Cefixime Dosing and Treatment Duration
Standard Dosing Recommendations
For most bacterial infections, cefixime is dosed at 400 mg daily in adults and 8 mg/kg/day in pediatric patients 6 months and older, with treatment duration typically 7-14 days depending on the infection site. 1
Adult Dosing
- Standard dose: 400 mg orally once daily 1
- May be administered without regard to food 1
- For uncomplicated gonorrhea: Single 400 mg oral dose (though no longer first-line—see below) 1
Pediatric Dosing (≥6 months)
- 8 mg/kg/day of oral suspension 1
- Can be given as single daily dose OR divided into 4 mg/kg every 12 hours 1
- Children >45 kg or >12 years: Use adult dose of 400 mg daily 1
- Important caveat: Otitis media must be treated with suspension formulation, not tablets/capsules, as suspension achieves higher peak blood levels 1
Renal Impairment Dosing
- CrCl ≥60 mL/min: Normal dose 1
- CrCl 21-59 mL/min: 260 mg daily (13 mL of 100 mg/5 mL suspension or 6.5 mL of 200 mg/5 mL suspension) 1
- CrCl ≤20 mL/min or on dialysis: 172 mg daily (8.6 mL of 100 mg/5 mL suspension or 4.4 mL of 200 mg/5 mL suspension) 1
Treatment Duration by Infection Type
Streptococcal Pharyngitis/Tonsillitis
- Minimum 10 days of therapy required to prevent rheumatic fever complications 1
- Efficacy comparable to amoxicillin in clinical trials 2, 3
Urinary Tract Infections
- 7-10 days for uncomplicated cystitis 1
- Clinical efficacy comparable to co-trimoxazole and amoxicillin 2
Respiratory Tract Infections
- 7-14 days for acute exacerbations of chronic bronchitis 1
- 10-14 days for community-acquired pneumonia 4
- Efficacy similar to cefaclor and clarithromycin 2, 4
Otitis Media
- 10 days standard duration in children 3
- Must use suspension formulation 1
- Comparable efficacy to cefaclor 20-40 mg/kg/day and amoxicillin 40 mg/kg/day 2
Critical Limitations and Warnings
Gonorrhea Treatment—Major Restriction
Cefixime is NO LONGER recommended as first-line therapy for gonorrhea due to rising resistance. 5, 6, 7
- First-line: Ceftriaxone 250 mg IM plus azithromycin 1 g orally 7
- Only if ceftriaxone unavailable: Cefixime 400 mg PLUS azithromycin 1 g orally (preferred) OR doxycycline 100 mg twice daily for 7 days 6
- Mandatory test-of-cure at 1 week when cefixime is used 6
- Avoid for pharyngeal gonorrhea: Only 91% efficacy vs. 99.1% for ceftriaxone 5, 7
- Resistance particularly problematic in Western U.S. and men who have sex with men 5, 7
Spectrum Limitations
- Poor activity against: Staphylococcus aureus, enterococci, Listeria monocytogenes, Pseudomonas aeruginosa 2, 8
- Good activity against: Enterobacteriaceae, H. influenzae, S. pyogenes, S. pneumoniae, M. catarrhalis, many beta-lactamase producers 2, 8, 9
Common Pitfalls to Avoid
- Do not substitute tablets/capsules for suspension in otitis media—pharmacokinetics differ significantly 1
- Do not use as monotherapy for gonorrhea—always combine with azithromycin or doxycycline if ceftriaxone unavailable 6
- Do not use for pharyngeal gonorrhea—unacceptably low cure rates 5, 7
- Do not forget dose adjustment in renal impairment when CrCl <60 mL/min 1
- Ensure 10-day minimum for streptococcal pharyngitis—shorter courses risk rheumatic fever 1