Recommended Dosage of Cefixime for Pediatric Patients
The recommended dose of cefixime for pediatric patients 6 months or older is 8 mg/kg/day, which may be administered as a single daily dose or divided into two doses of 4 mg/kg every 12 hours. 1
Dosing Guidelines by Weight
For pediatric patients, cefixime dosing is weight-based and available in oral suspension form:
- Weight 5-7.5 kg: 50 mg/day (2.5 mL of 100 mg/5 mL suspension) 1
- Weight 7.6-10 kg: 80 mg/day (4 mL of 100 mg/5 mL or 2 mL of 200 mg/5 mL suspension) 1
- Weight 10.1-12.5 kg: 100 mg/day (5 mL of 100 mg/5 mL or 2.5 mL of 200 mg/5 mL suspension) 1
- Weight 12.6-20.5 kg: 150 mg/day (7.5 mL of 100 mg/5 mL or 4 mL of 200 mg/5 mL suspension) 1
- Weight 20.6-28 kg: 200 mg/day (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL suspension) 1
- Weight 28.1-33 kg: 250 mg/day (12.5 mL of 100 mg/5 mL or 6 mL of 200 mg/5 mL suspension) 1
- Weight 33.1-40 kg: 300 mg/day (15 mL of 100 mg/5 mL or 7.5 mL of 200 mg/5 mL suspension) 1
- Weight 40.1-45 kg: 350 mg/day (17.5 mL of 100 mg/5 mL or 9 mL of 200 mg/5 mL suspension) 1
- Weight >45 kg or age >12 years: 400 mg/day (adult dose) 1
Administration Considerations
- For otitis media, the suspension form should be used rather than tablets or capsules, as clinical trials demonstrated higher peak blood levels with the suspension 1
- For Streptococcus pyogenes infections, treatment should continue for at least 10 days 1
- After reconstitution, the suspension may be kept for 14 days at room temperature or refrigerated 1
Special Populations
Renal Impairment
- Normal dose for creatinine clearance ≥60 mL/min 1
- For creatinine clearance 21-59 mL/min: reduced dosing required 1
- For creatinine clearance ≤20 mL/min: further dose reduction needed 1
Indications for Pediatric Use
Cefixime is indicated for pediatric patients 6 months and older with:
- Uncomplicated urinary tract infections 1
- Otitis media 1
- Pharyngitis and tonsillitis 1
- Acute exacerbations of chronic bronchitis 1
- Uncomplicated gonorrhea (cervical/urethral) 1
Clinical Efficacy
- Studies have shown excellent efficacy in pediatric respiratory infections with once-daily dosing, with 96-100% clinical cure or improvement rates in acute otitis media and sinusitis 2
- In pharyngitis, cefixime 8 mg/kg once daily for 10-14 days demonstrated clinical success in 98.2% of pediatric patients 3
- Cefixime has shown good activity against common pediatric pathogens including Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes 4, 2
Safety Profile
- Most common adverse effects are gastrointestinal, primarily diarrhea (16%), nausea (7%), and loose stools (6%) 1
- These side effects are usually mild to moderate, transient, and occur mainly in the first few days of treatment 4
- In pediatric studies, drug-related adverse effects occurred in 24.3% of patients but led to discontinuation in only 1.9% 3
Important Considerations
- Cefixime is not indicated for infants younger than 6 months of age 1
- For pediatric patients with suspected or confirmed MRSA infections, alternative antibiotics should be considered as cefixime has limited activity against Staphylococcus aureus 4
- When treating pharyngitis, remember that penicillin remains the drug of choice for Streptococcus pyogenes infections 1