Cefixime Dosage for Strep Throat Treatment
For strep throat (Group A Streptococcal pharyngitis), cefixime should be administered at a dose of 400 mg daily for adults or 8 mg/kg/day for children for at least 10 days. 1
Dosing Guidelines
Adults
- Dose: 400 mg once daily
- Duration: Minimum 10 days
- Administration: Can be given without regard to food 1
Pediatric Patients (6 months or older)
- Dose: 8 mg/kg/day
- Frequency: Can be given as a single daily dose or divided into two doses (4 mg/kg every 12 hours)
- Duration: Minimum 10 days
- Administration: Use oral suspension formulation 1
Pediatric Weight-Based Dosing Chart:
| Patient Weight (kg) | Daily Dose (mg) | Suspension 100 mg/5 mL | Suspension 200 mg/5 mL |
|---|---|---|---|
| 5 to 7.5 | 50 mg | 2.5 mL | -- |
| 7.6 to 10 | 80 mg | 4 mL | 2 mL |
| 10.1 to 12.5 | 100 mg | 5 mL | 2.5 mL |
| 12.6 to 20.5 | 150 mg | 7.5 mL | 4 mL |
| 20.6 to 28 | 200 mg | 10 mL | 5 mL |
| 28.1 to 33 | 250 mg | 12.5 mL | 6 mL |
| 33.1 to 40 | 300 mg | 15 mL | 7.5 mL |
| 40.1 to 45 | 350 mg | 17.5 mL | 9 mL |
| >45 | 400 mg | 20 mL | 10 mL |
Important Clinical Considerations
Diagnosis of Strep Throat
- Antibiotics should only be prescribed after confirming GAS pharyngitis through:
First-Line Treatment
- Penicillin or amoxicillin remains first-line therapy for GAS pharyngitis 2
- Cefixime is an alternative for penicillin-allergic patients (if not anaphylactically sensitive to beta-lactams) 2
Renal Dosage Adjustments
For adults with renal impairment:
- CrCl ≥60 mL/min: Normal dose
- CrCl 21-59 mL/min: 13 mL of 100 mg/5 mL or 6.5 mL of 200 mg/5 mL suspension
- CrCl ≤20 mL/min: 8.6 mL of 100 mg/5 mL or 4.4 mL of 200 mg/5 mL suspension 1
Clinical Efficacy
- Studies have shown cefixime to be effective in treating streptococcal pharyngitis with clinical cure rates of 86.7-98% 3, 4
- A 5-day course of cefixime has been shown to be as effective as a 10-day course of penicillin V in some studies, but the FDA-approved duration is 10 days 3
Common Side Effects
- Diarrhea and loose stools (16% of pediatric patients)
- Most adverse effects are mild to moderate and transient 4
Important Caveats
Duration of therapy: Despite some research suggesting shorter courses might be effective, the FDA-approved duration for strep throat treatment with cefixime is at least 10 days to prevent complications like acute rheumatic fever 2, 1
Return to school/work: Patients are considered non-contagious after 24 hours of effective antibiotic therapy 2
Follow-up: Routine follow-up throat cultures are not indicated for asymptomatic patients who have completed appropriate therapy 2
Children under 3 years: Testing for GAS pharyngitis is usually not indicated in this age group 2
Formulation choice: For otitis media, the suspension formulation is specifically recommended due to higher peak blood levels compared to tablets 1