What is the dosage and treatment duration of Taxim O (cefotaxime) for typhoid fever?

Treatment of Typhoid Fever with Taxim-O (Cefixime)

For uncomplicated typhoid fever, Taxim-O (cefixime) should be dosed at 8 mg/kg/day (maximum 400 mg/day) as a single daily dose for 7-14 days, though it is less effective than azithromycin or ceftriaxone and should be reserved as an alternative option when first-line agents cannot be used. 1

Dosing Regimen

• Standard dose: 8 mg/kg/day as a single daily dose for 7-14 days 1
• Alternative regimen from clinical trials: 20 mg/kg/day divided into two doses (every 12 hours) for a minimum of 12 days showed clinical cure in 50 children, with fever subsiding within a mean of 5.3 days 2
• The longer duration (12-14 days) may be preferable to reduce relapse risk, as only 2 of 50 patients relapsed with the 12-day regimen 2

Position in Treatment Algorithm

Cefixime is not a first-line agent for typhoid fever, particularly in regions with high fluoroquinolone resistance like India and South Asia:

• First-line therapy: Azithromycin 20 mg/kg/day (maximum 1g/day) orally for 7 days is preferred, with a 94% cure rate and lower relapse risk (OR 0.09) compared to ceftriaxone 1
• For severe cases: Ceftriaxone 50-80 mg/kg/day (maximum 2g/day) IV for 5-7 days, transitioning to oral therapy once afebrile for 24 hours 1
• Cefixime as alternative: Use when azithromycin is unavailable or contraindicated for uncomplicated cases 1

Clinical Efficacy Considerations

The evidence for cefixime shows it is less effective than fluoroquinolones but still clinically useful:

• In a Vietnamese trial comparing cefixime (7 days) versus ofloxacin (5 days), treatment failures were significantly higher with cefixime, and days of fever, poor eating, and immobility were significantly longer 3
• However, cefixime demonstrated 96% clinical cure (48/50 patients) in children with multidrug-resistant S. typhi, including chloramphenicol-resistant strains 2
• Expected fever clearance: 4-5 days with appropriate therapy; cefixime averaged 5.3 days in clinical trials 1, 2

Critical Pitfalls to Avoid

• Do not use fluoroquinolones empirically in patients returning from India or South Asia, where resistance exceeds 70% 4, 1
• Obtain blood cultures before starting antibiotics when possible, as they have the highest yield (40-80% sensitivity) within the first week of symptoms 1
• Monitor for complications (gastrointestinal bleeding, intestinal perforation, encephalopathy) which occur in 10-15% of patients, especially if illness duration exceeds 2 weeks 4, 1
• Relapse risk: Occurs in approximately 4% of cefixime-treated patients; monitor for 8 weeks post-treatment 2

When to Escalate Therapy

If the patient remains febrile beyond 4-5 days or shows clinical deterioration:

• Switch to IV ceftriaxone 2g daily (adults) or 50-80 mg/kg/day (children) for 14 days to reduce relapse risk 4
• Consider combination therapy with ciprofloxacin and cefotaxime for severe cases, which shows synergistic effects in vitro against nalidixic acid-resistant strains 5