Cefixime Administration with Food
Cefixime tablets may be administered without regard to food—patients can take them with or after meals, or on an empty stomach, as food does not significantly affect absorption. 1
Key Administration Guidelines
Food Does Not Affect Absorption
- The FDA-approved labeling explicitly states that cefixime capsules "may be administered without regard to food," meaning timing relative to meals is not clinically significant 1
- Pharmacokinetic studies demonstrate that food has no effect on peak serum concentrations or the extent of drug absorption, allowing flexible administration with or without meals 2
- The absolute bioavailability of cefixime remains consistent at approximately 50% regardless of food intake 2
Practical Dosing Recommendations
- Adults: The standard dose is 400 mg daily, which can be taken as a single daily dose without regard to meal timing 1
- Pediatric patients (≥6 months): 8 mg/kg/day of suspension, administered as a single daily dose or divided into two doses of 4 mg/kg every 12 hours 1
- For uncomplicated gonorrhea, a single 400 mg oral dose is recommended, again without food restrictions 1
Important Clinical Considerations
Gastrointestinal Tolerability
- While food is not required for absorption, some patients may experience gastrointestinal adverse effects including diarrhea or loose stools (occurring in up to 16-20% of patients) 3, 4
- Divided dosing may improve tolerability: Studies suggest that twice-daily dosing (200 mg BID) shows a lower incidence of gastrointestinal adverse effects compared to once-daily dosing (400 mg once daily) 5
- If gastrointestinal symptoms occur, consider splitting the daily dose into two administrations rather than changing meal timing 5
Duration of Therapy
- For infections due to Streptococcus pyogenes, therapeutic dosing must continue for at least 10 days regardless of meal timing 1
- Protein binding is approximately 33-70%, and the elimination half-life ranges from 3-4 hours, supporting once or twice-daily dosing 6, 2
Special Populations
- Renal impairment: Dose adjustments are based on creatinine clearance, not food intake—patients with CrCl 21-59 mL/min require reduced dosing, and those with CrCl ≤20 mL/min need further reduction 1
- Hepatic impairment: No dosage adjustment needed, though elimination half-life may increase to approximately 6.5 hours in cirrhotic patients 2
Bottom Line for Clinical Practice
The flexibility of cefixime administration without food restrictions offers a practical advantage for patient compliance. However, if gastrointestinal side effects emerge, consider dividing the daily dose rather than mandating food intake, as this strategy has demonstrated better tolerability in clinical studies 5.