Cefixime Dosing Recommendation
For adults, administer cefixime 400 mg as a single oral dose for uncomplicated gonococcal infections, or 400 mg daily (as a single dose or divided into 200 mg twice daily) for other indications such as urinary tract infections, respiratory infections, or pharyngitis. For pediatric patients ≥6 months, the recommended dose is 8 mg/kg/day, which can be given as a single daily dose or divided into 4 mg/kg every 12 hours 1.
Adult Dosing
The FDA-approved dosing for cefixime in adults is straightforward:
- Standard dose: 400 mg daily, administered as a single 400 mg capsule 1
- Uncomplicated gonorrhea: Single oral dose of 400 mg 1
- Streptococcus pyogenes infections: Continue for at least 10 days 1
The capsule may be taken without regard to food, improving compliance 1.
Renal Impairment Adjustments
For patients with impaired renal function, dosing adjustments are necessary 1:
- CrCl ≥60 mL/min: Normal dose (400 mg daily)
- CrCl 21-59 mL/min or on hemodialysis: 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 or on peritoneal dialysis: 172 mg daily (8.6 mL of 100 mg/5 mL suspension or 4.4 mL of 200 mg/5 mL suspension)
Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime 1.
Pediatric Dosing (≥6 months)
The recommended pediatric dose is 8 mg/kg/day, administered either as a single daily dose or divided into 4 mg/kg every 12 hours 1.
Weight-Based Dosing Table
For practical administration, use these weight-based doses 1:
- 5-7.5 kg: 50 mg/day (2.5 mL of 100 mg/5 mL suspension)
- 7.6-10 kg: 80 mg/day (4 mL of 100 mg/5 mL or 2 mL of 200 mg/5 mL)
- 10.1-12.5 kg: 100 mg/day (5 mL of 100 mg/5 mL or 2.5 mL of 200 mg/5 mL)
- 12.6-20.5 kg: 150 mg/day (7.5 mL of 100 mg/5 mL or 4 mL of 200 mg/5 mL)
- 20.6-28 kg: 200 mg/day (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL)
- 28.1-33 kg: 250 mg/day (12.5 mL of 100 mg/5 mL or 6 mL of 200 mg/5 mL)
- 33.1-40 kg: 300 mg/day (15 mL of 100 mg/5 mL or 7.5 mL of 200 mg/5 mL)
- 40.1-45 kg: 350 mg/day (17.5 mL of 100 mg/5 mL or 9 mL of 200 mg/5 mL)
- >45 kg or >12 years: 400 mg/day (adult dose)
Critical Pediatric Considerations
For otitis media, use only the oral suspension formulation, as clinical trials demonstrated the suspension achieves higher peak blood levels than tablets at equivalent doses 1. Do not substitute tablets or capsules for suspension in otitis media treatment.
For Streptococcus pyogenes infections (pharyngitis/tonsillitis), continue treatment for at least 10 days 1.
Important Clinical Caveats
Gonococcal Infections - Major Limitation
Cefixime is no longer recommended as first-line therapy for gonorrhea due to emerging resistance. The 2024 conjunctivitis guidelines note that cefixime 400 mg single dose may be used only when ceftriaxone is unavailable 2. Recent evidence shows cefixime plus doxycycline failed to achieve noninferiority to ceftriaxone plus azithromycin, particularly for pharyngeal gonorrhea, with only 86% cure rates at week 3 3. All treatment failures occurred in pharyngeal cases, though urogenital and rectal infections showed high efficacy 3.
Suspension Preparation
After reconstitution, the suspension remains stable for 14 days at room temperature or refrigerated. Shake well before each use and discard unused portions after 14 days 1.
Contraindications and Warnings
Cefixime is contraindicated in patients with known cephalosporin allergy 1. Exercise caution in penicillin-allergic patients, as cross-reactivity occurs in up to 10% of cases 1. Monitor for Clostridioides difficile-associated diarrhea, which can occur up to 2 months after treatment 1.