From the Guidelines
Cefixime is not the first-line treatment for tonsillitis in children, as penicillin or amoxicillin are recommended as the first-line treatment by the American Academy of Pediatrics 1. However, if the child is allergic to penicillin or has a history of recurrent infections, cefixime may be considered as an alternative. The recommended dose of cefixime for children is 8 mg/kg/day, up to a maximum of 400 mg/day, given once daily for 10 days. It's essential to note that cefixime should only be used under the guidance of a healthcare professional, and the diagnosis of bacterial tonsillitis should be confirmed before initiating treatment.
Key Points to Consider
- Penicillin V is recommended for 10 days, with a dosage of twice or three times daily 1
- Short-duration treatment with newer antibiotics (2-6 days) may have slightly better clinical outcomes, but also more side effects, particularly gastrointestinal issues [@103@]
- Cefixime may be considered for children with a history of recurrent infections or penicillin allergy, but its use should be guided by a healthcare professional 1
- Diagnosis of bacterial tonsillitis should be confirmed before initiating treatment with cefixime or any other antibiotic 1
Treatment Considerations
- The choice of antibiotic should be based on the severity of the infection, the child's medical history, and the potential for side effects 1
- Amoxicillin may be an alternative to penicillin for the treatment of streptococcal tonsillopharyngitis in children, with a clinical cure rate of 86% compared to 92% for penicillin [@110@]
- Cefixime should be used with caution and under the guidance of a healthcare professional, due to the potential for side effects and the importance of confirming the diagnosis of bacterial tonsillitis 1
From the FDA Drug Label
Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with pharyngitis and tonsillitis caused by susceptible isolates of Streptococcus pyogenes.
Cefixime is indicated for the treatment of tonsillitis in children six months of age or older, caused by susceptible isolates of Streptococcus pyogenes. The recommended dose for pediatric patients is 8 mg/kg/day of the suspension, which may be administered as a single daily dose or in two divided doses. However, penicillin is the usual drug of choice in the treatment of Streptococcus pyogenes infections 2.
From the Research
Role of Cefixime in Treating Tonsillitis in Children
- Cefixime, a third-generation cephalosporin antibiotic, has been studied for its effectiveness in treating tonsillitis in children 3, 4, 5.
- Studies have shown that cefixime is at least as effective as penicillin V in treating bacterial pharyngitis and tonsillitis in children, with cure rates ranging from 86.7% to 93.3% 3, 4, 5.
- Cefixime has been found to have a high eradication rate of pathogens, with rates ranging from 77% to 88.2% 3, 4, 5.
- The antibiotic has been shown to be well tolerated, with mild to moderate adverse events reported in a small number of patients 3, 4, 5.
Comparison with Other Antibiotics
- Cefixime has been compared to penicillin V in several studies, with results showing that cefixime is at least as effective as penicillin V in treating tonsillitis in children 3, 4, 5.
- Cefixime has also been compared to other antibiotics, such as amoxycillin and cefaclor, with results showing that it is a suitable alternative for the treatment of acute otitis media and upper and lower respiratory tract infections 6.
Clinical Experience with Cefixime
- Clinical experience with cefixime in the pediatric field has shown that it is effective in treating various bacterial infections, including acute tonsillitis, with good to excellent clinical response obtained in 23 out of 25 children 7.
- The flavor and odor of cefixime have been found to be well accepted by children, making it a suitable option for pediatric patients 7.