Cefixime is NOT Recommended for Pneumonia in a 9-Month-Old Infant
Amoxicillin 90 mg/kg/day divided into 2 doses is the preferred first-line treatment for community-acquired pneumonia in a 9-month-old infant, not cefixime. 1, 2
Why Cefixime Should Not Be Used
- Cefixime is not listed as a recommended agent for pneumonia treatment in the authoritative IDSA/PIDS pediatric pneumonia guidelines 1
- The FDA label for cefixime specifically lists approved indications as otitis media, pharyngitis/tonsillitis, acute exacerbations of chronic bronchitis, and uncomplicated gonorrhea—pneumonia is notably absent from this list 3
- While one older study from 1987 evaluated cefixime for pneumonia, it only included 5 patients with pneumonia (all with "possible pathogens"), making this insufficient evidence to support its use 4
Correct First-Line Treatment
- Prescribe oral amoxicillin 90 mg/kg/day divided into 2 doses for outpatient treatment of community-acquired pneumonia in this 9-month-old 1, 2
- This high-dose regimen specifically targets penicillin-resistant Streptococcus pneumoniae, the most common bacterial cause of pneumonia in this age group 1, 2
- Treatment duration should be 5-7 days, with reassessment if symptoms persist beyond 48-72 hours 2
Alternative Agents When Amoxicillin Cannot Be Used
For β-lactamase-producing organisms (if suspected):
- Amoxicillin-clavulanate 90 mg/kg/day (amoxicillin component) divided into 2 doses is the preferred alternative 1, 5
- Maximum daily dose is 4000 mg of the amoxicillin component 5
For non-type 1 penicillin allergy:
- Second- or third-generation oral cephalosporins can be considered, including cefpodoxime, cefuroxime, or cefprozil 1
- Cefdinir is mentioned as an alternative alongside cefixime, cefpodoxime, and ceftibuten specifically for β-lactamase-producing Haemophilus influenzae when amoxicillin-clavulanate cannot be used 6
- However, these are not first-line agents and have inferior pneumococcal coverage compared to high-dose amoxicillin 6, 2
For type 1 hypersensitivity to β-lactams:
- Azithromycin or clarithromycin should be used instead 2
Critical Clinical Pitfall
- Do not substitute cefixime for amoxicillin in pneumonia treatment—the evidence base is inadequate, it is not guideline-recommended, and it provides suboptimal coverage for S. pneumoniae, the primary pathogen 1, 2, 3
- The one comparative study showing cefixime efficacy used it as step-down therapy after initial parenteral ceftriaxone, not as primary monotherapy 7