Cefixime Dosing and Treatment Duration
Standard Adult Dosing
The recommended dose of cefixime for adults is 400 mg daily, which can be administered as a single daily dose without regard to food. 1
Pediatric Dosing (≥6 months)
For children 6 months and older, the recommended dose is 8 mg/kg/day, administered either as a single daily dose or divided into two doses of 4 mg/kg every 12 hours. 1
Weight-Based Pediatric Dosing Table:
- 5-7.5 kg: 50 mg/day 1
- 7.6-10 kg: 80 mg/day 1
- 10.1-12.5 kg: 100 mg/day 1
- 12.6-20.5 kg: 150 mg/day 1
- 20.6-28 kg: 200 mg/day 1
- 28.1-33 kg: 250 mg/day 1
- 33.1-40 kg: 300 mg/day 1
- 40.1-45 kg: 350 mg/day 1
- >45 kg or >12 years: Use adult dose of 400 mg/day 1
Infection-Specific Dosing and Duration
Uncomplicated Gonorrhea (Cervical/Urethral)
A single oral dose of 400 mg is recommended for uncomplicated gonococcal infections. 1 However, cefixime does not provide as high or sustained bactericidal levels as ceftriaxone 125 mg IM, and its effectiveness against pharyngeal gonorrhea is less well-established. 2, 3
Streptococcal Pharyngitis and Tonsillitis
Administer therapeutic dosage for at least 10 days to ensure eradication of Streptococcus pyogenes. 1 Clinical studies demonstrate comparable efficacy to amoxicillin when given at 8 mg/kg daily in children. 4, 5
Otitis Media
Use the oral suspension formulation specifically for otitis media, as it achieves higher peak blood levels than capsules at equivalent doses. 1 Treatment duration is typically 10-14 days at 8 mg/kg/day. 5
Uncomplicated Urinary Tract Infections
Standard adult dose of 400 mg daily is effective for uncomplicated UTIs. 1 For severe upper urinary tract infections (pyelonephritis), consider initial IV ceftriaxone 2 g daily for 4 days, then transition to oral cefixime 200 mg twice daily for 11 days (total 15 days). 6
Enteric Fever (Typhoid)
For enteric fever in children, cefixime 8 mg/kg/day as a single daily dose for 7-14 days is an appropriate oral option, particularly for children over 28 days old. 7 For adults, 400 mg orally in a single dose daily is recommended. 7 Note that azithromycin or ceftriaxone are preferred first-line agents in areas with high fluoroquinolone resistance. 7
Lower Respiratory Tract Infections
For acute exacerbations of chronic bronchitis and community-acquired pneumonia, 400 mg daily for 7-14 days demonstrates clinical success rates of 86-88%. 8, 9 Cefixime is particularly effective against beta-lactamase-producing H. influenzae, S. pneumoniae, and M. catarrhalis. 4, 9
Renal Impairment Dosing
Dose adjustment is required when creatinine clearance falls below 60 mL/min: 1
- CrCl ≥60 mL/min: Normal dose 1
- CrCl 21-59 mL/min OR hemodialysis: 260 mg daily (13 mL of 100 mg/5 mL suspension or 6.5 mL of 200 mg/5 mL suspension) 1
- CrCl ≤20 mL/min OR continuous peritoneal dialysis: 172 mg daily (8.6 mL of 100 mg/5 mL suspension or 4.4 mL of 200 mg/5 mL suspension) 1
Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime from the body. 1
Important Clinical Considerations
Formulation Selection
Do not substitute capsules for suspension in otitis media treatment, as the suspension achieves significantly higher peak blood levels. 1 This is critical for adequate middle ear penetration.
Pharmacokinetic Profile
Cefixime has a 3-4 hour half-life with a Cmax of 4.4 mcg/mL, well above the MIC90 for susceptible pathogens, permitting once-daily dosing. 4, 9 However, it achieves lower and less sustained bactericidal levels compared to injectable cephalosporins like ceftriaxone. 2, 3
Spectrum Limitations
Cefixime has minimal activity against Staphylococcus aureus and is inactive against Pseudomonas aeruginosa. 4 Do not use empirically when these organisms are suspected.
Suspension Storage
After reconstitution, the suspension remains stable for 14 days at room temperature or refrigerated. 1 Shake well before each use and discard unused portions after 14 days. 1
Common Adverse Effects
The most frequent adverse effect is diarrhea (16% of patients), typically mild to moderate and transient, occurring in the first few days of treatment. 5 Other gastrointestinal effects include loose stools (6%), nausea (7%), and abdominal pain (3%). 1