What is the recommended dosing of cefixime (Cephalosporin) for urinary tract infections (UTIs)?

From the Guidelines

Cefixime should be dosed at 400 mg orally twice daily for the treatment of urinary tract infections (UTIs). This recommendation is based on the guidelines from the MMWR Recommendations and Reports 1. The dosing frequency and duration of treatment may vary depending on the severity of the infection and patient factors.

Key Considerations

• The dosage of cefixime for UTIs is typically higher than for other infections, such as gonorrhea, due to the need to achieve adequate concentrations in the urinary tract.
• Cefixime is effective against many gram-negative bacteria, including Escherichia coli, which is a common cause of UTIs.
• Patient compliance is improved with the twice-daily dosing regimen, and taking cefixime with food may reduce gastrointestinal side effects.
• It is essential for patients to complete the full course of antibiotics, even if symptoms improve before completion, to prevent recurrence and antibiotic resistance.
• Adequate hydration is also crucial during treatment to help flush bacteria from the urinary tract.

Clinical Context

In clinical practice, the treatment of UTIs with cefixime should be guided by the severity of symptoms, patient comorbidities, and local antibiotic resistance patterns. The twice-daily dosing regimen of cefixime 400 mg orally may need to be adjusted in patients with renal impairment or other underlying health conditions.

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 recommended dosing of cefixime for uncomplicated urinary tract infections (UTIs) in adults is 400 mg daily 2. For pediatric patients (6 months or older), the recommended dose is 8 mg/kg/day of the suspension, which may be administered as a single daily dose or in two divided doses 2. Key points:

• The dose for adults is 400 mg daily.
• The dose for pediatric patients is 8 mg/kg/day.
• Cefixime is effective against susceptible isolates of Escherichia coli and Proteus mirabilis in uncomplicated UTIs 2.

From the Research

Cefixime Dosing for UTI

• The recommended dosing of cefixime for urinary tract infections (UTIs) varies, but studies suggest the following:
  • 200 mg twice daily 3, 4, 5
  • 400 mg once daily 3, 6, 7
• These dosing regimens have been shown to be effective in treating acute uncomplicated UTIs, with clinical efficacy rates ranging from 63% to 100% 3, 4, 7
• Cefixime has been compared to other antibiotics, such as co-trimoxazole and amoxycillin, and has been found to be a suitable alternative in the treatment of UTIs 3, 6, 5, 7
• The incidence of adverse effects, such as diarrhea and stool changes, was higher with once daily dosing of 400 mg compared to twice daily dosing of 200 mg 3, 5
• Cefixime has been shown to be effective against a range of pathogens, including Escherichia coli, Proteus mirabilis, and staphylococci 3, 4, 6

Specific Patient Populations

• In children, cefixime has been shown to be effective in treating UTIs, but more studies are needed to determine the optimal dosing regimen 4, 5
• In patients with complicated UTIs, cefixime may be effective, but treatment should not be initiated without sensitivity testing due to the potential for resistant pathogens 5

Adverse Effects

• The most commonly reported adverse effects of cefixime are diarrhea and stool changes, which are usually mild to moderate in severity and transient 3, 4, 6, 5, 7
• Other adverse effects, such as nausea and general malaise, have also been reported, but are less common 3, 4, 7