What is the appropriate dose of cefixime oral suspension for a 1‑year‑old child weighing 8.25 kg with normal renal function?

Cefixime Dosing for a 1-Year-Old Weighing 8.25 kg

For this 1-year-old child weighing 8.25 kg, administer cefixime 80 mg once daily (4 mL of 100 mg/5 mL suspension or 2 mL of 200 mg/5 mL suspension). 1, 2

Weight-Based Dosing Calculation

• The FDA-approved pediatric dose of cefixime is 8 mg/kg/day, which can be given as a single daily dose or divided into two doses of 4 mg/kg every 12 hours 2

• For this child: 8.25 kg × 8 mg/kg = 66 mg/day (calculated dose)

• However, the FDA dosing chart provides rounded doses for ease of administration based on weight ranges 2

• For children weighing 7.6–10 kg, the recommended dose is 80 mg/day 1, 2

Practical Administration

• Using 100 mg/5 mL suspension: Give 4 mL once daily 1, 2

• Using 200 mg/5 mL suspension: Give 2 mL once daily 1, 2

• The suspension may be administered without regard to food, though giving with meals may improve gastrointestinal tolerability 2

Important Clinical Considerations

Age Appropriateness

• Cefixime is FDA-approved for children 6 months or older 2
• At 1 year of age, this child is well within the approved age range 2

Otitis Media Exception

• If treating otitis media specifically, the suspension formulation is mandatory (not tablets/capsules) because clinical trials demonstrated the suspension achieves higher peak blood levels at the same dose 2

Duration of Therapy

• For Streptococcus pyogenes infections (e.g., pharyngitis), continue treatment for at least 10 days 2
• For other indications, duration varies by infection type and clinical response 2

Storage and Stability

• After reconstitution, the suspension remains stable for 14 days at room temperature or refrigerated 2
• Shake well before each use and discard unused portion after 14 days 2

Common Pitfalls to Avoid

• Do not confuse the two suspension concentrations (100 mg/5 mL vs 200 mg/5 mL) – always specify both dose in mg AND volume in mL with the concentration 2

• Do not use cefixime in neonates or infants <6 months – use alternative third-generation cephalosporins like ceftazidime (100-150 mg/kg/day divided every 8-12 hours) or cefotaxime (150 mg/kg/day divided every 8 hours) instead 1, 3

• The most common adverse effects are diarrhea and stool changes, typically mild to moderate, transient, and occurring in the first few days of treatment 4