Cefixime Adult Dosing
The recommended adult dose of cefixime is 400 mg orally once daily, which may alternatively be given as 200 mg twice daily for most infections. 1
Standard Dosing by Indication
Uncomplicated Urinary Tract Infections
- 400 mg once daily is the FDA-approved dose for uncomplicated UTI caused by E. coli and Proteus mirabilis 1
- Alternative dosing: 200 mg twice daily provides similar efficacy with potentially fewer gastrointestinal side effects 2
- Clinical trials demonstrate 94% cure rates with this regimen 3
Respiratory Tract Infections
- 400 mg once daily for acute exacerbations of chronic bronchitis 1
- For pharyngitis/tonsillitis caused by Streptococcus pyogenes, continue treatment for at least 10 days 1
- Studies show 98-100% cure or improvement rates in adults with respiratory infections 3
Uncomplicated Gonorrhea (Cervical/Urethral)
- Single oral dose of 400 mg is FDA-approved for uncomplicated gonococcal infections 1
- However, CDC no longer recommends cefixime as first-line therapy due to rising resistance, particularly in the Western United States and among men who have sex with men 4, 5, 6
- If ceftriaxone is unavailable, use cefixime 400 mg PLUS azithromycin 1 g orally as a single dose (preferred) OR doxycycline 100 mg twice daily for 7 days, with mandatory test-of-cure in 1 week 4, 6
- Cefixime has limited efficacy for pharyngeal gonorrhea and should be avoided for this site 4, 5
Dosing Adjustments for Renal Impairment
Creatinine clearance ≥60 mL/min: Normal dose (400 mg daily) 1
Creatinine clearance 21-59 mL/min: Reduce to 260 mg daily (13 mL of 100 mg/5 mL suspension or 6.5 mL of 200 mg/5 mL suspension) 1
Creatinine clearance ≤20 mL/min or on dialysis: Reduce to 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 1
Administration Considerations
- May be taken without regard to food 1
- The 3-4 hour elimination half-life permits once or twice daily dosing 7, 8
- Bioavailability is 40-52% and does not differ significantly between 200 mg and 400 mg doses 8
- Twice daily dosing (200 mg BID) may reduce gastrointestinal adverse effects compared to once daily 400 mg dosing 2
Critical Warnings
Do not use cefixime tablets/capsules for otitis media - the suspension achieves higher peak blood levels and was used in clinical trials; tablets should not be substituted 1
Avoid as monotherapy for gonorrhea - always combine with azithromycin or doxycycline due to resistance concerns, and only use when ceftriaxone is unavailable 4, 6