What is the recommended cefixime (cephalosporin) dosage and treatment duration for outpatient treatment of infections?

Cefixime Dosing for Outpatient Treatment

For outpatient treatment of common bacterial infections in adults, cefixime should be dosed at 400 mg once daily, with treatment duration of 7-14 days depending on the infection type. 1

Adult Dosing Recommendations

Standard adult dosing is 400 mg daily, administered as a single dose without regard to food. 1

Infection-Specific Dosing:

• Uncomplicated urinary tract infections: 400 mg once daily for 7-10 days 1
• Acute exacerbations of chronic bronchitis: 400 mg once daily for 10-14 days 1
• Pharyngitis/tonsillitis: 400 mg once daily for at least 10 days (mandatory duration for Streptococcus pyogenes infections) 1
• Uncomplicated gonorrhea (cervical/urethral): Single 400 mg dose 1

The FDA label explicitly states that for Streptococcus pyogenes infections, the full 10-day course must be completed to prevent rheumatic fever complications, though cefixime has not been proven to prevent rheumatic fever as effectively as penicillin. 1

Pediatric Dosing (≥6 months)

Children should receive 8 mg/kg/day, either as a single daily dose or divided into 4 mg/kg every 12 hours. 1

Weight-Based Dosing Algorithm:

• 5-7.5 kg: 50 mg daily (2.5 mL of 100 mg/5 mL suspension) 1
• 7.6-10 kg: 80 mg daily (4 mL of 100 mg/5 mL or 2 mL of 200 mg/5 mL) 1
• 10.1-12.5 kg: 100 mg daily (5 mL of 100 mg/5 mL or 2.5 mL of 200 mg/5 mL) 1
• 12.6-20.5 kg: 150 mg daily (7.5 mL of 100 mg/5 mL or 4 mL of 200 mg/5 mL) 1
• 20.6-28 kg: 200 mg daily (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL) 1
• >45 kg or >12 years: Use adult dose of 400 mg daily 1

Critical caveat: For otitis media in children, only the suspension formulation should be used, never tablets or capsules, as the suspension achieves higher peak blood levels necessary for middle ear penetration. 1

Renal Impairment Dosing

Dose adjustment is required when creatinine clearance falls below 60 mL/min: 1

• CrCl ≥60 mL/min: Normal dose (400 mg daily) 1
• CrCl 21-59 mL/min OR on hemodialysis: 260 mg daily (13 mL of 100 mg/5 mL or 6.5 mL of 200 mg/5 mL) 1
• CrCl ≤20 mL/min OR on peritoneal dialysis: 172 mg daily (8.6 mL of 100 mg/5 mL or 4.4 mL of 200 mg/5 mL) 1

Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime, so no supplemental dosing is needed post-dialysis. 1

Clinical Efficacy Evidence

Research demonstrates high cure rates with once-daily cefixime dosing. A large post-marketing surveillance study of 9,568 patients with respiratory tract infections showed cure or improvement in 98.7% of adults and 98.0% of children using 400 mg daily (adults) or 8 mg/kg daily (children) for a median of 6 days. 2

For streptococcal pharyngitis and bacterial cystitis in children, once-daily cefixime (8 mg/kg) achieved clinical success in 98.2% of evaluable patients, with bacteriologic failure in only 2 of 109 patients. 3

For acute pyelonephritis, oral cefixime 400 mg once daily for 12 days demonstrated equivalent efficacy to combination amoxicillin plus netilmicin, with 97% favorable clinical response and similar recurrence rates (16.9% vs 14%). 4

Important Clinical Considerations

Common pitfalls to avoid:

• Do not use cefixime for serious invasive infections (bacteremia, meningitis, endocarditis) - these require parenteral cephalosporins like ceftriaxone 5
• Do not substitute tablets/capsules for suspension in pediatric otitis media - bioavailability differs significantly 1
• Do not use cefixime as monotherapy for gonococcal pharyngitis - older CDC guidelines note uncertainty about its effectiveness for this indication 5
• Ensure concentration is specified when prescribing suspension in milliliters, as two concentrations exist (100 mg/5 mL and 200 mg/5 mL) 1

The most common adverse effects are gastrointestinal: diarrhea (16%), nausea (7%), loose stools (6%), and abdominal pain (3%). 1 These are generally mild, with only 1.9% of patients discontinuing therapy due to side effects. 3

For gonorrhea treatment specifically: While cefixime 400 mg as a single dose remains FDA-approved for uncomplicated urogenital gonorrhea 1, current CDC guidelines have shifted preference to ceftriaxone due to rising resistance concerns. Cefixime should only be used when ceftriaxone is not feasible. 6