Cefixime Dosage for Pediatric UTI
For pediatric urinary tract infections (UTIs), the recommended dose of cefixime is 8 mg/kg/day, which can be administered as a single daily dose or divided into two doses of 4 mg/kg every 12 hours. 1, 2
Dosage Guidelines
Standard Dosing
- Dose: 8 mg/kg/day
- Administration: Can be given as a single daily dose or divided into two doses (4 mg/kg every 12 hours)
- Duration: 7-14 days (minimum 7 days for febrile UTIs) 2
Age and Weight Considerations
For children 6 months and older, the FDA-approved dosing is weight-based:
| Patient Weight (kg) | Daily Dose (mg) | Dose with 100 mg/5 mL suspension (mL) | Dose with 200 mg/5 mL suspension (mL) |
|---|---|---|---|
| 5 to 7.5 | 50 | 2.5 | -- |
| 7.6 to 10 | 80 | 4 | 2 |
| 10.1 to 12.5 | 100 | 5 | 2.5 |
| 12.6 to 20.5 | 150 | 7.5 | 4 |
| 20.6 to 28 | 200 | 10 | 5 |
| 28.1 to 33 | 250 | 12.5 | 6 |
| 33.1 to 40 | 300 | 15 | 7.5 |
| 40.1 to 45 | 350 | 17.5 | 9 |
| >45 | 400 | 20 | 10 |
Clinical Considerations
Efficacy
- Cefixime has demonstrated excellent efficacy against common UTI pathogens, particularly Escherichia coli, which is responsible for approximately 85% of pediatric UTIs 3
- Clinical studies show comparable efficacy to trimethoprim-sulfamethoxazole but with the advantage of once-daily dosing 3
Advantages
- Once-daily dosing improves compliance
- High urinary concentrations maintained for 24 hours after administration 4
- Broad spectrum coverage against gram-negative pathogens commonly causing UTIs
Special Populations
- Renal impairment: Dose adjustment required for children with creatinine clearance <60 mL/min (follow adult adjustment guidelines) 1
- Infants <6 months: Cefixime is not FDA-approved for this age group
Alternative Treatments
If cefixime is not available or appropriate, consider:
- Amoxicillin-clavulanate: 20-40 mg/kg/day in 3 doses
- Cephalexin: 50-100 mg/kg/day in 4 doses
- Cefpodoxime: 10 mg/kg/day in 2 doses
- Trimethoprim-sulfamethoxazole: 6-12 mg/kg trimethoprim component per day in 2 doses 2
Important Considerations
- For febrile UTIs in infants, parenteral therapy may be initially required if the patient appears toxic or cannot tolerate oral medications 2
- Local antibiotic resistance patterns should be considered when selecting empiric therapy
- Nitrofurantoin should not be used for febrile UTIs as it does not achieve adequate tissue concentrations for pyelonephritis 2
- After reconstitution, cefixime suspension remains stable for 14 days at room temperature or refrigerated 1
Monitoring
- Clinical response should be assessed within 48-72 hours of treatment initiation
- Follow-up urine culture may be considered in complicated cases or treatment failures
By following these dosing guidelines, cefixime provides an effective and convenient treatment option for pediatric UTIs with good clinical outcomes and minimal side effects.