Cefixime Dosage for Empirical Treatment of Enteric Fever
The recommended dosage of cefixime for empirical treatment of enteric fever is 8 mg/kg/day orally in a single daily dose. 1
First-Line Treatment Options for Enteric Fever
- Azithromycin 20 mg/kg/day (maximum 1g/day) orally for 7 days is recommended as first-line therapy for enteric fever in children, especially in areas with high fluoroquinolone resistance 1
- For severe cases requiring hospitalization, ceftriaxone 50-80 mg/kg/day (maximum 2g/day) intravenously for 5-7 days is recommended 1
- Cefixime at 8 mg/kg/day in a single daily dose is an appropriate oral option for enteric fever treatment, particularly in children over 28 days old 2
Evidence Supporting Cefixime Use in Enteric Fever
- Cefixime has demonstrated efficacy in treating multidrug-resistant enteric fever in children at dosages of 10-12 mg/kg/day divided into two doses for 14 days, with a 95% response rate 3
- Cefixime is particularly active against many Enterobacteriaceae, including Salmonella species, and is resistant to hydrolysis by many beta-lactamases 4
- The long elimination half-life of cefixime (approximately 3 hours) allows for once-daily or twice-daily dosing 4
Dosing Considerations
- For children: 8 mg/kg/day as a single daily dose 2, 1
- For adults: 400 mg orally in a single dose is typically recommended 2
- In cases of severe infection or high resistance patterns, consider combination therapy with azithromycin (20 mg/kg/day) and cefixime (20 mg/kg/day in two divided doses, maximum 400 mg twice daily) for 7 days 5
Treatment Duration and Monitoring
- Treatment duration should typically be 7-14 days 2, 3
- Patients should be monitored for clinical response, with expected fever clearance within 4-5 days of appropriate therapy 1
- Blood cultures should be obtained before starting antibiotics whenever possible 1, 6
Resistance Considerations
- Local susceptibility patterns should guide therapy choice, as resistance patterns vary geographically 1, 6
- Over 70% of S. typhi isolates in many regions are now resistant to fluoroquinolones, making ceftriaxone or azithromycin better empiric choices in these areas 1
- In areas with known high resistance, combination therapy may be considered 5
Common Pitfalls to Avoid
- Avoid using ciprofloxacin empirically for cases originating from South Asia due to high resistance rates 1
- Do not rely solely on clinical presentation for diagnosis; obtain cultures whenever possible 1, 6
- For severe cases or patients unable to tolerate oral medications, parenteral therapy with ceftriaxone should be initiated 1
- Patients initially treated with parenteral antibiotics should be transferred to an oral regimen once clinical improvement occurs and temperature has been normal for 24 hours 1