Cefixime (Dosing, Interaction, Side Effect, Administration, Etc..)

DRUG CLASS:
3rd Generation Cephalosporin
Antibiotic
AntiInfective Agent

DOSE OF CEFIXIME:

Adult dose

:
General Dosage Information:
Oral

tablets

are not bioequivalent to oral chewable

tablets

or suspension.

Acute infective exacerbation of chronic obstructive pulmonary disease:
400 mg orally once a day OR 200 mg every 12 hours

Gonorrhea:
Uncomplicated infections: 400 mg orally as a single

dose

(FDA dosage).
Uncomplicated cervical; urethral; or rectal infections: 400 mg orally as a single

dose

plus azithromycin 1 g orally as a single

dose

(guideline dosage).

Otitis media:
400 mg orally once a day OR 200 mg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.

Pharyngitis:
400 mg orally once a day OR 200 mg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.

Tonsillitis:
400 mg orally once a day OR 200 mg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.

Urinary tract infectious disease; Uncomplicated:
400 mg orally once a day OR 200 mg every 12 hours

Pediatric Dose:
General Dosage Information:
Oral

tablets

are not bioequivalent to oral chewable

tablets

or suspension.

Acute infective exacerbation of chronic obstructive pulmonary disease:
(6 months to 12 years; 45 kg or less)
8 mg/kg orally once a day OR 4 mg/kg every 12 hours

(Older than 12 years or more than 45 kg)
400 mg orally once a day OR 200 mg every 12 hours

Gonorrhea:
(6 months to 12 years; 45 kg or less)
8 mg/kg orally once a day OR 4 mg/kg every 12 hours (FDA

dosage

)
(Older than 12 years or more than 45 kg)
400 mg orally as a single

dose

(FDA

dosage

)

(Greater than 45 kg)
Uncomplicated cervical; urethral; or rectal infections: 400 mg orally as a single

dose

plus azithromycin 1 g orally as a single

dose

(guideline

dosage

).

Otitis media:
(6 months to 12 years; 45 kg or less)
8 mg/kg orally once a day OR 4 mg/kg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.
(Older than 12 years or more than 45 kg)
400 mg orally once a day OR 200 mg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.

Pharyngitis:
(6 months to 12 years; 45 kg or less)
8 mg/kg orally once a day OR 4 mg/kg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.

(Older than 12 years or more than 45 kg)
400 mg orally once a day OR 200 mg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.

Sinusitis:
(Beta Lactam allergy; second line)
8 mg/kg/day orally in 2 divided

doses

plus clindamycin 30 to 40 mg/kg/day orally in 3 divided

doses

(guideline

dosage

).

Tonsillitis:
(6 months to 12 years; 45 kg or less)
8 mg/kg orally once a day OR 4 mg/kg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes.

(Older than 12 years or more than 45 kg)
400 mg orally once a day OR 200 mg every 12 hours; treat for at least 10 days for infections due to Streptococcus pyogenes

Urinary tract infectious disease; Uncomplicated:
(6 months to 12 years; 45 kg or less)
8 mg/kg orally once a day OR 4 mg/kg every 12 hours

(Older than 12 years or more than 45 kg)
400 mg orally once a day OR 200 mg every 12 hours

INDICATIONS:
FDA-LABELED INDICATIONS:
Acute infective exacerbation of chronic obstructive pulmonary disease
Gonorrhea
Otitis media
Pharyngitis
Tonsillitis
Urinary tract infectious disease; Uncomplicated

NON-FDA LABELED INDICATIONS:
Salmonella infection
Sinusitis

MECHANISM OF ACTION:

Cefixime

; a semisynthetic cephalosporin; is a broad spectrum bactericidal agent that inhibits cell wall synthesis and is stable in the presence of certain beta lactamases.

ADVERSE EFFECT:
Common:
Gastrointestinal:
Abdominal pain (3%)
Diarrhea (16%)
Flatulence (4%)
Indigestion (3%)
Loose stool (6%)
Nausea (7%)

Serious:
Dermatologic:
Erythema multiforme
Stevens Johnson syndrome
Toxic epidermal necrolysis

Gastrointestinal:
Clostridium difficile colitis

Immunologic:
Anaphylaxis

Renal:
Acute renal failure (less than 2%)

Other:
Angioedema (less than 2%)

CONTRAINDICATION:
Known allergy to Cefixime or other cephalosporin

DRUG Interaction with cefixime:
Carbamazepine:
Elevated carbamazepine levels have been reported in postmarketing experience when Cefixime is administered concomitantly. Drug monitoring may be of assistance in detecting alterations in carbamazepine plasma concentrations.

Warfarin and Anticogulants:
Increased prothrombin time; with or without clinical bleeding has been reported when Cefixime is administered concomitantly.

Drug/Laboratory Test Interactions:
A false positive reaction for ketones in the urine may occur with tests using nitroprusside but not with those using nitroferricyanide. The administration of Cefixime may result in a false positive reaction for glucose in the urine using Benedict’s solution; or Fehling’s solution. It is recommended that glucose tests based on enzymatic glucose oxidase reactions be used. A false positive direct Coombs test has been reported during treatment with other cephalosporins; therefore; it should be recognized that a positive Coombs test may be due to the drug.

Major:
Cholera Vaccine;Live(Theoretical)
Warfarin(Probable)

Pharmacokinetics of cefixime:
Absorption:
Oral Tablet:
Maximum Plasma Concentration (Tmax): 2 to 8 hours.

200mg

Tablet Cmax: Approximately 2 mcg/mL (range 1 to 4 mcg/mL)

400mg

Tablet Cmax: Approximately 3.7mcg/mL (range 1.3 to 7.7 mcg/mL)

Oral Suspension

:
Approximately 25% to 50% higher than the

tablets

200mg

Suspension Cmax: 3mcg/mL (range 1 to 4.5 mcg/mL)

400mg

Suspension Cmax: 4.6mcg/mL (range 1.9 to 7.7 mcg/mL)

Bioavailability:
About 40% to 50%.

Effect of food:
Insignificant

Distribution:
Plasma Protein binding: 65%.
Volume of Distribution (Vd): 0.6 to 1.1 L/kg.

Metabolism:
Not metabolized.

Excretion:
Bile: 5%.
Renal: 50% as unchanged drug.

Dialyzable:
Hemodialysis: No
Peritoneal dialysis: No

Elimination:
3 to 4 hours.

PRECAUTION:
Endocrine and metabolic:
Cefixime chewable

tablets

contain aspartame; which is a source of phenylalanine;

use

caution and consider the total daily amount of phenylalanine intake in patients with phenylketonuria.

Gastrointestinal:
Clostridium difficile associated diarrhea; including mild diarrhea to fatal colitis; has been reported and may occur more than 2 months after use; discontinuation of antibacterial use not directed against C. difficile may be required.

Hematologic:
Decreased prothrombin activity may occur; particularly in patients with renal or hepatic failure; poor nutritional state; concomitant protracted course of antimicrobial therapy; or prior stabilization on anticoagulant therapy; monitoring recommended.

Immunologic:
Anaphylactic and anaphylactoid reactions; including shock and fatalities; have been reported; discontinuation required.
Cross Sensitivity may occur in patients with penicillin sensitivity.
Drug Resistant bacteria may emerge if administered in absence of proven or strongly suspected infection.

Lab test interactions:
False positive reactions for glucose in the urine are possible with certain tests; glucose tests using enzymatic glucose oxidase reactions are recommended.
False positive reactions for ketones in the urine are possible with tests using nitroprusside;

use

of nitroferricyanide recommended.

Renal:
Exercise caution and adjust

dose

in patients with renal impairment and those on continuous ambulatory peritoneal dialysis and hemodialysis; monitoring recommended.

PREGNANCY CATEGORY:
B (FDA)

BREAST FEEDING:
Infant Risk cannot be ruled out.

MONITORING:
Pharyngeal Gonorrhea:
Test of cure with culture or nucleic acid amplification test; 14 days after treatment
Improvement in the signs and symptoms of the infection may indicate clinical efficacy.

Prothrombin time:
In high risk patients (ie; those with renal or hepatic impairment; poor nutritional status; prolonged treatment duration; and/or those previously stabilized on concomitant anticoagulation therapy). Dialysis patients closely

HOW TO TAKE OR ADMINISTRATION:
Oral:
Take with or without food

(Chewable

tablets

)
Chew or crush prior to swallowing

(Suspension)
Reconstitute powder prior to

use

and shake well before measuring

dose

.

(Suspension)
Keep reconstituted suspension at room temperature or under refrigeration for up to 14 days.

DOSAGE FORM:
Oral Capsule: 400 MG.

Oral Powder for Suspension: 100 MG/5 ML
200 MG/5 ML
500 MG/5 ML

Oral Tablet: 400 MG

Oral Tablet; Chewable: 100 MG
200 MG

TOXICOLOGY:
TOXICITY: Serious toxicity is unlikely following large oral

doses

of cephalosporins. Crystalluria and hematuria has been described in a 3 year old boy who ingested 104 mg/kg of cephalexin.

PATIENT COUNSELING OR CLINICAL TEACHING:
This drug may cause abdominal pain or nausea.
Instruct patient to report signs/symptoms serum sickness like reactions (rash; urticaria; arthralgia; fever; malaise; enlarged lymph nodes).
Advise patient to report severe diarrhea and consult healthcare professional prior to taking antidiarrhea medicine. Other superinfection signs/symptoms should be reported as well.




Disclaimer:
For the Registered Medical Practitioner Only. We are not recommended for self medication. self medication is may harmful for health. We are only information about medicine.