Cefixime Dosing
For adults, cefixime is dosed at 400 mg daily, and for children 6 months or older, 8 mg/kg/day (maximum 400 mg/day), with dose reductions required for creatinine clearance below 60 mL/min. 1
Adult Dosing
The standard adult dose is 400 mg once daily, which can be taken with or without food 1. For uncomplicated cervical or urethral gonococcal infections specifically, a single 400 mg dose is recommended 1.
Pediatric Dosing (≥6 months)
Administer 8 mg/kg/day of the oral suspension, either as a single daily dose or divided into 4 mg/kg every 12 hours 1.
Weight-Based Dosing Guide:
- 5-7.5 kg: 50 mg daily
- 7.6-10 kg: 80 mg daily
- 10.1-12.5 kg: 100 mg daily
- 12.6-20.5 kg: 150 mg daily
- 20.6-28 kg: 200 mg daily
- 28.1-33 kg: 250 mg daily
- 33.1-40 kg: 300 mg daily
- 40.1-45 kg: 350 mg daily
- >45 kg or >12 years: Use adult dose of 400 mg daily 1
Critical caveat: For otitis media, the suspension formulation must be used rather than tablets/capsules, as the suspension achieves higher peak blood levels at equivalent doses 1.
Renal Impairment Adjustments
Dose modifications are essential based on creatinine clearance 1:
- CrCl ≥60 mL/min: Normal dose (400 mg daily)
- CrCl 21-59 mL/min: Reduce to approximately 260 mg daily (13 mL of 100 mg/5 mL suspension or 6.5 mL of 200 mg/5 mL suspension)
- CrCl ≤20 mL/min: Reduce to approximately 200 mg daily (8.6 mL of 100 mg/5 mL suspension or 4.4 mL of 200 mg/5 mL suspension) 1
Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime, so no supplemental dosing post-dialysis is needed 1. Research confirms that elimination half-life increases from 3-4 hours in normal renal function to 12-14 hours in severe renal impairment (CrCl <20 mL/min), supporting these dose reductions 2, 3.
Duration of Therapy
For infections caused by Streptococcus pyogenes, continue treatment for at least 10 days regardless of clinical improvement 1.
Important Administration Details
- Cefixime bioavailability is approximately 50% and is not affected by food, allowing flexible administration 4
- After reconstitution, oral suspension remains stable for 14 days at room temperature or refrigerated—shake well before each use and discard after 14 days 1
- Protein binding is 70%, with elimination occurring 60% hepatically and 40% renally 4