Cefixime is a broad-spectrum, third-generation cephalosporin antibiotic derived semisynthetically from the marine fungus Cephalosporium acremonium with antibacterial activity. As does penicillin, the beta-lactam antibiotic cefixime inhibits bacterial cell wall synthesis by disrupting peptidoglycan synthesis, resulting in a reduction in bacterial cell wall stability and bacterial cell lysis. Stable in the presence of a variety of beta-lactamases, this agent is more active against gram-negative bacteria and less active against gram-positive bacteria compared to second-generation cephalosporins. Clinical efficacy has been demonstrated in infections caused by commonly occurring pathogens including Streptococcus pneumoniae, Streptococcus pyogenes, Escherichia coli, Proteus mirabilis, Klebsiella species, Haemophilus influenzae (beta-lactamase positive and negative), Branhamella catarrhalis (beta-lactamase positive and negative) and Enterobacter species. It is highly stable in the presence of beta-lactamase enzymes.
Mechanism of Action of Cefixime
Cefixime, an antibiotic, is a third-generation cephalosporin like ceftriaxone and cefotaxime. Cefixime is highly stable in the presence of beta-lactamase enzymes. As a result, many organisms resistant to penicillins and some cephalosporins due to the presence of beta-lactamases may be susceptible to cefixime. The antibacterial effect of cefixime results from inhibition of mucopeptide synthesis in the bacterial cell wall.
Cefixime is a broad-spectrum, third-generation cephalosporin antibiotic derived semisynthetically from the marine fungus Cephalosporium acremonium with antibacterial activity. As does penicillin, the beta-lactam antibiotic cefixime inhibits bacterial cell wall synthesis by disrupting peptidoglycan synthesis, resulting in a reduction in bacterial cell wall stability and bacterial cell lysis. Stable in the presence of a variety of beta-lactamases, this agent is more active against gram-negative bacteria and less active against gram-positive bacteria compared to second-generation cephalosporins. Like all beta-lactam antibiotics, cefixime’s ability to interfere with PBP-mediated cell wall synthesis ultimately leads to cell lysis. Lysis is mediated by bacterial cell wall autolytic enzymes (i.e., autolysins). The relationship between PBPs and autolysins is unclear, but it is possible that the beta-lactam antibiotic interferes with an autolysin inhibitor.
Indications of Cefixime
- Urinary Tract Infection – e.g. cystitis, cystourethritis, uncomplicated pyelonephritis.
- Otitis Media – Otitis caused by Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes.
- Uncomplicated urinary tract infections caused by Escherichia coli and Proteus mirabilis,
- Otitis media caused by Haemophilus influenzae (beta-lactamase positive and negative strains), Moraxella catarrhalis (most of which are beta-lactamase positive), and S. pyogenes,
- Pharyngitis and tonsillitis caused by S. pyogenes,
- Acute bronchitis and acute exacerbations of chronic bronchitis caused by Streptococcus pneumoniae and Haemophilus influenzae (beta-lactamase positive and negative strains), and
- Uncomplicated gonorrhea (cervical/urethral) caused by Neisseria gonorrhoeae (penicillinase- and non-penicillinase-producing strains).
- Tonsillitis
- Bronchitis
- Sinusitis.
- Pharyngitis caused by Streptococcus pyogenes.
- Pneumonia caused by Streptococcus pneumoniae and Haemophilus influenzae.
- Typhoid fever.
- Enteric fever
- Gonorrhea
- Osteomyelitis
- Prevention of Chronic Kidney Disease (CKD) / Renal Hypodysplasia, Nonsyndromic
- Cervicitis, Vaginitis
- Acute bronchitis and acute exacerbations of chronic bronchitis caused by Streptococcus pneumoniae and Haemophilus influenzae
- Gonococcal Infection – Uncomplicated or Disseminated
Contra-Indications of Cefixime
- Hemolytic anemia
- Liver problems
- Interstitial nephritis
- Subacute cutaneous lupus erythematosus
- Systemic lupus erythematosus
- Allergies cephalosporins & beta-lactams
Dosage of Cefixime
Strengths: 100 mg; 200 mg; 400 mg;100 mg/5 mL;
Urinary Tract Infection
- Uncomplicated infections: 400 mg orally once a day or 200 mg orally every 12 hours
Otitis Media
- Oral suspension, chewable tablets: 400 mg orally once a day or 200 mg orally every 12 hours
Tonsillitis/Pharyngitis
- 400 mg orally once a day or 200 mg orally every 12 hours
Bronchitis
- Acute exacerbations of chronic bronchitis: 400 mg orally once a day or 200 mg orally every 12 hours
Gonococcal Infection
- Uncomplicated cervical/urethral infections: 400 mg orally as a single dose
Centers for Disease Control and Prevention (CDC) recommendations
- Uncomplicated infections of the cervix, urethra, or rectum: 400 mg orally as a single dose plus (azithromycin or doxycycline) plus test-of-cure in 1 week
Pediatric Otitis Media
Oral suspension, chewable tablets
- 6 months to 12 years (weighing 45 kg or less): 8 mg/kg orally once a day or 4 mg/kg orally every 12 hours
- Children weighing more than 45 kg or older than 12 years: 400 mg orally once a day or 200 mg orally every 12 hours
Pediatric Urinary Tract Infection
Uncomplicated infections, 6 months to 12 years (weighing 45 kg or less)
- Oral suspension, chewable tablets: 8 mg/kg orally once a day or 4 mg/kg orally every 12 hours
- Children weighing more than 45 kg or older than 12 years: 400 mg orally once a day or 200 mg orally every 12 hours
Pediatric Tonsillitis/Pharyngitis
6 months to 12 years (weighing 45 kg or less)
- Oral suspension, chewable tablets: 8 mg/kg orally once a day or 4 mg/kg orally every 12 hours
- Children weighing more than 45 kg or older than 12 years: 400 mg orally once a day or 200 mg orally every 12 hours
Pediatric Bronchitis
Acute exacerbations of chronic bronchitis, 6 months to 12 years (weighing 45 kg or less)
- Oral suspension, chewable tablets: 8 mg/kg orally once a day or 4 mg/kg orally every 12 hours
- Children weighing more than 45 kg or older than 12 years: 400 mg orally once a day or 200 mg orally every 12 hours
Reconstitution Directions For Oral Suspension
| Strength | Bottle Size | Reconstitution Directions |
| 100 mg/5 mL and 200 mg/5 mL | 100 mL | To reconstitute, suspend with 68 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well. |
| 100 mg/5 mL and 200 mg/5 mL | 75 mL | To reconstitute, suspend with 51 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well. |
| 100 mg/5 mL and 200 mg/5 mL | 50 mL | To reconstitute, suspend with 34 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well. |
| 200 mg/5 mL | 37.5 mL | To reconstitute, suspend with 26 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well. |
| 200 mg/5 mL | 25 mL | To reconstitute, suspend with 17 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well. |
| 500 mg/5 mL | 20 mL | To reconstitute, suspend with 14 mL water. Method: Tan the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well. |
| 500 mg/5 mL | 10 mL | To reconstitute, suspend with 8 mL water. Method: Tap the bottle several times to loosen powder contents prior to reconstitution. Add approximately half the total amount of water for reconstitution and shake well. Add the remainder of water and shake well. |
Side Effects of Cefixime
The most common
- skin color change, mild diarrhea
- mild nausea
- loss of appetite
- vaginal discharge and itching
- swelling of feet or legs
- chest pain
- constipation
- cough
- diarrhea or loose stools
- difficulty with breathing
- dizziness
- heartburn
More common
- Abdominal or stomach pain, discomfort, or tenderness
- chills or fever
- difficulty with moving
- a headache, severe and throbbing
- joint or back pain
- muscle aching or cramping
- muscle pains or stiffness
- chest pressure or squeezing pain in the chest
- excessive sweating
- feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
- sudden tingling or coldness in an arm or leg
- sudden slow or difficult speech
- sudden drowsiness or need to sleep
- fast breathing
- sharp pain when taking a deep breath
- fast or slow heartbeat
- coughing up blood
- rust colored urine
- decreased amount of urine
Rare
- Anxiety
- change in vision
- seizures
- abnormal or fast heart rate
- tremors
- weight loss
- chest pain or tightness
- confusion
- a cough
- Agitation
- arm, back, or jaw pain
- blurred vision
- chest pain or discomfort
- convulsions
- extra heartbeats
- fainting
- hallucinations
- headache
- irritability
- lightheadedness
- mood or mental changes
- muscle pain or cramps
Drug Interactions
Cefixime may interact with following drugs, supplements, & may change the efficacy of drugs
- aminoglycoside antibiotics (e.g., gentamicin, tobramycin)
- probenecid
- cholera vaccine,
- amoxicillin
- BCG vaccine
- Aspirin Low Strength (aspirin)
- Diphenhydramine
- Rosuvastatin
- Duloxetine
- Albuterol
- Topiramate
- Carbamazepine
- Vitamin D3 (cholecalciferol)
- Alprazolam
- Cetirizine
- Phenprocoumon
- Picosulfuric acid
- Warfarin
Pregnancy Catagory of Cefixime
FDA Pregnancy Category B
Pregnancy
It is not known if cefoperazone is safe for use by pregnant women. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Lactation
This medication may passes into breast milk. If you are a breastfeeding mother and are taking cefoperazone it may affect your baby. Talk to your doctor about whether you should continue breastfeeding.It is not known if cefoperazone is safe for children under 6 months of age.
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