Recommended Cefixime Dosage for Typhoid Fever Treatment
The recommended dose of cefixime for typhoid fever is 20 mg/kg/day orally divided into two doses (maximum 400 mg twice daily) for 7-14 days. 1, 2, 3
Dosing Guidelines
Adults:
- 400 mg orally twice daily for 7-14 days
Children:
- 20 mg/kg/day orally divided into two doses for 7-14 days
- Maximum dose: 400 mg twice daily
Efficacy and Considerations
Cefixime has demonstrated effectiveness against Salmonella typhi, including multidrug-resistant strains, with an MIC90 value of 0.25 μg/ml 4. However, it's important to note that:
- When used as an alternative oral first-line agent, cefixime has reported treatment failure rates of 4-37.6% 5
- Fever clearance time with cefixime (mean 7.1 days) is longer compared to azithromycin (mean 5.8 days) 6
- Clinical cure rates with cefixime (71%) are lower than with azithromycin (85%) 6
Treatment Algorithm for Typhoid Fever
First-line therapy (preferred):
- Azithromycin 20 mg/kg/day (maximum 1g/day) once daily for 7 days 1
Alternative options (based on susceptibility):
- Cefixime 20 mg/kg/day divided into two doses for 7-14 days
- Ceftriaxone 1-2g IV once daily for 7-14 days (for severe infections)
- Fluoroquinolones (if susceptible): ciprofloxacin 500-750 mg twice daily for 7-14 days
For multidrug-resistant strains:
- Azithromycin or ceftriaxone are preferred over cefixime due to higher cure rates
Duration of Treatment
- Uncomplicated typhoid fever: 7-14 days of therapy
- Treatment should be continued for the full course even if symptoms resolve earlier
- Shorter courses (8 days) of cefixime have shown 95% clinical cure rates in children 3, but the standard recommendation remains 7-14 days
Monitoring Response
- Clinical improvement typically occurs within 48-72 hours of starting appropriate therapy
- Fever clearance time with cefixime averages 7.1 days 6
- Consider alternative antibiotics if no clinical improvement after 3-5 days
Important Caveats
- Increasing antimicrobial resistance threatens the effectiveness of single-agent treatments
- Cefixime is less effective than azithromycin for typhoid fever treatment 6
- Some research is investigating combination therapy of azithromycin plus cefixime for better outcomes 7
- For severe infections or patients unable to take oral medications, parenteral ceftriaxone is preferred
Cefixime remains a viable option for typhoid fever treatment, particularly in settings where fluoroquinolone resistance is common and azithromycin is unavailable. However, clinicians should be aware of its higher failure rates compared to azithromycin and monitor patients closely for clinical response.