More information about Cefixime
Pronunciation(sef IKS eem)
U.S. Brand NamesSuprax®
Canadian Brand NamesSuprax®
UseTreatment of urinary tract infections, otitis media, respiratory infections due to susceptible organisms including S. pneumoniae and S. pyogenes, H. influenzae and many Enterobacteriaceae; uncomplicated cervical/urethral gonorrhea due to N. gonorrhoeae
Pregnancy Risk FactorB
LactationExcretion in breast milk unknown/use caution
ContraindicationsHypersensitivity to cefixime, any component of the formulation, or other cephalosporins
Warnings/PrecautionsProlonged use may result in superinfection; modify dosage in patients with renal impairment; use with caution in patients with a history of penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis, urticaria). May cause antibiotic-associated colitis or colitis secondary to C. difficile.
>10%: Gastrointestinal: Diarrhea (16%)
2% to 10%: Gastrointestinal: Abdominal pain, nausea, dyspepsia, flatulence, loose stools
<2%: Acute renal failure, anaphylactic/anaphylactoid reactions, angioedema, BUN increased, candidiasis, creatinine increased, dizziness, drug fever, eosinophilia, erythema multiforme, facial edema, fever, headache, hepatitis, hyperbilirubinemia, jaundice, leukopenia, neutropenia, prolonged PT, pruritus, pseudomembranous colitis, rash, seizure, serum sickness-like reaction, Stevens-Johnson syndrome, thrombocytopenia, toxic epidermal necrolysis, transaminases increased, urticaria, vaginitis, vomiting
Reactions reported with other cephalosporins include interstitial nephritis, aplastic anemia, hemolytic anemia, hemorrhage, pancytopenia, agranulocytosis, colitis, superinfection
Overdosage/ToxicologySymptoms of overdose include neuromuscular hypersensitivity and convulsions. Many beta-lactam containing antibiotics have the potential to cause neuromuscular hyperirritability or convulsive seizures. Hemodialysis may be helpful to aid in the removal of drug from blood; otherwise, treatment is supportive or symptom-directed.
Aminoglycosides: May be a possible additive to nephrotoxicity.
Carbamazepine: Cefixime may increase serum levels of carbamazepine; monitor.
Furosemide: May be a possible additive to nephrotoxicity.
Probenecid: May decrease cephalosporin elimination.
Warfarin: Cefixime may increase prothrombin time when administered with warfarin; monitor.
Ethanol/Nutrition/Herb InteractionsFood: Delays cefixime absorption.
StabilityAfter reconstitution, suspension may be stored for 14 days at room temperature or under refrigeration.
Mechanism of ActionInhibits bacterial cell wall synthesis by binding to one or more of the penicillin binding proteins (PBPs); which in turn inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell walls, thus inhibiting cell wall biosynthesis. Bacteria eventually lyse due to ongoing activity of cell wall autolytic enzymes (autolysins and murein hydrolases) while cell wall assembly is arrested.
Absorption: 40% to 50%
Distribution: Widely throughout the body and reaches therapeutic concentration in most tissues and body fluids, including synovial, pericardial, pleural, peritoneal; bile, sputum, and urine; bone, myocardium, gallbladder, and skin and soft tissue
Protein binding: 65%
Bioavailability: Bioavailability of suspension is higher than that of the tablet.
Half-life elimination: Normal renal function: 3-4 hours; Renal failure: Up to 11.5 hours
Time to peak, serum: 2-6 hours; delayed with food
Excretion: Urine (50% of absorbed dose as active drug); feces (10%)
Children >50 kg or >12 years and Adults: 400 mg/day divided every 12-24 hours
Uncomplicated cervical/urethral gonorrhea due to N. gonorrhoeae: 400 mg as a single dose
For S. pyogenes infections, treat for 10 days; use suspension for otitis media due to increased peak serum levels as compared to tablet form
Dosing adjustment in renal impairment:
Clcr 21-60 mL/minute or with renal hemodialysis: Administer 75% of the standard dose
Clcr<20 mL/minute or with CAPD: Administer 50% of the standard dose
Moderately dialyzable (10%)
AdministrationMay be administered with or without food; administer with food to decrease GI distress
Monitoring ParametersWith prolonged therapy, monitor renal and hepatic function periodically; observe for signs and symptoms of anaphylaxis during first dose
Test InteractionsPositive direct Coombs', false-positive urinary glucose test using cupric sulfate (Benedict's solution, Clinitest®, Fehling's solution), false-positive serum or urine creatinine with Jaffé reaction
Dietary ConsiderationsMay be taken with food.
Patient EducationInform prescriber of all prescriptions, OTC medications, or herbal products you are taking, and any allergies you have. Do not take any new medication during therapy unless approved by prescriber. Take as directed, at regular intervals around-the-clock (with or without food). Chilling oral suspension improves flavor (do not freeze). Maintain adequate hydration (2-3 L/day of fluids) unless instructed to restrict fluid intake. Complete full course of medication, even if you feel better. May cause false test results with Clinitest®; use of another type of glucose testing is preferable. May cause nausea or vomiting (small, frequent meals, frequent mouth care, sucking lozenges, or chewing gum may help); or diarrhea (yogurt, boiled milk, or buttermilk may help). Report changes in urinary pattern; unresolved diarrhea; opportunistic infection (eg, vaginal itching or drainage, sores in mouth, blood in stool or urine, unusual fever or chills); or respiratory difficulty; rash or other persistent adverse reactions. Breast-feeding precaution: Consult prescriber if breast-feeding.
Nursing ImplicationsModify dosage in patients with renal impairment
Additional InformationOtitis media should be treated with the suspension since it results in higher peak blood levels than the tablet.
Dental Health: Effects on Dental TreatmentNo significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic PrecautionsNo information available to require special precautions
Mental Health: Effects on Mental StatusMay cause nervousness; case reports of euphoria, delusion, illusions, and depersonalization with cephalosporins
Mental Health: Effects on Psychiatric TreatmentMay rarely cause neutropenia; use caution with clozapine and carbamazepine
Powder for oral suspension: 100 mg/5 mL (50 mL, 75 mL, 100 mL) [contains sodium benzoate; strawberry flavor]
Tablet [film coated]: 400 mg
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International Brand NamesAerocef® (AT); Bonocef® (PT); Cef-3® (BD); Cefimix® (PT); Cefiton® (PT); Cefixdura® (DE); Cefixima Fabra® (AR); Cefixime Ilab® (AR); Cefixim® (HR); Cefixim ratiopharm® (DE); Cefixoral® (IT); Cefspan® (CL, ID, JP, TH); Cephoral® (CH, DE); Ceptik® (ID); Cetaxim® (AR); CFIX® (JP); Comsporin® (ID); Denvar® (CR, DO, ES, GT, HN, MX, PA, SV); Devoxim® (CO); Fixef® (ID); Fixime® (ZA); Fixim® (NL); Fixiphar® (ID); Fixx® (IN); Maxpro® (ID); Necopen® (ES); Neocef® (PT); Novacef® (AR); Oroken® (FR); Plenax® (BR); Prolifen® (AT); Sofix® (ID); Spancef® (ID); Sporetic® (ID); Starcef® (ID); Supran® (IL); Suprax® (CA, CZ, DE, EG, GB, HU, ID, IE, IT, JO, KW, LB, PL, SY, TR); Tocef® (ID); Tricef® (AT, CL, PT); Unixime® (IT); Uro Cephoral® (DE); Urotricef® (CL); Vixcef® (AR)