What is the recommended dose of cefixime (antibiotic) for a 9-year-old male patient weighing 20.3 kg?

Cefixime Dosing for a 9-Year-Old Male Weighing 20.3 kg

For this 9-year-old patient weighing 20.3 kg, administer cefixime 8 mg/kg/day, which equals 162 mg daily, rounded to 160 mg for practical administration (8 mL of the 100 mg/5 mL suspension or 4 mL of the 200 mg/5 mL suspension). 1

Standard Pediatric Dosing

• The FDA-approved dose for pediatric patients 6 months or older is 8 mg/kg/day of the oral suspension 1
• This may be administered as a single daily dose or divided into two doses of 4 mg/kg every 12 hours 1
• For a 20.3 kg child, the calculated dose is 162.4 mg/day, which should be rounded to 160 mg for ease of administration 1

Practical Administration

• Using the 100 mg/5 mL suspension: administer 8 mL once daily (or 4 mL twice daily) 1
• Using the 200 mg/5 mL suspension: administer 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/day (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL), but this patient at 20.3 kg falls just below this range 1
• The more precise calculation of 160 mg is appropriate for this weight 1

Important Clinical Considerations

• Always specify the concentration when prescribing in milliliters, as cefixime suspension is available in two different concentrations (100 mg/5 mL and 200 mg/5 mL) 1
• The suspension may be administered without regard to food 1
• For otitis media specifically, the suspension must be used rather than tablets or capsules, as the suspension achieves higher peak blood levels at the same dose 1
• Treatment duration should be at least 10 days for infections caused by Streptococcus pyogenes 1

Common Pitfalls to Avoid

• Do not substitute tablets or capsules for suspension in treating otitis media, as bioavailability differs 1
• Do not exceed the adult maximum dose of 400 mg daily, even in larger children 1
• Ensure proper reconstitution of the suspension and shake well before each use 1
• Discard unused suspension after 14 days, whether refrigerated or stored at room temperature 1

Alternative Consideration

• While cefixime 400 mg once daily can be used as an alternative to ceftriaxone 125 mg IM for uncomplicated gonorrhea in sexual assault cases, this is only appropriate if only genital penetration occurred (not for oral or anal penetration) 2
• For most pediatric respiratory and urinary tract infections, the standard 8 mg/kg/day dosing is appropriate and has demonstrated excellent efficacy in clinical trials 3, 4, 5