternate dosing:

    • Infants older than 2 months and Children less than 2 years:
      • 8 mg/kg/day once a day for 7 - 14 days

Pregnancy Risk Factor B

• Cefixime crosses over the placental barrier to enter the amniotic liquid, but no adverse effects on fetal health have been observed.
• It can also be used to treat certain infections in pregnancy.

Cefixime use during breastfeeding:

• It is unknown if cefixime can be absorbed into breastmilk. According to manufacturer's instructions, breastfeeding could be temporarily stopped.

Cefixime dose in renal disease:

• CrCl of 60 mL/minute or more:

  • Dosage adjustment is not necessary.

• CrCl 21 - 59 mL/minute:

  • Oral suspensions may be used in a dose of 260 mg once daily

• CrCl of less than 20 mL/minute:

  • Chewable tablet: 200 mg once a day
  • 100 mg/5 mL suspension: 172 mg once a day
  • 200 mg/5 mL suspension: 176 mg once a day
  • 500 mg/5 mL suspension: 180 mg once a day

• Intermittent hemodialysis (not removed by hemodialysis):

  • Suspension: 260 mg once a day

• CAPD (not removed by peritoneal dialysis):

  • Chewable tablet: 200 mg once a day
  • 100 mg/5 mL suspension: 172 mg once a day
  • 200 mg/5 mL suspension: 176 mg once a day
  • 500 mg/5 mL suspension: 180 mg once a day

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Renal Dose adjustment as per Canadian labeling:

• CrCl of 40 mL/minute or more:

  • Dosage adjustment is necessary

• CrCl 20 - 40 mL/minute:

  • Administer 75% of recommended daily dose

• CrCl less than 20 mL/minute:

  • Administer half the recommended dose.

Dose in Liver disease:

The manufacturer has not recommended any dose adjustment in patients with liver disease.

Common Side Effects Of Cefixime Include:

• Gastrointestinal:
  • Diarrhea

Less Common Side Effects Of Cefixime Include:

• Gastrointestinal:
  • Abdominal pain
  • Nausea
  • Dyspepsia
  • Flatulence
  • Loose stools

Contraindication to Cefixime include:

• Allergy reactions to cefixime, penicillins, and other cephalosporins.

Warnings and Precautions

• Dermatologic reactions

  • Drug rash with eosinophilia and systemic symptoms (DRESS), toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and other severe drug responses have been documented.
  • If cutaneous signs and symptoms develop, it is important to stop using the therapy immediately.

• Hemolytic anemia

  • Cefixime therapy has been linked to immune-mediated hemolytic anemias.
  • You can have your hemoglobin and antibody tests done every 2 to 3 weeks.
  • Patients who have previously experienced hemolytic anaemia brought on by cephalosporins should use the medication with caution since a repeat of the condition (hemolytic anaemia) could be fatal.

• Hypersensitivity

  • Cefixime therapy can cause severe allergic reactions, especially for penicillin- and cephalosporin-allergic patients. 
  • If allergic reactions are detected, therapy should be stopped immediately.

• Failure of the renal system:

  • Patients with kidney disease must be cautious when using the drug. The dose should also be adjusted.

• Superinfection

  • Cefixime-treated patients for more than two months may contract superinfections, including fungal or bacterial superinfections. 
  • C. difficile-associated diarrhea, (CDAD), and pseudomembranous collitis can occur.

• Gastrointestinal Disease:

  • Patients who have had colitis in the past should not take this drug.

Monitor:

• Renal function
• Liver function
• Observe for clinical features of anaphylaxis during first dose
• The CDC advises against using test-of-cure as a substitute therapy for gonococcal infection.

How to take Cefixime?

• Shake the oral suspension prior to its use. Chewable tablets may be crushed or chewed before swallowing.
• It can be administered with or without regard to meals.

Cefixime Mechanism of Action:

• Cefixime blocks the formation of proteins, peptidoglycans and penicillin-binding proteins.
• This eventually leads to cell lysis through the autolytic enzymes.

40% to 50% of the drug is absorbed. It is distributed widely throughout the body tissues and reaches therapeutic concentrations in most body fluids including synovial fluid, peritoneal, pleural, and pericardial fluids. It can also penetrate the bile and sputum, bone and gallbladder, myocardium as well as the skin and soft tissues. 65% of the drug is protein -bound. The half-life elimination is 3 - 4 hours. It is increased to 6.4 and 11.5 hours in moderate (CrCl of 20 - 40 ml/min) and severe renal failure respectively. It is nowReach your peak serum concentrationThe suspension takes 2 to 6 hours and the capsule takes 3 to 8 hours. It may take longer if taken with food. Oral suspensions and tablets Chewable are available.bioequivalentHowever, both the oral suspension as well as the capsules cannot be considered bioequivalent. It isexcretedPrimarily, the active drug is absorbed through urine.

Cefixime Brand Names International:

• Auro-Cefixime
• Suprax
• Aerocef
• Anfix
• Bicebid
• Cavlis
• Cefarox
• Cefexin
• Ceffix
• Cefiac
• Cefiget
• Cefim
• Cefimark
• Cefime
• Cefirax
• Cefix
• Ceforal
• Cefrax
• Cefspan
• Ceftoral
• Cephoral
• Cerafix
• Cexim
• Cexima
• Chifix
• Cifacure
• Cifex
• Denvar
• Devoxim
• Edixim
• Eficef
• Fix A
• Fixcef
• Fixef
• Fixim
• Fixime
• Fixiphar
• Fixx
• Hafixim
• Innoxime
• Ixime
• Lanfix
• Longacef
• Magnacef
• Maxicef
• Maxpro
• Minixime
• Mycefix
• Neocef
• Novacef
• Oralcef
• Oroken
• Pancef
• Profim
• Refix
• Septipan
• Simfix
• Sixime
• Sofix
• Spaxim
• Starcef
• Supracef
• Supran
• Suprax
• Tadix
• Taxocef-O
• Tergecef
• Tocef
• Topcef
• Tricef
• Ultraxime
• Urticef
• Vipime
• Winex
• Xifia
• Ximacef
• Yafix
• Zefral

Cefixime brands in Pakistan: