Cefixime: Potent Broad-Spectrum Antibiotic Therapy
Cefixime
Cefixime is a third-generation cephalosporin antibiotic renowned for its exceptional efficacy against a wide range of bacterial infections. As an oral medication with superior bioavailability and extended half-life, it offers clinicians a reliable first-line treatment option for respiratory, urinary, and ENT infections. Its bactericidal action disrupts bacterial cell wall synthesis, ensuring rapid pathogen eradication with convenient once-daily dosing. This makes cefixime a cornerstone therapy in both outpatient and inpatient settings where gram-negative coverage is paramount.
Features
- Active ingredient: Cefixime (as trihydrate or other salt forms)
- Drug class: Third-generation cephalosporin antibiotic
- Mechanism: Bactericidal; inhibits bacterial cell wall synthesis
- Administration: Oral formulation (tablets, capsules, oral suspension)
- Bioavailability: 40-50% (unaffected by food)
- Half-life: 3-4 hours (permits once-daily dosing)
- Spectrum: Broad-spectrum coverage including gram-positive and gram-negative bacteria
- Excretion: Primarily renal (unchanged drug)
Benefits
- Effective against β-lactamase producing strains of Haemophilus influenzae and Neisseria gonorrhoeae
- Superior stability against many bacterial β-lactamase enzymes compared to earlier cephalosporins
- Convenient once-daily dosing regimen enhances patient compliance
- Well-tolerated profile with generally mild adverse effects
- Suitable for pediatric populations through oral suspension formulation
- Rapid clinical response with symptomatic improvement often within 24-48 hours
Common use
Cefixime is indicated for the treatment of infections caused by susceptible strains of designated microorganisms, including acute bacterial exacerbations of chronic bronchitis due to Streptococcus pneumoniae and Haemophilus influenzae, otitis media caused by H. influenzae, Moraxella catarrhalis, and Streptococcus pyogenes, pharyngitis and tonsillitis attributable to Streptococcus pyogenes, uncomplicated urinary tract infections caused by Escherichia coli and Proteus mirabilis, and uncomplicated gonorrhea (cervical/urethral) due to Neisseria gonorrhoeae. It is particularly valuable in community-acquired infections where resistance patterns favor cephalosporin therapy.
Dosage and direction
The recommended dosage varies based on infection severity, pathogen susceptibility, and patient factors. For adults and children ≥12 years or ≥50 kg: 400 mg daily (single dose or divided q12h). For otitis media: 8 mg/kg/day (maximum 400 mg daily). For uncomplicated gonorrhea: 400 mg as single dose. Pediatric suspension (100 mg/5 mL): 8 mg/kg/day (divided q12-24h). Administration with food may minimize gastrointestinal discomfort. Complete the full prescribed course even if symptoms improve to prevent resistance development. Dosage adjustment required in renal impairment (creatinine clearance <60 mL/min).
Precautions
Use with caution in patients with history of gastrointestinal disease, particularly colitis. Prolonged use may result in overgrowth of nonsusceptible organisms. Carefully monitor patients with renal impairment (dose adjustment necessary). Use during pregnancy only if clearly needed (Category B). Cefixime is excreted in human milk; exercise caution when administering to nursing women. False positive reactions for glucose in urine may occur with Benedict’s or Fehling’s solutions but not with enzyme-based tests. Superinfections with fungi or other bacteria may occur during therapy.
Contraindications
Known hypersensitivity to cefixime, any cephalosporin, or any component of the formulation. Cross-hypersensitivity may occur in patients allergic to penicillins; contraindicated in patients with history of severe hypersensitivity reaction (anaphylaxis) to any β-lactam antibiotic. Not recommended in patients with known phenylketonuria (oral suspension contains aspartame).
Possible side effect
Common adverse reactions (>1%) include diarrhea (16%), nausea (7%), abdominal pain (3%), dyspepsia (3%), flatulence (4%), headache (2%), and dizziness (1%). Less frequent effects include transient elevations in liver enzymes, eosinophilia, leukopenia, vaginitis, genital pruritus. Serious but rare side effects include pseudomembranous colitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, anaphylaxis, hemolytic anemia, and antibiotic-associated colitis. Most adverse effects are mild and self-limiting.
Drug interaction
Probenecid may decrease renal excretion of cefixime, increasing serum concentrations. Carbamazepine levels may be increased with concomitant cefixime administration. Warfarin: may potentiate anticoagulant effect (monitor INR). Oral contraceptives: potential decreased efficacy (recommend alternative contraception during therapy). Nephrotoxic drugs (aminoglycosides, potent diuretics) may increase renal toxicity risk. False-positive urinary glucose tests may occur with certain methods.
Missed dose
If a dose is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. Do not double the dose to make up for a missed administration. Maintain the regular dosing schedule to ensure consistent antibiotic levels. Consult healthcare provider if multiple doses are missed for guidance on therapy continuation.
Overdose
Gastrointestinal effects such as nausea, vomiting, and diarrhea would be expected. Neurological symptoms including seizures might occur at very high doses. No specific antidote exists; gastric lavage may be considered if ingestion recent. Management should be supportive with maintenance of hydration and electrolyte balance. Hemodialysis may remove approximately 50% of the drug from circulation in overdose situations.
Storage
Store tablets and capsules at controlled room temperature (20-25°C/68-77°F) in tightly closed containers. Protect from light and moisture. Reconstituted oral suspension remains stable for 14 days at room temperature or refrigerated (2-8°C/36-46°F); discard any unused portion after this period. Keep all medications out of reach of children and pets.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment recommendations. Dosage and administration should be determined by a physician based on individual patient characteristics and local resistance patterns. Never self-medicate with antibiotics.
Reviews
Clinical studies demonstrate cefixime’s efficacy with cure rates of 85-95% in approved indications. Meta-analyses confirm its non-inferiority to other oral antibiotics for respiratory and urinary tract infections. Physicians appreciate its reliable coverage and convenient dosing schedule. Patients report high satisfaction with once-daily administration and generally good tolerability. Ongoing surveillance continues to support its role in empiric therapy where resistance patterns remain favorable.