What is the recommended dosage of cefixime (Cefixime) for various infections?

Cefixime Dosing Recommendations

For adults, cefixime is dosed at 400 mg orally as a single daily dose for most infections, though this can be divided into 200 mg twice daily to reduce gastrointestinal side effects; for pediatric patients 6 months and older, the dose is 8 mg/kg/day given once daily or divided into 4 mg/kg every 12 hours. 1

Adult Dosing

Standard Infections

• 400 mg orally once daily is the FDA-approved dose for uncomplicated urinary tract infections, otitis media, pharyngitis/tonsillitis, acute exacerbations of chronic bronchitis, and uncomplicated gonorrhea 1
• The 400 mg dose may be given as a single daily administration or divided into 200 mg twice daily 1, 2
• Divided dosing (200 mg twice daily) is preferred as it reduces gastrointestinal adverse effects compared to once-daily 400 mg dosing 2, 3

Uncomplicated Gonorrhea

• Single oral dose of 400 mg for uncomplicated cervical/urethral gonococcal infections 1
• Important caveat: Cefixime is no longer recommended as first-line therapy for gonorrhea in the United States due to rising resistance 4
• Cefixime provides lower and less sustained bactericidal levels than ceftriaxone 125 mg IM, with only 97.1-97.4% cure rates for urogenital/anorectal gonorrhea compared to 99.1% for ceftriaxone 4
• Cefixime has limited efficacy for pharyngeal gonorrhea 4

Streptococcal Infections

• For pharyngitis/tonsillitis caused by Streptococcus pyogenes, continue treatment for at least 10 days regardless of clinical improvement 1

Pediatric Dosing (≥6 months old)

Standard Dose

• 8 mg/kg/day of oral suspension 1
• May be given as a single daily dose or divided into 4 mg/kg every 12 hours 1
• Children weighing >45 kg or >12 years should receive the adult dose of 400 mg daily 1

Weight-Based Dosing Table

The FDA label provides specific volume 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)
• ≥45 kg: 400 mg/day (adult dose)

Critical Otitis Media Consideration

• Use suspension formulation only for otitis media—do not substitute tablets or capsules 1
• The suspension achieves higher peak blood levels than tablets at equivalent doses, which is essential for otitis media treatment 1

Renal Impairment Dosing

Dose Adjustments for Adults

• CrCl ≥60 mL/min: Normal dose (400 mg daily) 1
• CrCl 21-59 mL/min: 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 on 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 drug amounts 1

Special Clinical Contexts

Enteric Fever (Typhoid)

• 8 mg/kg/day as a single daily dose for children >28 days old 5
• 400 mg orally once daily for adults 5
• Treatment duration: 7-14 days 5
• Important limitation: Cefixime showed significantly more treatment failures and longer fever duration compared to ofloxacin in randomized trials of typhoid fever 5
• Azithromycin or ceftriaxone are preferred first-line agents for enteric fever due to better efficacy 5

Urinary Tract Infections

• 400 mg daily (200 mg twice daily preferred) for uncomplicated UTIs 1, 2
• For complicated UTIs, sensitivity testing is mandatory before initiating cefixime, as gram-positive and non-fermenting organisms resistant to cefixime may be present 2
• Cefixime achieves only about 20% urinary excretion as active drug, lower than some other oral cephalosporins 2

Important Clinical Caveats

Resistance Concerns

• Do not use for gonorrhea as routine first-line therapy—ceftriaxone 250 mg IM is now the only recommended cephalosporin 4
• Rising minimum inhibitory concentrations (MICs) to cefixime have been documented, particularly in the Western United States and among men who have sex with men 4

Administration Considerations

• May be administered without regard to food for capsules 1
• Always specify concentration when prescribing suspension in milliliters, as two concentrations exist (100 mg/5 mL and 200 mg/5 mL) 1

Comparative Efficacy

• Cefixime provides lower and less sustained bactericidal levels than injectable ceftriaxone at equivalent antimicrobial spectrum 4, 6
• The 3-hour elimination half-life permits simplified once or twice daily dosing 7