Cefixime for Dental Infections: Not Recommended
Cefixime is not an appropriate antibiotic choice for dental infections and should not be used in this clinical context. The available evidence exclusively addresses cefixime's role in gonorrhea, urinary tract infections, and respiratory infections—none of which are relevant to odontogenic infections 1, 2.
Why Cefixime Is Inappropriate for Dental Infections
Spectrum of Activity Mismatch
- Cefixime demonstrates excellent activity against Enterobacteriaceae, Haemophilus influenzae, Streptococcus pneumoniae, and Moraxella catarrhalis, but has poor activity against Staphylococcus aureus and is inactive against anaerobes 3, 4, 5.
- Dental infections are predominantly polymicrobial, involving oral streptococci and obligate anaerobes (particularly Prevotella, Porphyromonas, and Fusobacterium species), which are not covered by cefixime's spectrum 3.
Lack of Clinical Evidence
- No guidelines or clinical trials support cefixime use for odontogenic infections 1, 2.
- All available evidence focuses on genitourinary infections, gonorrhea, and respiratory tract infections—completely different bacterial ecosystems from the oral cavity 3, 4, 6.
Appropriate Alternatives for Dental Infections
First-Line Therapy
- Amoxicillin or amoxicillin-clavulanate provides appropriate coverage for both aerobic streptococci and oral anaerobes commonly implicated in dental abscesses and periodontal infections.
- Clindamycin serves as the preferred alternative for penicillin-allergic patients, offering excellent anaerobic coverage.
Clinical Pitfall to Avoid
- Do not select antibiotics based solely on "third-generation cephalosporin" classification—the specific spectrum matters more than the generation 3, 4.
- Cefixime's poor staphylococcal activity and complete lack of anaerobic coverage make it fundamentally unsuitable for the mixed aerobic-anaerobic environment of dental infections 5.
Additional Considerations
- Even cefepime, a fourth-generation cephalosporin with broader gram-positive activity than cefixime, is not indicated for dental infections despite its improved spectrum 7.
- The 3-4 hour half-life permitting once-daily dosing is irrelevant when the drug lacks activity against the causative pathogens 4, 5.