Cefixime Dosing for a 12 kg Pediatric Patient
For a 12 kg child receiving cefixime 100 mg/5 mL suspension, the dose of 2.5 mL delivers 50 mg, which equals approximately 4.2 mg/kg—this is BELOW the recommended therapeutic dose of 8 mg/kg/day (96 mg daily for this patient) and should be increased to 5 mL daily (100 mg) as a single dose or divided into 2.5 mL twice daily. 1
Standard Pediatric Dosing
The FDA-approved dose for cefixime in pediatric patients 6 months or older is 8 mg/kg/day, which may be administered as a single daily dose or divided as 4 mg/kg every 12 hours 1
For a 12 kg patient, this translates to 96-100 mg daily (rounded for ease of administration) 1
Using the 100 mg/5 mL concentration, the appropriate volume is 5 mL daily (can be given as 5 mL once daily or 2.5 mL twice daily) 1
Current Dose Assessment
The prescribed 2.5 mL of 100 mg/5 mL suspension contains only 50 mg of cefixime 1
This represents approximately 4.2 mg/kg for a 12 kg patient—roughly half the recommended dose 1
Clinical trials demonstrating efficacy used 8 mg/kg/day dosing in children 2, 3
Clinical Efficacy Data
Studies in acute otitis media showed that cefixime 8 mg/kg daily (given once daily or in 2 divided doses) achieved favorable clinical response rates of 90-100% 3
Comparative trials demonstrated that 8 mg/kg/day was as effective as amoxicillin 40-50 mg/kg/day in treating pediatric infections 2, 3
Lower doses have not been validated in clinical trials and may lead to treatment failure or development of resistance 2
Dosing Recommendations by Indication
For otitis media: The suspension formulation must be used (not tablets/capsules) as it achieves higher peak blood levels; dose is 8 mg/kg/day 1
For respiratory tract infections: 8 mg/kg/day administered once daily or in 2 divided doses 2, 4
For urinary tract infections: 8 mg/kg/day, though pediatric UTI data are limited 5
Important Caveats
Concentration confusion risk: Cefixime suspension is available in two concentrations (100 mg/5 mL and 200 mg/5 mL)—always verify which concentration is being used to avoid dosing errors 1
Duration of therapy: For Streptococcus pyogenes infections, treatment must continue for at least 10 days regardless of clinical improvement 1
Gastrointestinal effects: Twice-daily dosing (2.5 mL BID) may be better tolerated than once-daily dosing, as single daily doses showed higher incidence of diarrhea in some studies 5
After reconstitution, the suspension remains stable for 14 days at room temperature or refrigerated; shake well before each use 1