Cefixime Dosing for Pediatric UTI
For pediatric urinary tract infections, cefixime should be dosed at 8 mg/kg/day orally, administered either as a single daily dose or divided into 4 mg/kg every 12 hours, for children 6 months and older. 1
FDA-Approved Dosing
- The standard pediatric dose is 8 mg/kg/day of oral suspension for children ≥6 months of age 1
- This can be given as:
- Single daily dose (8 mg/kg once daily), OR
- Divided dosing (4 mg/kg every 12 hours) 1
- Maximum daily dose is 400 mg (for children >45 kg or >12 years, use adult dosing) 1
Weight-Based Dosing Table
The FDA provides specific milliliter dosing based on weight ranges 1:
- 5-7.5 kg: 50 mg/day (2.5 mL of 100 mg/5 mL suspension)
- 7.6-10 kg: 80 mg/day (4 mL of 100 mg/5 mL or 2 mL of 200 mg/5 mL)
- 10.1-12.5 kg: 100 mg/day (5 mL of 100 mg/5 mL or 2.5 mL of 200 mg/5 mL)
- 12.6-20.5 kg: 150 mg/day (7.5 mL of 100 mg/5 mL or 4 mL of 200 mg/5 mL)
- 20.6-28 kg: 200 mg/day (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL)
- >45 kg: 400 mg/day (adult dose) 1
Treatment Duration
- Uncomplicated UTI: 7-10 days of therapy 2, 3
- The suspension may be kept for 14 days after reconstitution at room temperature or refrigerated 1
Clinical Evidence Supporting Efficacy
- A randomized study demonstrated that oral cefixime 8 mg/kg/day for 10 days achieved 92% cure rates in pediatric UTI, with urine cultures becoming sterile within 24 hours in all children 2
- Once-daily cefixime (8 mg/kg) showed comparable efficacy to twice-daily trimethoprim/sulfamethoxazole, with no treatment failures and only 5% relapse rate within 4 weeks 3
- All Gram-negative organisms causing UTI in pediatric studies were susceptible to cefixime 3
Important Caveats
- Age restriction: Cefixime is NOT approved for infants <6 months of age 1
- Concentration matters: Always specify concentration when ordering, as cefixime suspension comes in two strengths (100 mg/5 mL and 200 mg/5 mL) 1
- Renal adjustment: Not typically needed in children, but adults with creatinine clearance <60 mL/min require dose reduction 1
- Side effects: Gastrointestinal effects (diarrhea 16%, loose stools 6%) are most common; divided dosing (twice daily) may reduce GI side effects compared to once-daily dosing 1, 4