From the Guidelines
Cefixime 400 mg orally is not the preferred initial treatment for acute uncomplicated pyelonephritis, but it may be considered in certain cases, as evidenced by a study that showed initial therapy with intravenous ceftriaxone (1 g for 3 days) was comparable to 1 dose of intravenous ceftriaxone (1 g) followed by oral cefixime (400 mg once daily for 2 days) 1.
Key Considerations
- The choice of antibiotic should be based on local resistance data and tailored to the specific uropathogen, with fluoroquinolones being the preferred antimicrobial class for oral therapy in regions with low levels of fluoroquinolone resistance 1.
- A 5-7 day regimen of a once-daily fluoroquinolone is effective for mild to moderate pyelonephritis, and once-daily dosing is supported by several studies 1.
- In areas with high rates of fluoroquinolone resistance, a dose of a long-acting parenteral antimicrobial, such as a 1-g dose of ceftriaxone, may be given at the initiation of therapy 1.
Treatment Approach
- For acute uncomplicated pyelonephritis, a fluoroquinolone regimen is generally recommended, with a 5-7 day course being effective for mild to moderate cases 1.
- Cefixime 400 mg orally may be considered as part of a treatment regimen, but its use should be guided by local resistance patterns and susceptibility testing 1.
- Patients should be monitored for symptoms and treatment response, with alternative therapy considered if symptoms persist or worsen 1.
From the FDA Drug Label
1.1 Uncomplicated Urinary Tract Infections Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coliand Proteus mirabilis. 2.1 Adults The recommended dose of cefixime is 400 mg daily.
The dose of 400 mg of cefixime PO may be sufficient for treating a possible urinary tract infection (UTI) in adults, as it is the recommended dose for uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli and Proteus mirabilis 2 2.
From the Research
Cefixime 400 mg PO for UTI Treatment
- The efficacy of cefixime in treating urinary tract infections (UTIs) has been demonstrated in several studies 3, 4.
- A study published in 1990 found that cefixime was effective in treating uncomplicated UTIs, with good results achieved in patients with infections caused by sensitive strains 3.
- Another study published in 1998 found that cefixime 400 mg once daily was effective in treating UTIs in adults, with a cure rate of 94% 4.
- However, it is worth noting that the study published in 1990 also found that the once daily dose of 400 mg showed a higher incidence of gastrointestinal adverse effects than a twice daily dose of 200 mg 3.
- The pharmacokinetics of cefixime have been studied, and it has been found that the drug can be given once daily or twice daily with similar efficacy 5.
Dosage and Administration
- The recommended dosage of cefixime for UTI treatment is 400 mg once daily or 200 mg twice daily 3, 5.
- The choice of dosage regimen should be based on the severity of the infection and the patient's tolerance to the drug.
- It is essential to note that cefixime should not be initiated without sensitivity testing in cases of complicated UTIs, as gram-positive and nonfermenting pathogens resistant to cefixime can be present 3.
Efficacy and Safety
- Cefixime has been shown to be effective in treating UTIs caused by a variety of pathogens, including Enterobacteriaceae 3, 4.
- The drug has a broad spectrum of activity and is generally well tolerated, with gastrointestinal disturbances being the most common adverse effects 3, 4.
- However, the use of cefixime in combination with other antibiotics, such as amoxicillin-clavulanic acid, may be considered in cases of UTIs caused by ESBL-producing microorganisms 6.