Cefixime: Potent Oral Cephalosporin for Bacterial Infections
Cefixime is a third-generation cephalosporin antibiotic indicated for the treatment of susceptible bacterial infections. It exerts bactericidal activity by inhibiting bacterial cell wall synthesis, making it a reliable choice for clinicians managing a range of community-acquired infections. Its oral bioavailability and extended half-life support convenient once or twice-daily dosing, enhancing patient adherence. This agent demonstrates particular efficacy against common Gram-negative pathogens while retaining activity against some Gram-positive organisms.
Features
- Third-generation cephalosporin antibiotic
- Available as oral tablets, chewable tablets, and powder for suspension
- Bactericidal mechanism via inhibition of cell wall synthesis
- Acid-stable with good oral bioavailability
- Extended serum half-life permitting once or twice-daily dosing
- Spectrum includes coverage of beta-lactamase producing strains
Benefits
- Effective against common respiratory pathogens including Streptococcus pneumoniae and Haemophilus influenzae
- Reliable treatment for uncomplicated urinary tract infections caused by Escherichia coli and Proteus mirabilis
- Clinical efficacy in managing otitis media and acute bacterial exacerbations of chronic bronchitis
- Convenient dosing regimen supports improved patient compliance
- Generally well-tolerated with a favorable safety profile
- Useful alternative for patients with penicillin allergies (with appropriate caution)
Common use
Cefixime is commonly prescribed for the treatment of acute bacterial otitis media caused by Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. It is also indicated for pharyngitis and tonsillitis attributable to Streptococcus pyogenes, though penicillin remains the preferred agent for streptococcal pharyngitis. In genitourinary medicine, cefixime demonstrates efficacy against uncomplicated urinary tract infections caused by Escherichia coli and Proteus mirabilis. Additionally, it is employed in the management of acute exacerbations of chronic bronchitis when caused by susceptible strains of Streptococcus pneumoniae and Haemophilus influenzae.
Dosage and direction
The recommended dosage of cefixime varies according to the infection being treated, patient age, renal function, and formulation. For adults and children weighing more than 50 kg, the typical dose is 400 mg daily, which may be administered as a single dose or divided as 200 mg every 12 hours. For otitis media, the recommended pediatric dosage is 8 mg/kg/day of the suspension, administered either once daily or divided every 12 hours. Patients with renal impairment (creatinine clearance <60 mL/min) require dosage adjustment, typically 300 mg once daily as a maximum dose. Tablets should be swallowed whole with water, while the suspension must be shaken well before each administration.
Precautions
Exercise caution when prescribing cefixime to patients with documented hypersensitivity to cephalosporins, penicillins, or other beta-lactam antibiotics due to potential cross-reactivity. Use with caution in patients with gastrointestinal disease, particularly colitis, as antibiotic use may predispose to Clostridium difficile-associated diarrhea. Monitor renal function periodically during prolonged therapy, as dosage adjustments may be necessary in patients with compromised renal function. Elderly patients may require dosage adjustments based on renal function. Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi.
Contraindications
Cefixime is contraindicated in patients with known hypersensitivity to cefixime, any component of the formulation, or other cephalosporin antibiotics. Do not administer to patients who have experienced anaphylactic reactions to penicillins or other beta-lactam antibiotics. The chewable tablet formulation contains aspartame and is contraindicated in patients with phenylketonuria. Avoid use in patients with a history of severe gastrointestinal disease, including antibiotic-associated colitis.
Possible side effect
The most frequently reported adverse reactions involve the gastrointestinal system, including diarrhea (16%), nausea (7%), abdominal pain (3%), and dyspepsia (3%). Dermatological reactions may occur, with rash developing in approximately 3% of patients. Headache and dizziness have been reported in 2% and 1.5% of patients respectively. Transient elevations in liver enzymes occur in approximately 2-3% of patients. Less common side effects include vaginal candidiasis, transient neutropenia, and eosinophilia. Serious but rare adverse effects include pseudomembranous colitis, anaphylaxis, and Stevens-Johnson syndrome.
Drug interaction
Probenecid may decrease renal tubular secretion of cefixime, resulting in increased and prolonged blood levels. Carbamazepine concentrations may be elevated when co-administered with cefixime, requiring monitoring and possible dosage adjustment. Oral anticoagulants may have enhanced effects when taken concurrently with cefixime, necessitating close monitoring of prothrombin time. Concomitant use with potent diuretics may increase the risk of nephrotoxicity. Cefixime may reduce the efficacy of oral contraceptives; recommend additional contraceptive methods during therapy.
Missed dose
If a dose of cefixime is missed, it should be taken as soon as possible. However, if it is almost time for the next scheduled dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed administration. Maintaining consistent blood levels is important for therapeutic efficacy, so patients should be instructed to establish a routine for medication administration.
Overdose
In cases of cefixime overdose, gastric lavage may be considered if performed soon after ingestion. Symptoms of overdose may include nausea, vomiting, epigastric distress, and diarrhea. Hemodialysis may remove cefixime from the circulation, particularly in patients with renal impairment. Management should be supportive and symptomatic, with particular attention to hydration status and electrolyte balance. There is no specific antidote for cefixime overdose.
Storage
Store cefixime tablets at controlled room temperature (20-25°C/68-77°F) in a tightly closed container, protected from light and moisture. The powder for oral suspension should be stored at room temperature before reconstitution. After reconstitution, the suspension should be stored in the refrigerator (2-8°C/36-46°F) and discarded after 14 days. Keep all medications out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. The prescribing physician should be consulted for diagnosis and treatment decisions regarding any medical condition. Dosage and administration should be determined by a qualified healthcare professional based on the individual patient’s condition, renal function, and susceptibility of the causative organisms. The complete prescribing information should be reviewed before initiating therapy.
Reviews
Clinical studies demonstrate cefixime’s efficacy with bacterial eradication rates exceeding 85% for susceptible organisms in otitis media and urinary tract infections. Physicians report satisfactory clinical outcomes in community-acquired respiratory infections, particularly noting the convenience of once-daily dosing. Microbiological studies confirm maintained susceptibility among common pathogens in many regions, though resistance patterns should be monitored locally. Patient satisfaction surveys indicate preference for the taste-masked suspension formulation in pediatric populations compared to other antibiotic suspensions.