Cefixime; Indications/Uses, Dosage, Side Effects, Interactions,

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

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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.

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Side Effects of Cefixime

The most common

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.

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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.