What is the recommended dosage of Taxim-O (cefixime) for treating Lower Respiratory Tract Infections (LRTIs)?

Recommended Dosage of Cefixime (Taxim-O) for Lower Respiratory Tract Infections

For adults with lower respiratory tract infections (LRTIs), the recommended dosage of cefixime (Taxim-O) is 200 mg twice daily for 7-14 days. 1, 2

Rationale for Cefixime in LRTIs

• Cefixime is an orally active third-generation cephalosporin with effective antibacterial activity against common LRTI pathogens, including Haemophilus influenzae, Moraxella catarrhalis, and penicillin-susceptible Streptococcus pneumoniae 3
• Its long elimination half-life (approximately 3 hours) allows for convenient twice-daily dosing, improving patient compliance compared to medications requiring more frequent administration 4
• Cefixime is resistant to hydrolysis by many beta-lactamases, making it effective against beta-lactamase producing strains of H. influenzae and M. catarrhalis 4

Dosing Recommendations Based on Infection Severity

Mild to Moderate LRTIs

• For outpatient management: 200 mg twice daily for 7-14 days 1, 2
• Duration of treatment should typically be 7 days for uncomplicated cases, with assessment of response after 5-7 days 5

Severe LRTIs

• For more severe infections requiring hospitalization, parenteral therapy with other third-generation cephalosporins (such as ceftriaxone or cefotaxime) may be more appropriate initially 5
• Once clinical improvement occurs, patients can be switched to oral cefixime to complete the treatment course 3

Special Populations and Considerations

Pediatric Dosing

• For children with LRTIs: 8 mg/kg daily divided into two doses 4
• Maximum pediatric dose should not exceed adult dosing 5

Renal Impairment

• Dose adjustment is necessary in patients with significant renal dysfunction 4
• For patients with creatinine clearance 30-50 mL/min, consider reduced dosing frequency 5

Comparative Efficacy

• Clinical studies have shown that cefixime 200 mg twice daily is comparable in efficacy to:
  • Amoxicillin-clavulanate 500/125 mg three times daily 2
  • Other oral cephalosporins like cefaclor and cefuroxime axetil 3, 4
• Bacteriological eradication rates of approximately 54% and clinical response rates (cured or improved) of 71% have been reported for cefixime in LRTI treatment 2

Common Pathogens in LRTIs and Cefixime Coverage

• Cefixime is effective against:
  • Haemophilus influenzae (including beta-lactamase producing strains) 4
  • Moraxella catarrhalis 4
  • Streptococcus pneumoniae (penicillin-susceptible strains) 3
• Important limitation: Cefixime has limited activity against Staphylococcus aureus and is ineffective against Pseudomonas aeruginosa 4, 2

Monitoring and Follow-up

• Clinical response should be assessed within 48-72 hours of initiating therapy 5
• Consider alternative therapy if no improvement is observed after 72 hours 5
• For patients with persistent symptoms, consider obtaining sputum cultures to guide therapy 5

Adverse Effects

• Most common side effects are gastrointestinal disturbances (diarrhea and stool changes) 3, 4
• These adverse effects are usually mild to moderate in severity and transient, occurring mainly in the first few days of treatment 4
• Cases of pseudomembranous colitis have been reported, though rare 3

Clinical Pearls

• Cefixime can be taken without regard to meals, improving patient convenience 4
• For patients with difficulty swallowing tablets, cefixime is also available as an oral suspension 4
• In areas with high prevalence of resistant S. pneumoniae, consider alternative agents or higher doses 5