Cefixime Dosing for Typhoid Fever in Children
For typhoid fever in children, cefixime should be dosed at 10-20 mg/kg/day divided into two doses (every 12 hours) for 7-14 days, with a maximum daily dose of 400 mg.
Recommended Dosing Regimen
The standard dose is 10 mg/kg/day divided every 12 hours for 14 days, which has been validated in multiple clinical trials for multidrug-resistant typhoid fever 1, 2.
Higher doses of 20 mg/kg/day divided twice daily (maximum 400 mg twice daily) have also been used successfully in clinical trials, particularly in South Asian populations 3.
Shorter treatment courses of 7-8 days have demonstrated comparable efficacy to the traditional 14-day regimen 3, 4.
Duration Considerations
An 8-day course of cefixime achieved 95% clinical cure rates in children with multidrug-resistant typhoid fever, with only one relapse documented 4.
The 14-day regimen remains the most extensively studied duration, with cure rates of 90-93% in comparative trials 1, 2.
For practical purposes, a 7-day course is increasingly used and appears adequate based on recent trial protocols, though the traditional 14-day course may be preferred in severe cases or areas with high resistance 3.
Clinical Efficacy Data
Oral cefixime demonstrated equivalent efficacy to intravenous ceftriaxone in treating multidrug-resistant typhoid fever, with comparable defervescence times (8.0 ± 4.1 days vs. 8.3 ± 3.7 days) 1.
In head-to-head comparison with chloramphenicol, cefixime achieved superior cure rates (90% vs. 45%), with 93.3% overall cure when chloramphenicol failures were switched to cefixime 2.
Important Caveats
Cefixime is specifically indicated for multidrug-resistant typhoid fever where first-line agents (chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole) have failed or resistance is documented 1, 4.
The medication is well-tolerated with mild side effects including nausea/vomiting (8%) and loose stools (6%), which may be difficult to distinguish from typhoid symptoms 4.
Therapeutic failure occurs in approximately 5-10% of cases, requiring a change to alternative antibiotics such as ceftriaxone 1, 4.
Relapse rates are low (0-4%) but monitoring for 3-4 weeks post-treatment is advisable 1, 4.