Cefixime Pediatric Dosage
The recommended cefixime dosage for pediatric patients 6 months and older is 8 mg/kg/day, administered either as a single daily dose or divided into two doses of 4 mg/kg every 12 hours, with a maximum daily dose of 400 mg. 1
Weight-Based Dosing Table
The FDA-approved dosing provides specific weight-based recommendations 1:
| Patient Weight (kg) | Daily Dose (mg) | Volume (100 mg/5 mL) | Volume (200 mg/5 mL) |
|---|---|---|---|
| 5-7.5 kg | 50 mg | 2.5 mL | — |
| 7.6-10 kg | 80 mg | 4 mL | 2 mL |
| 10.1-12.5 kg | 100 mg | 5 mL | 2.5 mL |
| 12.6-20.5 kg | 150 mg | 7.5 mL | 4 mL |
| 20.6-28 kg | 200 mg | 10 mL | 5 mL |
| 28.1-33 kg | 250 mg | 12.5 mL | 6 mL |
| 33.1-40 kg | 300 mg | 15 mL | 7.5 mL |
| 40.1-45 kg | 350 mg | 17.5 mL | 9 mL |
| >45 kg or >12 years | 400 mg | 20 mL | 10 mL |
Key Clinical Considerations
For otitis media specifically, only the suspension formulation should be used because clinical trials demonstrated that the suspension achieves higher peak blood levels than tablets at equivalent doses. Tablets or capsules must not be substituted for suspension in otitis media treatment 1.
Duration of therapy: For infections caused by Streptococcus pyogenes (pharyngitis/tonsillitis), cefixime must be administered for at least 10 days to ensure adequate eradication and prevent complications, though data on rheumatic fever prevention are not available 1.
Dosing Frequency Options
The 8 mg/kg/day total dose can be given either:
- Once daily (8 mg/kg as single dose)
- Twice daily (4 mg/kg every 12 hours)
Both regimens are FDA-approved and equally acceptable 1. Research data from post-marketing surveillance showed that twice-daily dosing was preferred in 54.4% of pediatric patients, with excellent efficacy (98% cure/improvement rate) 2.
Important Pitfalls to Avoid
Concentration confusion: Cefixime suspension comes in two concentrations (100 mg/5 mL and 200 mg/5 mL). All prescriptions specifying volume must include the concentration to prevent dosing errors 1.
Age restriction: Cefixime is only approved for children ≥6 months of age. Do not use in younger infants 1.
Renal impairment: While pediatric-specific renal dosing is not well-established in the label, adult data shows dose reduction is needed when creatinine clearance falls below 60 mL/min 1.
Alternative Context: Haemophilus influenzae Coverage
While not the primary question, it's worth noting that cefixime is listed as an alternative oral agent for Haemophilus influenzae infections in pediatric pneumonia guidelines, though it is not a preferred first-line agent 3. The guidelines favor amoxicillin-clavulanate for β-lactamase producing strains.