Cefixime Dosing in Pediatric Patients
The recommended dose of cefixime for pediatric patients 6 months or older is 8 mg/kg/day of oral suspension, administered either as a single daily dose or divided into 4 mg/kg every 12 hours, with weight-based dosing tables provided for practical administration. 1
Age Restrictions and Critical Safety Considerations
- Cefixime is NOT approved for infants younger than 6 months of age 2, 1
- For neonates and young infants requiring third-generation cephalosporin therapy, alternative agents must be used: ceftazidime (100-150 mg/kg/day divided every 8-12 hours) or cefotaxime (150 mg/kg/day divided every 8 hours) 3, 2
- Cefixime is contraindicated in patients with known allergy to cefixime or other cephalosporins 1
Standard Pediatric Dosing (≥6 months)
Weight-Based Dosing Table
The FDA provides specific weight-based dosing recommendations for ease of administration 1:
- 5-7.5 kg: 50 mg/day (2.5 mL of 100 mg/5 mL suspension) 2, 1
- 7.6-10 kg: 80 mg/day (4 mL of 100 mg/5 mL or 2 mL of 200 mg/5 mL) 2, 1
- 10.1-12.5 kg: 100 mg/day (5 mL of 100 mg/5 mL or 2.5 mL of 200 mg/5 mL) 2, 1
- 12.6-20.5 kg: 150 mg/day (7.5 mL of 100 mg/5 mL or 4 mL of 200 mg/5 mL) 2, 1
- 20.6-28 kg: 200 mg/day (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL) 2, 1
- 28.1-33 kg: 250 mg/day (12.5 mL of 100 mg/5 mL or 6 mL of 200 mg/5 mL) 2, 1
- 33.1-40 kg: 300 mg/day (15 mL of 100 mg/5 mL or 7.5 mL of 200 mg/5 mL) 2, 1
- 40.1-45 kg: 350 mg/day (17.5 mL of 100 mg/5 mL or 9 mL of 200 mg/5 mL) 2, 1
- >45 kg or >12 years: 400 mg daily (adult dose) 1
Dosing Frequency Options
- The total daily dose may be administered as a single daily dose 1
- Alternatively, it may be given in two divided doses as 4 mg/kg every 12 hours 1
- Clinical studies support both once-daily and twice-daily regimens with comparable efficacy 4, 5
Special Considerations for Specific Infections
Otitis Media
- Otitis media MUST be treated with the suspension formulation 1
- The suspension produces higher peak blood levels than tablets/capsules at the same dose 1
- Tablets or capsules should NOT be substituted for suspension in otitis media treatment 1
Streptococcal Pharyngitis/Tonsillitis
- Administer for at least 10 days when treating infections due to Streptococcus pyogenes 1
- This extended duration is necessary despite lack of data establishing efficacy in preventing rheumatic fever 1
- Clinical studies demonstrate 93.3% cure rates with once-daily cefixime dosing 5
Uncomplicated Gonorrhea
- Single oral dose of 400 mg for uncomplicated cervical/urethral gonococcal infections in adolescents 1
Renal Impairment Adjustments
Pediatric Patients with Renal Dysfunction
- Normal dosing for creatinine clearance ≥60 mL/min 1
- For creatinine clearance 21-59 mL/min or on hemodialysis: reduce to approximately 65% of normal dose 1
- For creatinine clearance ≤20 mL/min or on peritoneal dialysis: reduce to approximately 50% of normal dose 1
- Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime 1
Critical Prescribing Pitfalls
- Always specify concentration when ordering in milliliters because cefixime suspension is available in two concentrations: 100 mg/5 mL and 200 mg/5 mL 1
- Failure to specify concentration can lead to significant dosing errors 1
- The capsule may be administered without regard to food 1
- After reconstitution, suspension remains stable for 14 days at room temperature or refrigerated; discard unused portion after 14 days 1
Clinical Efficacy Data
- Urinary tract infection studies demonstrate 92% cure rates with oral cefixime 8 mg/kg/day for 10 days 4
- Pharyngitis/tonsillitis studies show 93.3% cure with once-daily dosing versus 89.2% with penicillin V three times daily 5
- Eradication rates for group A streptococcus reach 82.7% with cefixime 5
- The drug is well-tolerated with minimal adverse effects reported in pediatric populations 4, 6, 5