Cefixime for UTI Prophylaxis: Not Recommended
Cefixime is not indicated or recommended for UTI prophylaxis. The FDA-approved indications for cefixime are limited to treatment of acute uncomplicated UTIs, not prevention 1.
Why Cefixime Should Not Be Used for Prophylaxis
No FDA approval for prophylaxis: Cefixime is approved only for treatment of uncomplicated UTIs caused by E. coli and Proteus mirabilis, not for prevention 1.
Absence from guideline recommendations: The 2018 Journal of Urology guidelines on recurrent UTI prevention evaluated multiple antibiotics for prophylaxis (including nitrofurantoin, trimethoprim-sulfamethoxazole, norfloxacin, ciprofloxacin, and fosfomycin) but cefixime was notably absent from all prophylactic regimens studied 2.
No clinical trial evidence: There are no published studies evaluating cefixime for UTI prophylaxis, only for acute treatment 3, 4, 5, 6.
Appropriate Treatment Dosing (Not Prophylaxis)
If you are asking about treatment rather than prophylaxis:
Adults: 400 mg daily (can be given as single daily dose) for uncomplicated UTI 1.
Pediatric patients ≥6 months: 8 mg/kg/day, either as single daily dose or divided as 4 mg/kg every 12 hours 1.
Renal impairment: Dose adjustment required when creatinine clearance <60 mL/min 1.
Evidence-Based Prophylaxis Alternatives
For actual UTI prophylaxis, consider these guideline-supported options instead:
Nitrofurantoin 50-100 mg nightly showed significant reduction in recurrent UTIs 2.
Trimethoprim-sulfamethoxazole 40/200 mg nightly or post-coital demonstrated effectiveness 2.
Fosfomycin 3 grams every 10 nights showed fewer infections per patient-year versus placebo (p <0.001) 2.
Ciprofloxacin 125 mg nightly (only if local resistance <10%) 2.
Critical Pitfall to Avoid
Do not use treatment-dose antibiotics for prophylaxis without evidence. Using cefixime 400 mg daily long-term for prophylaxis would expose patients to unnecessary adverse effects (particularly diarrhea and stool changes, which occur more frequently with once-daily dosing) 6, 7 without proven benefit for prevention, and would promote antimicrobial resistance.