Cefixime

General

• Type: 3rd generation cephalosporin
• Dosage Forms: tablet, chewable tablet, oral suspension
• Dosage Strengths: tablet: 400mg; chewable tablet: 100, 200mg; oral suspension: 100mg/5mL, 200mg/5mL, 500mg/mL
• Routes of Administration: PO
• Common Trade Names: Suprax

Adult Dosing

Indications by Disease

Disease	Dose	Context
Cervicitis	800 mg PO x 1	GC/Chlamydia, CTX Contraindicated
Pyelonephritis	400mg PO daily x 10 days	Outpatient
Typhoid fever	10-15 mg/kg IV q 12 hrs x 8 days	Quinolone Resistant, Parenteral
Urethritis in men	800 mg PO x 1	CTX Contraindicated

Pediatric Dosing

Indications by Disease

Disease	Dose	Context
Acute cystitis	8mg/kg/day PO daily (max 400mg)	Pediatric
Pyelonephritis	8mg/kg PO daily x 10-14 days (max 400mg)	Pediatric Outpatient
Typhoid fever	15-20mg/kg/day PO divided BID x 7-14 days (max 400mg/dose)	Pediatric Oral Step-down

Special Populations

• Pregnancy:
• Lactation:
• Renal Dosing
  • Adult
    • CrCl ≥ 60 mL/min: No adjustment
    • CrCl 21 to 59 mL/min:
      • Chewable tablet: not recommended
      • Suspension: 260 mg once daily
    • CrCl ≤ 20
      • Chewable tablet: 200 mg once daily
      • 100 mg/5 mL suspension: 172 mg once daily
      • 200 mg/5 mL suspension: 176 mg once daily
      • 500 mg/5 mL suspension: 180 mg once daily
    • Hemodialysis
      • Chewable tablet: not recommended
      • Suspension: 260 mg once daily
  • Pediatric
    • limited data
    • Mild to moderate impairment - no adjustment
    • Severe impairment and anuric - reduce dose 50%
• Hepatic Dosing
  • Adult
    • Not defined
  • Pediatric
    • Not defined

Contraindications

• Allergy to class/drug

Pharmacology

• Half-life: 3-4 hr
• Metabolism:
• Excretion: Urine (50% as unchanged drug), feces (10%)
• Mechanism of Action: arrests bacterial cell wall synthesis

Antibiotic Sensitivities

Group	Organism	Sensitivity
Gram Positive	Strep. Group A, B, C, G	S
	Strep. Pneumoniae	S
	Viridans strep	S
	Strep. anginosus gp	X1
	Enterococcus faecalis	R
	Enterococcus faecium	X1
	MSSA	R
	MRSA	R
	CA-MRSA	R
	Staph. Epidermidis	R
	C. jeikeium	R
	L. monocytogenes	R
Gram Negatives	N. gonorrhoeae	S
	N. meningitidis	I
	Moraxella catarrhalis	S
	H. influenzae	S
	E. coli	S
	Klebsiella sp	S
	E. coli/Klebsiella ESBL+	R
	E coli/Klebsiella KPC+	R
	Enterobacter sp, AmpC neg	R
	Enterobacter sp, AmpC pos	R
	Serratia sp	I
	Serratia marcescens	X1
	Salmonella sp	S
	Shigella sp	S
	Proteus mirabilis	S
	Proteus vulgaris	S
	Providencia sp.	S
	Morganella sp.	R
	Citrobacter freundii	R
	Citrobacter diversus	X1
	Citrobacter sp.	S
	Aeromonas sp	S
	Acinetobacter sp.	R
	Pseudomonas aeruginosa	R
	Burkholderia cepacia	R
	Stenotrophomonas maltophilia	R
	Yersinia enterocolitica	S
	Francisella tularensis	X1
	Brucella sp.	X1
	Legionella sp.	R
	Pasteurella multocida	S
	Haemophilus ducreyi	S
	Vibrio vulnificus	X1
Misc	Chlamydophila sp	X1
	Mycoplasm pneumoniae	X1
	Rickettsia sp	X1
	Mycobacterium avium	X1
Anaerobes	Actinomyces	X1
	Bacteroides fragilis	R
	Prevotella melaninogenica	S
	Clostridium difficile	X1
	Clostridium (not difficile)	R
	Fusobacterium necrophorum	X1
	Peptostreptococcus sp.	S

Key

• S susceptible/sensitive (usually)
• I intermediate (variably susceptible/resistant)
• R resistant (or not effective clinically)
• S+ synergistic with cell wall antibiotics
• U sensitive for UTI only (non systemic infection)
• X1 no data
• X2 active in vitro, but not used clinically
• X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
• X4 active in vitro, but not clinically effective for strep pneumonia

See Also

• Antibiotics (Main)

References

Cefixime: Drug information. UpToDate. www.uptodate.com. Accessed April 2, 2019.