Cefixime Tablet Dosing and Treatment Duration
For adults with bacterial infections, cefixime is dosed at 400 mg once daily, while pediatric patients 6 months and older receive 8 mg/kg/day, administered either as a single daily dose or divided into two doses of 4 mg/kg every 12 hours. 1
Adult Dosing
- Standard dose: 400 mg once daily for most bacterial infections 1
- The 400 mg dose can be given as a single capsule daily, administered without regard to food 1
- For uncomplicated gonorrhea (cervical/urethral): single 400 mg oral dose 1
- For streptococcal pharyngitis/tonsillitis: continue treatment for at least 10 days to ensure eradication of Streptococcus pyogenes 1
Pediatric Dosing (≥6 months)
- Standard dose: 8 mg/kg/day of oral suspension 1
- Can be administered as a single daily dose OR divided as 4 mg/kg every 12 hours 1
- Weight-based dosing examples: 1
- 10-12.5 kg: 100 mg daily (5 mL of 100 mg/5 mL suspension)
- 20.6-28 kg: 200 mg daily (10 mL of 100 mg/5 mL suspension or 5 mL of 200 mg/5 mL suspension)
45 kg or >12 years: use adult dose of 400 mg daily
- For otitis media specifically: must use suspension formulation (not tablets/capsules), as suspension achieves higher peak blood levels at equivalent doses 1
- For streptococcal infections: minimum 10-day treatment course 1
Renal Impairment Adjustments
Dose reduction is required when creatinine clearance falls below 60 mL/min: 1
- CrCl ≥60 mL/min: Normal dose (400 mg daily for adults)
- CrCl 21-59 mL/min OR on hemodialysis: 13 mL of 100 mg/5 mL suspension (260 mg) OR 6.5 mL of 200 mg/5 mL suspension (260 mg) daily
- CrCl ≤20 mL/min OR on peritoneal dialysis: 8.6 mL of 100 mg/5 mL suspension (172 mg) OR 4.4 mL of 200 mg/5 mL suspension (176 mg) daily
- Neither hemodialysis nor peritoneal dialysis removes significant drug amounts 1
Clinical Spectrum and Applications
Cefixime provides effective coverage against common respiratory and urinary pathogens: 2, 3
- Respiratory pathogens: Haemophilus influenzae, Moraxella catarrhalis, penicillin-susceptible Streptococcus pneumoniae, Streptococcus pyogenes 2, 3
- Enterobacteriaceae: E. coli, Klebsiella pneumoniae, Proteus mirabilis 3
- Limited activity: Minimal against Staphylococcus aureus; inactive against Pseudomonas aeruginosa 3
Predicted clinical efficacy for acute bacterial rhinosinusitis: 82-87% in children and 83-88% in adults 2
Treatment Duration by Indication
- Uncomplicated UTI: 7-10 days based on clinical response 4
- Pharyngitis/tonsillitis: Minimum 10 days for streptococcal infections 1, 5
- Otitis media: 10-14 days 5
- Acute exacerbations of chronic bronchitis: 7-14 days 1
- Uncomplicated gonorrhea: Single dose 1
Important Clinical Considerations
Common pitfalls to avoid:
- Do NOT substitute tablets/capsules for suspension in otitis media treatment, as bioavailability differs significantly 1
- Always specify concentration when ordering suspension (available as 100 mg/5 mL and 200 mg/5 mL) to prevent dosing errors 1
- Twice-daily dosing (200 mg BID in adults) shows lower incidence of gastrointestinal adverse effects compared to once-daily 400 mg dosing, though both are effective 4
Adverse effects: Most common are gastrointestinal (diarrhea 16%, loose stools, nausea), typically mild and transient, occurring in first few days of treatment 3, 5, 6
Allergy considerations: For patients with non-immediate beta-lactam hypersensitivity, cefixime may be used; avoid in immediate Type I hypersensitivity reactions 2