Is cefixime (cephalosporin antibiotic) 200mg a suitable dose?

Cefixime 200mg Dosing

Yes, cefixime 200mg is an appropriate and FDA-approved dose, but it should be given twice daily (100mg BID totaling 200mg/day) rather than as a single 200mg dose for most infections. 1

FDA-Approved Dosing for Adults

• The standard adult dose is 400mg daily, which can be administered as a single 400mg dose or divided into twice-daily dosing 1
• For uncomplicated gonorrhea specifically, a single oral dose of 400mg is the FDA-approved regimen 1
• The 200mg daily dose (100mg twice daily) has been extensively studied and shown effective for urinary tract infections and respiratory infections, though the FDA label emphasizes 400mg as the standard adult dose 1, 2, 3

Clinical Context for 200mg Dosing

For uncomplicated cystitis and mild infections, 200mg daily (administered as 100mg BID) has demonstrated 94-96% clinical effectiveness rates in controlled trials 4

• Studies comparing 200mg once daily versus 100mg twice daily showed equivalent efficacy (96% vs 94% effectiveness) for acute uncomplicated cystitis 4
• However, once-daily 400mg dosing showed higher gastrointestinal adverse effects than twice-daily 200mg dosing, making divided doses preferable when using lower total daily amounts 5

Critical Limitation: Gonorrhea Treatment

Cefixime is no longer recommended as first-line therapy for gonorrhea due to emerging resistance, and when used, requires 400mg (not 200mg) as a single dose plus mandatory azithromycin co-treatment 6, 7

• The CDC removed cefixime from first-line recommendations in 2012 after resistance increased from 0.1% to 1.5% nationally between 2006-2011 7
• Cefixime achieves only 91% efficacy for pharyngeal gonorrhea, falling below the 95% threshold required for first-line therapy 7
• Ceftriaxone 250mg IM plus azithromycin 1g orally is the only recommended first-line regimen 6

Practical Dosing Algorithm

For respiratory/ENT infections in adults:

• Use 400mg daily (either as single dose or 200mg BID) 1
• Continue for at least 10 days for Streptococcus pyogenes infections 1

For uncomplicated UTI:

• 200mg daily (100mg BID) is adequate for simple cystitis 4
• 400mg daily for acute pyelonephritis without underlying uropathy 8

For gonorrhea (if ceftriaxone unavailable):

• Must use 400mg single dose, never 200mg 1
• Mandatory azithromycin 1g co-treatment and test-of-cure at 1 week 6, 7

Renal Dosing Adjustment

• Normal dosing for creatinine clearance ≥60 mL/min 1
• For CrCl 21-59 mL/min: reduce to approximately 260mg daily 1
• For CrCl ≤20 mL/min or dialysis: reduce to approximately 172mg daily 1