What infections does cefixime (Cefixime) cover?

Cefixime Coverage Spectrum

Cefixime is a third-generation oral cephalosporin that effectively treats uncomplicated gonorrhea, urinary tract infections, otitis media, pharyngitis, tonsillitis, and acute exacerbations of chronic bronchitis caused by susceptible organisms. 1

Antimicrobial Coverage

Highly Effective Against:

• Gram-negative organisms:

  • Neisseria gonorrhoeae (including penicillinase and non-penicillinase producing strains) 1
  • Escherichia coli 1
  • Proteus mirabilis 1
  • Haemophilus influenzae 1, 2
  • Moraxella catarrhalis (Branhamella catarrhalis) 1, 2
  • Many Enterobacteriaceae 2

• Gram-positive organisms:

  • Streptococcus pyogenes (Group A streptococci) 1
  • Streptococcus pneumoniae 1, 2

Limited or No Activity Against:

• Staphylococcus aureus (limited activity) 2
• Pseudomonas aeruginosa (inactive) 2

FDA-Approved Indications

1. Uncomplicated Urinary Tract Infections caused by E. coli and P. mirabilis 1
2. Otitis Media caused by H. influenzae, M. catarrhalis, and S. pyogenes 1
3. Pharyngitis and Tonsillitis caused by S. pyogenes 1
4. Acute Exacerbations of Chronic Bronchitis caused by S. pneumoniae and H. influenzae 1
5. Uncomplicated Gonorrhea (cervical/urethral) caused by N. gonorrhoeae 1

Clinical Efficacy

Gonorrhea Treatment

• Cures 97.1-97.4% of uncomplicated urogenital and anorectal gonococcal infections 3, 4
• Standard dose: 400 mg orally in a single dose 3, 5, 4
• Less effective for pharyngeal gonorrhea compared to ceftriaxone 6
• Often combined with azithromycin or doxycycline to cover potential chlamydial co-infection 5, 4

Urinary Tract Infections

• Effective for uncomplicated UTIs 1, 7, 8
• Approximately 20% excreted by kidneys as active drug 7
• Particularly effective against common UTI pathogens like E. coli 7

Respiratory Tract Infections

• Effective for otitis media, sinusitis, pharyngitis, and bronchitis 1, 9
• Comparable efficacy to amoxicillin and other oral cephalosporins 2

Important Considerations

Resistance Patterns

• Maintains activity against many beta-lactamase producing organisms 2
• Increasing concerns about cefixime-resistant N. gonorrhoeae 6
• As of 2012, CDC no longer recommends cefixime as first-line therapy for gonorrhea due to increasing MICs 6

Dosing

• Adults: 400 mg daily (single dose or divided) 1
• Children (≥6 months): 8 mg/kg/day 1
• For UTIs, twice daily dosing (200 mg BID) may have fewer GI side effects than single 400 mg dose 7

Common Adverse Effects

• Gastrointestinal: diarrhea (16%), nausea (7%), loose stools (6%) 1
• Abdominal pain (3%), dyspepsia (3%), vomiting 1

Clinical Pearls

• Advantage over injectable cephalosporins is oral administration 3, 5, 4
• Long half-life (3 hours) allows for once or twice daily dosing 2
• For gonorrhea treatment, ceftriaxone is now preferred due to higher cure rates and concerns about cefixime resistance 6
• When treating gonorrhea, always consider co-treatment for chlamydia 3, 5, 4