Recommended Dosage of Cefixime
The recommended dose of cefixime for adults is 400 mg daily, which can be given as a single 400 mg dose or divided into two 200 mg doses. 1
Adult Dosing
General Infections
- Standard adult dose: 400 mg daily
- Can be administered as:
- Single daily dose of 400 mg
- Two divided doses of 200 mg every 12 hours
- May be taken without regard to food
- For Streptococcus pyogenes infections: continue treatment for at least 10 days 1
Specific Conditions
- Uncomplicated gonorrhea: 400 mg as a single oral dose 2
- Note: For gonorrhea treatment, ceftriaxone is now preferred over cefixime due to increasing resistance patterns 3
Pediatric Dosing (6 months or older)
- Standard pediatric dose: 8 mg/kg/day 1, 2
- Can be administered as:
- Single daily dose
- Two divided doses (4 mg/kg every 12 hours)
- Available in two concentrations:
- 100 mg/5 mL suspension
- 200 mg/5 mL suspension
Weight-Based Dosing Guide for Children
| Patient Weight (kg) | Daily Dose (mg) |
|---|---|
| 5 to 7.5 | 50 mg |
| 7.6 to 10 | 80 mg |
| 10.1 to 12.5 | 100 mg |
| 12.6 to 20.5 | 150 mg |
| 20.6 to 28 | 200 mg |
| 28.1 to 33 | 250 mg |
| 33.1 to 40 | 300 mg |
| 40.1 to 45 | 350 mg |
| >45 | 400 mg |
- Children weighing more than 45 kg or older than 12 years should receive the adult dose 1
- For otitis media: use the suspension formulation only, not tablets or capsules 1
- For Streptococcus pyogenes infections: continue treatment for at least 10 days 1
Dosage Adjustments for Renal Impairment
- Normal renal function (CrCl ≥60 mL/min): Standard dose
- Moderate impairment (CrCl 21-59 mL/min): 65% of standard dose
- Severe impairment (CrCl ≤20 mL/min): 43% of standard dose
- Hemodialysis or peritoneal dialysis: No additional dose adjustment needed as these procedures do not remove significant amounts of the drug 1
Pharmacokinetic Considerations
- Elimination half-life: 3-4 hours 3, 4
- Peak plasma concentration reached after approximately 3-4 hours 5
- Approximately 15-20% of the drug is excreted unchanged in urine 6, 5
- The twice daily dosing regimen (200 mg twice daily) may have fewer gastrointestinal side effects than the once-daily regimen (400 mg once daily) 6
Important Clinical Considerations
- Cefixime provides sustained bactericidal levels but not as high or sustained as ceftriaxone for certain infections like gonorrhea 2
- For treatment of gonorrhea, ceftriaxone is now preferred due to increasing resistance to cefixime 3
- Cefixime has good activity against many Enterobacteriaceae, H. influenzae, S. pyogenes, S. pneumoniae, and B. catarrhalis 4
- It has limited activity against S. aureus and is inactive against P. aeruginosa 4
- In children with urinary tract infections, plasma and urine concentrations remain above MIC for most common urinary tract pathogens for up to 12 and 24 hours after administration, respectively 5