What is the recommended dose of cefixime (cephalosporin antibiotic)?

Cefixime Dosing Recommendations

Adult Dosing

The standard dose of cefixime for adults is 400 mg daily, which can be administered as a single daily dose or divided into 200 mg twice daily. 1

• For most infections (uncomplicated UTIs, pharyngitis, acute exacerbations of chronic bronchitis), the dose is 400 mg once daily 1
• For uncomplicated urogenital gonorrhea, a single 400 mg oral dose is recommended 1
• The medication may be taken without regard to food 1
• Important caveat: The CDC recommends against using cefixime for serious invasive infections (bacteremia, meningitis, endocarditis) as these require parenteral cephalosporins like ceftriaxone 2
• Cefixime should not be used as monotherapy for gonococcal pharyngitis due to uncertain effectiveness 2

Pediatric Dosing (≥6 months)

The recommended pediatric dose is 8 mg/kg/day, administered either as a single daily dose or divided into 4 mg/kg every 12 hours. 1

Weight-Based Dosing Table

The FDA label provides specific dosing by weight 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)
• 28.1-33 kg: 250 mg/day (12.5 mL of 100 mg/5 mL or 6 mL of 200 mg/5 mL)
• 33.1-40 kg: 300 mg/day (15 mL of 100 mg/5 mL or 7.5 mL of 200 mg/5 mL)
• 40.1-45 kg: 350 mg/day (17.5 mL of 100 mg/5 mL or 9 mL of 200 mg/5 mL)
• >45 kg or >12 years: 400 mg/day (adult dose) 1

Pediatric-Specific Considerations

• For otitis media, use the suspension formulation only (not tablets/capsules), as clinical trials demonstrated the suspension achieves higher peak blood levels 1
• The maximum daily dose is 400 mg 3, 1
• Efficacy and safety have not been established in infants <6 months of age 1

Renal Impairment Dosing

Dose adjustment is required when creatinine clearance is <60 mL/min. 1

• CrCl ≥60 mL/min: Normal dose (400 mg/day)
• CrCl 21-59 mL/min or on hemodialysis: 260 mg/day (13 mL of 100 mg/5 mL or 6.5 mL of 200 mg/5 mL suspension)
• CrCl ≤20 mL/min or on continuous peritoneal dialysis: 172 mg/day (8.6 mL of 100 mg/5 mL or 4.4 mL of 200 mg/5 mL suspension) 1
• Neither hemodialysis nor peritoneal dialysis removes significant amounts of the drug 1

Duration of Therapy

• Streptococcus pyogenes infections: Minimum 10 days of therapy required 1
• Uncomplicated gonorrhea: Single dose 1
• Other infections: Typically 7-14 days based on clinical response 4

Clinical Context from Guidelines

The Taiwan pneumonia guidelines list cefixime at 8 mg/kg/day divided every 12 hours or once daily, with a maximum of 400 mg/day for pediatric respiratory infections 3. This aligns with FDA labeling and supports the flexibility of once-daily versus twice-daily dosing based on clinical circumstances.