Cefixime is a third-generation cephalosporin antibiotic indicated for the treatment of susceptible bacterial infections. It exerts bactericidal activity by inhibiting bacterial cell wall synthesis, making it a reliable choice for clinicians managing a range of community-acquired infections. Its oral bioavailability and extended half-life support convenient once or twice-daily dosing, enhancing patient adherence. This agent is particularly valued for its efficacy against common Gram-negative pathogens while retaining activity against some Gram-positive organisms.

Features

• Third-generation cephalosporin antibiotic
• Available as oral tablets, chewable tablets, and powder for suspension
• Bactericidal mechanism: inhibits cell wall synthesis
• Spectrum includes Gram-negative bacteria like Haemophilus influenzae, Moraxella catarrhalis, Escherichia coli, and Proteus mirabilis
• Also active against some Gram-positive organisms, including Streptococcus pyogenes and Streptococcus pneumoniae
• Acid-stable, allowing for oral administration
• Typically dosed once or twice daily

Benefits

• Effective against beta-lactamase producing strains of H. influenzae and M. catarrhalis
• High clinical cure rates in respiratory, urinary, and ENT infections
• Convenient dosing schedule supports patient compliance
• Well-tolerated profile with predominantly mild adverse effects
• Useful alternative for penicillin-allergic patients (with appropriate caution)
• Oral formulation avoids need for intravenous administration in appropriate cases

Common use

Cefixime is commonly prescribed for uncomplicated urinary tract infections caused by E. coli and Proteus mirabilis. It is also effective in treating acute bacterial exacerbations of chronic bronchitis, community-acquired pneumonia, acute otitis media, and pharyngitis/tonsillitis. Additionally, it serves as an option for uncomplicated gonorrhea treatment (as a single dose) and for early Lyme disease in certain clinical scenarios. Off-label uses may include other susceptible infections when oral therapy is preferred.

Dosage and direction

The typical adult dosage is 400 mg daily, administered as a single dose or divided as 200 mg every 12 hours. For severe infections, higher doses may be utilized under medical supervision. Pediatric dosing is weight-based, typically 8 mg/kg/day, either once daily or divided every 12 hours. The suspension formulation is preferred for children. Administration with food may enhance absorption and reduce gastrointestinal discomfort. Complete the full course of therapy even if symptoms improve earlier to prevent resistance development.

Precautions

Use with caution in patients with renal impairment; dosage adjustment is recommended for creatinine clearance below 60 mL/min. Monitor for superinfection or pseudomembranous colitis, especially with prolonged use. Exercise caution in patients with history of gastrointestinal disease, particularly colitis. May cause false-positive urinary glucose tests when using copper reduction methods. Use during pregnancy only if clearly needed (Category B). Breastfeeding should be reconsidered during therapy as cefixime excretes into breast milk.

Contraindications

Cefixime is contraindicated in patients with known hypersensitivity to cephalosporin antibiotics. Avoid use in those with previous anaphylactic reactions to penicillins due to cross-reactivity potential. Do not administer to patients with history of severe gastrointestinal reactions to antibiotics, including pseudomembranous colitis. Contraindicated in patients with phenylketonuria (for chewable tablet formulation containing aspartame).

Possible side effect

Common adverse effects include diarrhea (2-16%), nausea (3-7%), abdominal pain (2-4%), and loose stools. Less frequently reported are headache, dizziness, flatulence, and dyspepsia. Transient elevations in liver enzymes may occur. Serious but rare side effects include pseudomembranous colitis, allergic reactions (rash, urticaria, rarely anaphylaxis), hematologic abnormalities (eosinophilia, neutropenia), and interstitial nephritis. Stevens-Johnson syndrome and toxic epidermal necrolysis are extremely rare but possible.

Drug interaction

Probenecid may increase and prolong cefixime blood levels. Concurrent use with potent diuretics may increase nephrotoxicity risk. May enhance anticoagulant effect of warfarin; monitor INR closely. Chloramphenicol may antagonize bactericidal effect. False-positive Coombs’ test possible. Reduced efficacy of oral typhoid vaccine; avoid concurrent administration. Potential interaction with other nephrotoxic agents (aminoglycosides, vancomycin).

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 the missed one. Maintain regular dosing intervals to ensure consistent antibiotic levels. If multiple doses are missed, contact healthcare provider for guidance on resuming therapy. Consistent dosing is crucial for therapeutic efficacy and resistance prevention.

Overdose

Symptoms of overdose may include nausea, vomiting, epigastric distress, and diarrhea. In severe cases, hematologic abnormalities or seizures might occur. Management is primarily supportive; gastric lavage may be considered if ingestion was recent. Hemodialysis may remove approximately 50% of the drug from plasma. Maintain adequate hydration and electrolyte balance. There is no specific antidote; symptomatic treatment should be provided based on clinical manifestations.

Storage

Store tablets at controlled room temperature (20-25°C/68-77°F) in original container. Keep suspension refrigerated (2-8°C/36-46°F) after reconstitution; discard unused portion after 14 days. Protect from light and moisture. Keep all medications out of reach of children and pets. Do not use beyond expiration date printed on packaging. Do not freeze the suspension formulation.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any medication. The prescribing physician should determine appropriate therapy based on individual patient factors, local resistance patterns, and specific clinical circumstances. Dosage may need adjustment based on renal function, severity of infection, and patient response.

Reviews

Clinical studies demonstrate cefixime’s efficacy with cure rates of 85-95% for approved indications. Physicians appreciate its convenient dosing and reliable coverage of common pathogens. Patients report general satisfaction with tolerability, though gastrointestinal side effects are noted. The drug maintains favorable positioning in treatment guidelines for specific infections where resistance patterns remain favorable. Long-term clinical experience supports its safety profile when used appropriately.