Cefixime Dosing Recommendations
The recommended dose of cefixime for adults is 400 mg daily, which may be given as a single daily dose or divided into two 200 mg doses. 1
Adult Dosing
- Standard adult dose: 400 mg daily 1
- Uncomplicated gonorrhea: Single 400 mg oral dose 2, 3
- Renal impairment dosing:
- Creatinine clearance 60 mL/min or greater: Normal dose
- Creatinine clearance 21-59 mL/min: Reduced dose (approximately 65% of normal)
- Creatinine clearance 20 mL/min or less: Further reduced dose (approximately 43% of normal) 1
Pediatric Dosing
- Standard pediatric dose: 8 mg/kg/day of suspension for children 6 months or older 1
- This may be administered as:
- Single daily dose of 8 mg/kg
- Two divided doses of 4 mg/kg every 12 hours 1
Pediatric Weight-Based Dosing Table
| 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 |
Note: Children weighing more than 45 kg or older than 12 years should receive the adult dose of 400 mg daily. 1
Special Considerations
Streptococcal infections: For infections due to Streptococcus pyogenes, cefixime should be administered for at least 10 days to prevent rheumatic fever 1
Otitis media: Should be treated with the suspension form rather than tablets or capsules, as the suspension results in higher peak blood levels 1
Gonorrhea in children:
Urinary tract infections: Cefixime has shown excellent efficacy in both adults and children with urinary tract infections, with cure rates of 94-100% 4, 5
Administration Considerations
- Cefixime may be administered without regard to food 1
- For adults, dividing the daily dose (200 mg twice daily) may result in fewer gastrointestinal side effects compared to a single 400 mg dose 6
- For children, cefixime is available in two different suspension concentrations (100 mg/5 mL and 200 mg/5 mL), so prescriptions should clearly specify the concentration 1
Efficacy and Safety
- Clinical trials have demonstrated that cefixime is effective against respiratory tract infections, urinary tract infections, and otitis media 7, 4, 8
- In pediatric studies, once-daily cefixime (8 mg/kg) was as effective as twice-daily trimethoprim/sulfamethoxazole for treating urinary tract infections 5
- The most common adverse effects are mild to moderate diarrhea and stool changes, which are usually transient and occur in the first few days of treatment 7
Remember that cefixime has excellent activity against many Enterobacteriaceae, Haemophilus influenzae, Streptococcus pyogenes, Streptococcus pneumoniae, and Moraxella catarrhalis, but limited activity against Staphylococcus aureus and no activity against Pseudomonas aeruginosa 7.