From the Guidelines
Oral third-generation cephalosporins, specifically cefpodoxime and cefdinir, are suitable agents for the treatment of acute bacterial sinusitis, as they have adequate activity against common respiratory pathogens, including S pneumoniae 1. When considering oral third-generation cephalosporins, it is essential to note that cefixime and ceftibuten have poor activity against S pneumoniae and are especially ineffective against penicillin-resistant strains, making them unsuitable for acute bacterial sinusitis 1. Key characteristics of oral third-generation cephalosporins include:
- Effective against many gram-negative bacteria, including Haemophilus influenzae 1
- Variable activity against gram-positive organisms, with cefpodoxime and cefdinir being more effective against S pneumoniae 1
- Common dosing regimens, such as cefpodoxime 100-400mg twice daily and cefdinir 300mg twice daily
- Treatment duration typically ranges from 10-14 days for acute bacterial sinusitis, although some experts suggest treating until symptoms resolve plus 7 days 1
- Potential side effects, including diarrhea, nausea, and allergic reactions, and the need for cautious use in patients with penicillin allergies due to potential cross-reactivity 1
From the FDA Drug Label
Cefixime is a semisynthetic, cephalosporin antibacterial for oral administration. The FDA drug label does not answer the question about whether cefixime is an oral third generation cephalosporin.
From the Research
Oral Third Generation Cephalosporin
- The oral third-generation cephalosporins, such as cefixime, have an improved antibacterial spectrum and reduced minimum inhibitory concentrations against common Gram-negative pathogens 2.
- Cefixime is highly active against a broad range of gram-negative and some gram-positive aerobic bacteria, making it effective in treating urinary tract infections (UTIs) and upper respiratory tract infections (URTIs) 3, 4, 5.
- Cefixime has been shown to be at least as effective as other usual treatments in non-complicated UTIs, with a low rate of side effects 4.
- In pediatric patients, cefixime has been found to be a safe and effective alternative to amoxycillin in the treatment of acute otitis media, with the advantage of less frequent dosing 6.
- The safety profiles of cefixime in children have been extensively studied, with generally favorable outcomes, and adverse events are typically mild and infrequent, with gastrointestinal disturbances being most commonly reported 5, 6.
Clinical Indications
- Possible clinical indications for the use of oral third-generation cephalosporins include upper and lower respiratory, genitourinary, and soft-tissue infections, as well as follow-on treatment of severe infections requiring hospitalization 2.
- Cefixime may be considered for use in cases of acute upper and lower respiratory tract infections, acute otitis media, and acute uncomplicated urinary tract infections, particularly in patients with hypersensitivity to penicillins or where there is a high incidence of resistance to first-line therapy 2, 5.