Cefixime Dosing in Renal Impairment
For a patient with an eGFR of 53 and CrCl of 64, the standard adult dose of cefixime (400 mg daily) can be administered without adjustment. 1
Dosing Considerations Based on Renal Function
According to the FDA label for cefixime, patients with creatinine clearance of 60 mL/min or greater can receive the normal dose and schedule 1. Your patient's CrCl is 64 mL/min, which falls within this range.
The dosing recommendations for cefixime based on renal function are as follows:
| Renal Function (CrCl) | Recommended Dose |
|---|---|
| ≥60 mL/min | Normal dose (400 mg daily) |
| 21-59 mL/min | 300 mg daily (75% of normal dose) |
| ≤20 mL/min or on dialysis | 200 mg daily (50% of normal dose) |
Clinical Considerations
- Your patient has mild renal impairment with a CrCl of 64 mL/min, which is just above the threshold requiring dose adjustment
- The drug's elimination half-life is approximately 3-4 hours in patients with normal renal function but can increase to 11-12 hours in those with severe renal impairment 2
- Cefixime is cleared partly by the liver (60%) and partly by the kidneys (40%), which explains why mild-to-moderate renal impairment doesn't significantly affect dosing 2
Important Monitoring Considerations
- While dose adjustment isn't required for your patient, it's important to monitor renal function during therapy, especially if there's risk of further deterioration
- If the patient's renal function worsens during treatment (CrCl dropping below 60 mL/min), consider reducing the dose to 300 mg daily
- Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime from the body 1
Administration
- Cefixime can be administered without regard to food 1
- For the treatment of infections due to Streptococcus pyogenes, cefixime should be administered for at least 10 days 1
- For uncomplicated cervical/urethral gonococcal infections, a single oral dose of 400 mg is recommended 1
Clinical Pearls
- If your patient's renal function were to deteriorate to a CrCl between 21-59 mL/min, pharmacokinetic studies show that the elimination half-life would increase, necessitating dose reduction 3
- Studies have demonstrated that appropriate dose adjustments in patients with renal impairment can achieve similar minimum plasma concentrations as those with normal renal function, ensuring adequate antimicrobial efficacy while minimizing toxicity 4