Treatment of Cefixime Overdose
For cefixime overdose, gastric lavage may be indicated as the primary intervention, but no specific antidote exists. 1
Initial Management
- Gastric lavage should be considered as the first intervention for cefixime overdose, especially if the ingestion was recent 1
- Supportive care with monitoring of vital signs and symptoms is essential as the mainstay of treatment 1
- Cefixime is not removed in significant quantities from the circulation by hemodialysis or peritoneal dialysis, limiting these as effective treatment options 1
Clinical Manifestations and Monitoring
- Based on data from healthy adult volunteers receiving single doses up to 2g of cefixime, adverse reactions did not differ significantly from those seen at recommended therapeutic doses 1
- Monitor for common adverse effects which may include:
Special Considerations
For patients with renal impairment:
- More careful monitoring is required as renal failure is the main risk factor for beta-lactam induced neurotoxicity 3, 4
- Watch for neurological symptoms such as encephalopathy, myoclonus, or seizures which may indicate neurotoxicity 3, 4
- Consider obtaining serum drug levels if available and clinically indicated 4
For laboratory test interference:
- Be aware that cefixime may cause false-positive reactions for ketones in urine when using tests with nitroprusside 1
- Cefixime may result in false-positive reactions for glucose in urine when using Clinitest, Benedict's solution, or Fehling's solution 1
- Consider using glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix or TesTape) for more accurate results 1
Follow-up Care
- After initial management, continue to monitor the patient for at least 24 hours for potential delayed adverse effects 2, 5
- If neurological symptoms develop, consider electroencephalogram (EEG) to evaluate for potential neurotoxicity, especially in patients with renal impairment 4
- Document the overdose event thoroughly and consider consultation with poison control center for complex cases 1
Pitfalls to Avoid
- Do not assume hemodialysis will effectively remove cefixime in cases of severe overdose 1
- Do not overlook the possibility of neurotoxicity in patients with renal impairment, as this may be a serious complication 3, 4
- Do not rely solely on laboratory tests that may be affected by cefixime (glucose, ketones) without considering the potential for false-positive results 1