Cefixime Dosing for Typhoid Fever
For uncomplicated typhoid fever, cefixime should be dosed at 20 mg/kg/day orally divided into two doses (maximum 400 mg twice daily) for 7-14 days in children, and 400 mg daily (200 mg twice daily) for 7-10 days in adults. 1, 2
Adult Dosing
- Standard dose: 400 mg daily (can be given as 200 mg twice daily), administered orally for 7-10 days 1, 2
- The capsule may be taken without regard to food 2
- Treatment duration of at least 7 days is recommended for typhoid fever 1
Pediatric Dosing (≥6 months)
- 20 mg/kg/day divided into two doses (maximum 400 mg/day) 1, 2
- Administer as 10 mg/kg every 12 hours 2
- Treatment duration: 7-14 days based on clinical response 1, 3, 4
- Children weighing >45 kg or >12 years should receive the adult dose 2
Weight-Based Dosing Table for Children
For practical administration using oral suspension 2:
- 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)
- >45 kg: 400 mg/day (adult dose)
Renal Impairment Adjustments
Dose adjustment is essential in renal impairment 2:
- CrCl ≥60 mL/min: Normal dose (no adjustment needed) 2
- CrCl 21-59 mL/min OR hemodialysis: Reduce to 260 mg daily (13 mL of 100 mg/5 mL suspension or 6.5 mL of 200 mg/5 mL suspension) 2
- CrCl ≤20 mL/min OR continuous peritoneal dialysis: Reduce to 172 mg daily (8.6 mL of 100 mg/5 mL suspension or 4.4 mL of 200 mg/5 mL suspension) 2
Neither hemodialysis nor peritoneal dialysis removes significant amounts of cefixime from the body 2
Clinical Efficacy Considerations
Cefixime is less effective than fluoroquinolones but remains a viable oral option, particularly in settings where fluoroquinolone resistance is not prevalent 5, 6:
- Clinical cure rates of 62-95% have been reported with cefixime in multidrug-resistant typhoid 7, 3, 4
- Fever clearance time with cefixime (mean 5.3-8.5 days) is longer compared to fluoroquinolones (4.4 days) or azithromycin (5.8 days) 7, 5, 3
- Treatment failures occur in approximately 10-25% of cases, higher than with fluoroquinolones 5, 6
- Relapse rates of 4-25% have been observed 3, 6
Important Clinical Caveats
- Cefixime should NOT be used as first-line therapy in areas with high fluoroquinolone resistance or extensively drug-resistant (XDR) typhoid, as azithromycin or carbapenems are preferred 8
- The oral suspension formulation is preferred over tablets/capsules in children, as it achieves higher peak blood levels 2
- Treatment duration should be at least 10-14 days for optimal outcomes, particularly in multidrug-resistant cases 3, 4
- Monitor for treatment failure (persistent fever beyond 7 days) and consider switching to alternative antimicrobials 7, 5
- Local antimicrobial susceptibility patterns must guide therapy selection 2, 8, 6