What is the dosage and treatment duration of Cefixime (a cephalosporin antibiotic) for various bacterial infections?

Cefixime Dosage and Treatment Duration for Various Bacterial Infections

For most bacterial infections, cefixime is administered at a dose of 400 mg daily for adults, with treatment duration varying by infection type. 1

Adult Dosing Regimens

• Uncomplicated Urinary Tract Infections: 400 mg orally once daily 1
• Pharyngitis and Tonsillitis: 400 mg orally once daily for 10 days 1
• Acute Exacerbations of Chronic Bronchitis: 400 mg orally once daily 1
• Otitis Media: 400 mg orally once daily 1
• Uncomplicated Gonorrhea (cervical/urethral): Single 400 mg oral dose 1, 2
  • Note: Cefixime is no longer recommended as first-line therapy for gonorrhea but may be used as an alternative when ceftriaxone is not available 2
  • When used for gonorrhea, it should be combined with azithromycin 1g orally in a single dose or doxycycline 100 mg orally twice daily for 7 days 2

Pediatric Dosing (6 months and older)

• Recommended dose: 8 mg/kg/day of suspension 1
• Can be administered as a single daily dose or divided into two doses (4 mg/kg every 12 hours) 1
• Children weighing more than 45 kg or older than 12 years should receive the adult dose 1

Dosing in Special Populations

Renal Impairment 1

• Normal renal function (CrCl ≥60 mL/min): Standard dose
• Moderate impairment (CrCl 21-59 mL/min): Reduce to 65% of normal dose
• Severe impairment (CrCl ≤20 mL/min): Reduce to 43% of normal dose
• Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime 1

Clinical Efficacy

• Cefixime has demonstrated 97.4% efficacy for uncomplicated urogenital and anorectal gonococcal infections 2
• For urinary tract infections, clinical trials show comparable efficacy to co-trimoxazole and amoxicillin 3
• In respiratory infections, efficacy is similar to amoxicillin, amoxicillin/clavulanic acid, and cefaclor 3

Important Considerations

• Cefixime has an antimicrobial spectrum similar to ceftriaxone but does not provide as high or sustained bactericidal levels 2
• The primary advantage of cefixime is oral administration versus injectable cephalosporins 2, 4
• For Streptococcus pyogenes infections, treatment should continue for at least 10 days 1
• Cefixime can be administered without regard to food 1

Common Adverse Effects

• Most common adverse reactions are gastrointestinal: diarrhea (16%), nausea (7%), loose stools (6%), abdominal pain (3%), dyspepsia (3%), and vomiting 1
• Adverse effects are usually mild to moderate, transient, and occur primarily in the first few days of treatment 3

Caveats and Pitfalls

• For otitis media, the oral suspension should be used rather than tablets or capsules as it achieves higher peak blood levels 1
• Cefixime is ineffective against Staphylococcus aureus, enterococci, and Pseudomonas species 3, 5
• Always consider local resistance patterns when prescribing cefixime 2
• For gonorrhea treatment, ceftriaxone 250 mg IM is now preferred over cefixime due to increasing cefixime MICs and concerns about emerging resistance 2