Cefixime Oral Suspension: Dosing and Treatment Duration
For bacterial infections, cefixime oral suspension should be dosed at 8 mg/kg/day in pediatric patients ≥6 months, administered either as a single daily dose or divided into 4 mg/kg every 12 hours, with a maximum of 400 mg daily; adults receive 400 mg daily as a single dose, with treatment duration of 10 days for streptococcal infections and 7-14 days for other bacterial infections depending on the site. 1
Pediatric Dosing (≥6 months)
Standard dosing is 8 mg/kg/day of the oral suspension, which can be given as:
- Single daily dose, OR
- Divided into 4 mg/kg every 12 hours 1
Weight-Based Dosing Table
The FDA provides specific dosing recommendations based on weight 1:
- 5-7.5 kg: 50 mg/day (2.5 mL of 100 mg/5 mL suspension)
- 7.6-10 kg: 80 mg/day (4 mL of 100 mg/5 mL or 2 mL of 200 mg/5 mL)
- 10.1-12.5 kg: 100 mg/day (5 mL of 100 mg/5 mL or 2.5 mL of 200 mg/5 mL)
- 12.6-20.5 kg: 150 mg/day (7.5 mL of 100 mg/5 mL or 4 mL of 200 mg/5 mL)
- 20.6-28 kg: 200 mg/day (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL)
- 28.1-33 kg: 250 mg/day (12.5 mL of 100 mg/5 mL or 6 mL of 200 mg/5 mL)
- 33.1-40 kg: 300 mg/day (15 mL of 100 mg/5 mL or 7.5 mL of 200 mg/5 mL)
- 40.1-45 kg: 350 mg/day (17.5 mL of 100 mg/5 mL or 9 mL of 200 mg/5 mL)
- >45 kg or >12 years: 400 mg/day (adult dose) 1
Critical Prescribing Consideration
Always specify the concentration when prescribing in milliliters, as cefixime oral suspension is available in two concentrations: 100 mg/5 mL and 200 mg/5 mL 1. This prevents potentially dangerous dosing errors.
Adult Dosing
The standard adult dose is 400 mg daily, administered as a single dose 1. The capsule may be taken without regard to food 1.
Treatment Duration by Indication
Streptococcal Pharyngitis/Tonsillitis
Minimum 10 days of therapy is required for infections due to Streptococcus pyogenes to ensure adequate eradication and prevent rheumatic fever complications 1. Clinical studies demonstrated effectiveness in streptococcal pharyngitis with once-daily dosing 2.
Uncomplicated Gonorrhea
Single oral dose of 400 mg for uncomplicated cervical/urethral gonococcal infections 1. However, the CDC no longer recommends cefixime as first-line therapy due to increasing resistance 3. When used, it must be combined with azithromycin 1 g orally as a single dose or doxycycline 100 mg twice daily for 7 days, with azithromycin preferred 3. A test of cure in 1 week is mandatory 3.
Respiratory Tract Infections
7-14 days of treatment for acute exacerbations of chronic bronchitis, otitis media, and pneumonia 4, 2. Clinical trials demonstrated excellent efficacy with once-daily dosing in both children and adults 4.
Urinary Tract Infections
7-14 days for uncomplicated UTIs 5, 6. Studies showed clinical cure or improvement in 94-99% of patients with uncomplicated UTIs 6, 4.
Special Populations
Renal Impairment Dosing (Adults)
Dose adjustment is required for creatinine clearance <60 mL/min 1:
- CrCl ≥60 mL/min: Normal dose (400 mg daily)
- CrCl 21-59 mL/min OR hemodialysis: 260 mg daily (13 mL of 100 mg/5 mL or 6.5 mL of 200 mg/5 mL suspension)
- CrCl ≤20 mL/min OR continuous peritoneal dialysis: 172 mg daily (8.6 mL of 100 mg/5 mL or 4.4 mL of 200 mg/5 mL suspension) 1
Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime 1.
Important Clinical Considerations
Otitis Media Specific Requirement
Use suspension formulation only for otitis media, not tablets or capsules 1. Clinical trials demonstrated that the suspension achieves higher peak blood levels than tablets at the same dose, which is critical for adequate middle ear penetration 1.
Antimicrobial Spectrum
Cefixime provides excellent coverage against:
- Haemophilus influenzae (including beta-lactamase producers)
- Moraxella catarrhalis
- Penicillin-susceptible Streptococcus pneumoniae
- Most Enterobacteriaceae (E. coli, Proteus mirabilis)
- Streptococcus pyogenes
- Neisseria gonorrhoeae (though resistance increasing) 1, 5, 7
Poor activity against: Staphylococcus aureus, enterococci, Pseudomonas aeruginosa, and Listeria monocytogenes 5, 7.
Adverse Effects
Diarrhea and stool changes occur in up to 16-20% of patients 2, 7. These are typically mild, transient, and occur in the first few days of treatment 5. Twice-daily dosing (200 mg BID) has lower gastrointestinal adverse effects than once-daily 400 mg dosing 6.
Dosing Frequency Consideration
While once-daily dosing is convenient and supported by the 3-hour elimination half-life 5, 7, twice-daily administration may improve tolerability by reducing gastrointestinal side effects 6.