Cefixime Dose Calculation for 4-Year-Old Child
The patient is receiving 50 mg of cefixime per dose (2.5 mL × 100 mg/5 mL = 50 mg), which translates to approximately 3.3-3.7 mg/kg/day if given once daily, or 6.6-7.4 mg/kg/day if given twice daily—both significantly below the recommended 8 mg/kg/day dosing for pediatric patients. 1
Recommended Dosing
The FDA-approved dose for pediatric patients 6 months or older is 8 mg/kg/day of cefixime suspension, which may be administered as a single daily dose or divided into two doses of 4 mg/kg every 12 hours. 1
For a child weighing 13.5-15 kg, the correct total daily dose should be:
Current Dose Assessment
- The current prescription of 2.5 mL of 100 mg/5 mL concentration delivers only 50 mg per dose 1
- If this is being given once daily, the patient receives only 50 mg/day (3.3-3.7 mg/kg/day)
- If given twice daily, the patient receives 100 mg/day (6.6-7.4 mg/kg/day)—still below the recommended 8 mg/kg/day 1
Clinical Implications
Underdosing may lead to treatment failure and development of antibiotic resistance, particularly problematic given cefixime's role in treating respiratory and urinary tract infections. 2, 3
Clinical trials demonstrating cefixime's efficacy in pediatric otitis media and respiratory infections used the standard 8 mg/kg/day dosing regimen. 4
The dose should be corrected to approximately 5.4-6 mL once daily (or 2.7-3 mL twice daily) of the 100 mg/5 mL suspension to achieve the therapeutic target of 8 mg/kg/day. 1
Dosing Frequency Considerations
While cefixime's 3-hour half-life permits once-daily dosing for many infections, the FDA label allows flexibility for either once-daily or twice-daily administration. 1, 2
For otitis media specifically, clinical trials used the suspension formulation, as it achieves higher peak blood levels than tablets at equivalent doses. 1