Cefixime Oral Suspension Dosing
For pediatric patients 6 months or older, administer cefixime at 8 mg/kg/day, either as a single daily dose or divided into 4 mg/kg every 12 hours, with weight-based dosing detailed in the FDA-approved table below. 1
Pediatric Dosing (≥6 months of age)
Standard Dosing Algorithm
- Total daily dose: 8 mg/kg/day 1
- Administration options: Single daily dose OR divided as 4 mg/kg every 12 hours 1
- Maximum daily dose: 400 mg 2, 1
Weight-Based Dosing Table (FDA-Approved)
For 100 mg/5 mL suspension 1:
- 5-7.5 kg: 50 mg/day (2.5 mL daily)
- 7.6-10 kg: 80 mg/day (4 mL daily)
- 10.1-12.5 kg: 100 mg/day (5 mL daily)
- 12.6-20.5 kg: 150 mg/day (7.5 mL daily)
- 20.6-28 kg: 200 mg/day (10 mL daily)
- 28.1-33 kg: 250 mg/day (12.5 mL daily)
- 33.1-40 kg: 300 mg/day (15 mL daily)
- 40.1-45 kg: 350 mg/day (17.5 mL daily)
For 200 mg/5 mL suspension 1:
- 7.6-10 kg: 80 mg/day (2 mL daily)
- 10.1-12.5 kg: 100 mg/day (2.5 mL daily)
- 12.6-20.5 kg: 150 mg/day (4 mL daily)
- 20.6-28 kg: 200 mg/day (5 mL daily)
- 28.1-33 kg: 250 mg/day (6 mL daily)
- 33.1-40 kg: 300 mg/day (7.5 mL daily)
- 40.1-45 kg: 350 mg/day (9 mL daily)
Adolescents and Adults
- Children >45 kg or >12 years: Use adult dose of 400 mg daily 1
- Adults: 400 mg once daily 1
- Administration: May be taken with or without food 1, 3
Renal Impairment Dosing
Adults with renal dysfunction require dose adjustment only when creatinine clearance falls below 60 mL/min 1:
- CrCl ≥60 mL/min: Normal dose (400 mg daily) 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 continuous peritoneal dialysis: 172 mg daily (8.6 mL of 100 mg/5 mL suspension OR 4.4 mL of 200 mg/5 mL suspension) 1
- Hemodialysis patients: Same as CrCl 21-59 mL/min dosing 1
The pharmacokinetic data confirm that elimination half-life increases from 3.73 hours in normal subjects to 12-14 hours in severe renal failure (CrCl <20 mL/min), necessitating dose reduction 4, 5.
Critical Prescribing Considerations
Age Restrictions
Cefixime is NOT approved for infants <6 months of age 6. For neonates and young infants requiring third-generation cephalosporin therapy, use ceftazidime or cefotaxime instead 6.
Concentration Specification
Always specify the concentration (100 mg/5 mL or 200 mg/5 mL) when prescribing in milliliters, as both formulations are available 1. This prevents potentially dangerous dosing errors.
Otitis Media Exception
For otitis media, only the suspension formulation should be used because clinical trials demonstrated the suspension achieves higher peak blood levels than tablets at equivalent doses 1.
Duration for Streptococcal Infections
For Streptococcus pyogenes infections, continue cefixime for at least 10 days 1.
Common Pitfalls to Avoid
Inappropriate Use for Serious Infections
Never use cefixime for bacteremia, meningitis, or endocarditis—these invasive infections require parenteral cephalosporins like ceftriaxone 6, 2.
Gonorrhea Treatment Limitations
- Cefixime is NOT first-line for gonorrhea due to increasing resistance 6, 2
- If ceftriaxone unavailable, use cefixime 400 mg PLUS azithromycin 1 g, with mandatory test-of-cure at 1 week 6, 2
- Avoid cefixime for pharyngeal gonorrhea due to limited efficacy 6, 2
Storage and Stability
After reconstitution, the suspension remains stable for 14 days at room temperature or refrigerated 1. Shake well before each use and discard unused portion after 14 days 1.