Cefixime Dosing for a 9-Year-Old Male Weighing 20.3 kg
For this 9-year-old patient weighing 20.3 kg, administer cefixime 162 mg daily (8 mL of the 100 mg/5 mL suspension OR 4 mL of the 200 mg/5 mL suspension), which can be given as a single daily dose or divided into 4 mg/kg every 12 hours (81 mg twice daily). 1
Standard Pediatric Dosing Algorithm
The FDA-approved dosing for pediatric patients 6 months or older is 8 mg/kg/day of the oral suspension 1. This can be administered either:
- Single daily dose: 8 mg/kg once daily
- Divided dosing: 4 mg/kg every 12 hours 1
Specific Calculation for This Patient
For a 20.3 kg child:
- Total daily dose: 20.3 kg × 8 mg/kg = 162.4 mg/day (round to 162 mg)
- Using 100 mg/5 mL suspension: 8 mL once daily (or 4 mL twice daily)
- Using 200 mg/5 mL suspension: 4 mL once daily (or 2 mL twice daily) 1
According to the FDA dosing chart, children weighing 20.6 to 28 kg should receive 200 mg daily (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL), but for this patient at 20.3 kg, the weight-based calculation of 162 mg is more precise 1.
Critical Indication-Specific Considerations
For otitis media specifically, you must use the suspension formulation - the tablet or capsule should never be substituted because the suspension achieves higher peak blood levels at the same dose 1. This is a common pitfall to avoid.
For infections caused by Streptococcus pyogenes (pharyngitis/tonsillitis), treatment must continue for at least 10 days regardless of clinical improvement 1.
Alternative Oral Cephalosporin Options
If cefixime is unavailable or not tolerated, guideline-supported alternatives for common pediatric infections include 2:
- Cefdinir, cefpodoxime, or ceftibuten as alternatives for beta-lactamase producing Haemophilus influenzae infections 2
- Cefpodoxime: 10 mg/kg/day divided into 2 doses 3
- Cefprozil: 30 mg/kg/day divided into 2 doses 3
Administration and Storage
After reconstitution, the suspension remains stable for 14 days at room temperature or refrigerated 1. Always shake well before each use and ensure the bottle specifies concentration (100 mg/5 mL vs 200 mg/5 mL) to prevent dosing errors 1.
Common Pitfalls to Avoid
- Never substitute tablets/capsules for suspension in otitis media - this results in inadequate blood levels 1
- Always verify suspension concentration before calculating volume - two different concentrations exist 1
- Do not use cefixime for staphylococcal infections - it has poor activity against Staphylococcus aureus 4, 5
- Avoid for Pseudomonas aeruginosa - cefixime is inactive against this pathogen 4, 5