Cefixime Syrup Dosage for Pediatric Patients
The recommended dose of cefixime oral suspension for children 6 months or older is 8 mg/kg/day, which can be administered as a single daily dose or divided into two doses of 4 mg/kg every 12 hours. 1
Weight-Based Dosing Table
The FDA-approved dosing provides specific volumes based on patient weight to ensure accurate administration 1:
- 5-7.5 kg: 50 mg/day (2.5 mL of 100 mg/5 mL suspension)
- 7.6-10 kg: 80 mg/day (4 mL of 100 mg/5 mL or 2 mL of 200 mg/5 mL)
- 10.1-12.5 kg: 100 mg/day (5 mL of 100 mg/5 mL or 2.5 mL of 200 mg/5 mL)
- 12.6-20.5 kg: 150 mg/day (7.5 mL of 100 mg/5 mL or 4 mL of 200 mg/5 mL)
- 20.6-28 kg: 200 mg/day (10 mL of 100 mg/5 mL or 5 mL of 200 mg/5 mL)
- 28.1-33 kg: 250 mg/day (12.5 mL of 100 mg/5 mL or 6 mL of 200 mg/5 mL)
- 33.1-40 kg: 300 mg/day (15 mL of 100 mg/5 mL or 7.5 mL of 200 mg/5 mL)
- 40.1-45 kg: 350 mg/day (17.5 mL of 100 mg/5 mL or 9 mL of 200 mg/5 mL)
- >45 kg or >12 years: 400 mg/day (adult dose) 1
Critical Administration Guidelines
Always verify the concentration when prescribing in milliliters, as cefixime suspension is available in two concentrations: 100 mg/5 mL and 200 mg/5 mL. 1 This is a common source of dosing errors.
Dosing Frequency Options
Both once-daily and twice-daily regimens are effective 1, 2:
- Once daily: Full 8 mg/kg dose given as single administration
- Twice daily: 4 mg/kg every 12 hours (may reduce gastrointestinal side effects) 3
Clinical studies demonstrate that twice-daily dosing may be better tolerated with fewer gastrointestinal adverse effects compared to once-daily administration 3.
Age Restrictions and Important Contraindications
Cefixime is NOT approved for infants younger than 6 months of age. 1 For neonates and young infants requiring third-generation cephalosporin therapy, use alternative agents such as ceftazidime (100-150 mg/kg/day divided every 8-12 hours) or cefotaxime (150 mg/kg/day divided every 8 hours) instead 4.
Special Considerations for Otitis Media
For otitis media, the suspension formulation must be used rather than tablets or capsules, as the suspension achieves higher peak blood levels at equivalent doses. 1 Clinical trials demonstrating efficacy in otitis media were conducted exclusively with the suspension formulation 1.
Duration of Therapy
- Streptococcus pyogenes infections: Minimum 10 days of treatment required 1
- Most other infections: Typically 5-7 days, though duration depends on clinical response 2, 5
Common Pitfalls to Avoid
- Do not use cefixime for serious invasive infections (bacteremia, meningitis, endocarditis) - these require parenteral cephalosporins like ceftriaxone 6
- Do not use as first-line therapy for gonorrhea due to increasing resistance; if used as alternative (400 mg single dose), must combine with azithromycin 1g and perform test-of-cure at 1 week 7, 6, 8
- Avoid for pharyngeal gonorrhea due to limited efficacy at this site 6
- Do not substitute tablets for suspension in children with otitis media 1
Adverse Effects
The most common side effects are gastrointestinal, including diarrhea and stool changes, which are usually mild to moderate, transient, and occur primarily in the first few days of treatment 2. These effects occurred in approximately 1.92% of children in large surveillance studies 5.