Recommended Dose of Cefixime for Enteric Fever in Children
The recommended dose of cefixime for treating enteric fever in children is 15-20 mg/kg/day divided into two doses, with a maximum of 400 mg twice daily for 7-14 days.
Dosage Considerations
The dosage recommendation is based on several key factors:
- Clinical studies have demonstrated efficacy of cefixime at doses of 10-20 mg/kg/day in treating multidrug-resistant enteric fever in children 1, 2
- Higher dosing (15-20 mg/kg/day) is preferred due to increasing antimicrobial resistance patterns
- Twice daily administration provides optimal pharmacokinetic coverage
- The maximum daily dose should not exceed 800 mg (400 mg twice daily)
Treatment Duration
- Standard treatment duration is 7-14 days
- Short-course therapy (8 days) has shown 95% efficacy in some studies 3
- Treatment should continue for at least 48-72 hours beyond resolution of fever
Efficacy and Advantages
Cefixime offers several advantages for treating enteric fever in children:
- High efficacy (95%) against multidrug-resistant Salmonella typhi 1
- Oral administration allows for outpatient treatment
- More cost-effective than parenteral options for outpatient management 2
- Well-tolerated with minimal side effects in pediatric populations
Alternative Regimens
If cefixime monotherapy is insufficient or unavailable:
- Combination therapy with azithromycin (20 mg/kg/day, max 1g/day) plus cefixime (20 mg/kg/day divided twice daily, max 400 mg twice daily) may be considered for difficult cases 4
- For severe cases requiring hospitalization, parenteral options include:
Monitoring Response
- Clinical improvement should be assessed within 48-72 hours
- Key indicators of response include:
- Decreased fever
- Improved appetite and activity level
- Resolution of abdominal symptoms
- If no improvement is seen within 72 hours, consider:
- Alternative diagnosis
- Resistant organism
- Need for parenteral therapy
- Complications such as intestinal perforation or hemorrhage
Common Pitfalls and Caveats
- Underdosing increases risk of treatment failure and resistance development
- Cefixime may have a slower time to defervescence (approximately 5.3 days) compared to parenteral ceftriaxone (3.9 days) 2
- Relapse rates of approximately 5-6% have been reported with cefixime therapy 2, 3
- Gastrointestinal side effects (nausea, vomiting, loose stools) may occur but are generally mild
In summary, cefixime at 15-20 mg/kg/day divided twice daily is an effective, safe, and practical option for treating enteric fever in children, particularly in outpatient settings where multidrug-resistant strains are prevalent.