Cefixime (cefixime)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Cefixime is a semisynthetic, third generation cephalosporin antibiotic.
Cefixime is a semisynthetic oral aminothiazolyl methoxyimino cephalosporin antibiotic. Based on its spectrum of activity, cefixime is classified as a third generation cephalosporin. Cefixime is structurally similar to other oral (cefdinir, cefpodoxime proxetil, ceftibuten) or parenteral (cefotaxime, ceftazidime, ceftriaxone) cephalosporins that contain an aminothiazolyl side chain at position 7 of the cephalosporin nucleus.
The aminothiazolyl side chain enhances antibacterial activity, particularly against Enterobacteriaceae, and the methoxyimino group imparts stability against hydrolysis by many beta-lactamases. Cefixime contains a vinyl moiety at position 3 of the cephalosporin nucleus, which is partially responsible for the GI absorption characteristics of the drug. The vinyl moiety also may contribute to cefixime's potent bactericidal activity, although it appears to be partially responsible for the drug's poor in vitro activity against staphylococci.
Cefixime is usually bactericidal in action. Like other cephalosporins, the antibacterial activity of the drug results from inhibition of mucopeptide synthesis in the bacterial cell wall.
Cefixime has a high affinity for penicillin-binding proteins (PBPs) 3, 1a, and 1b of Escherichia coli. Since PBP 1b is a killing site for beta-lactam anti-infectives, cefixime's high affinity for this site may be a major factor in the drug's potent bactericidal activity against this organism. Cefixime has only low affinity for PBP 2 of staphylococci and little or no affinity for PBP 4 or 5.
In vitro studies indicate that low concentrations of cefixime usually cause the formation of filamentous cells in susceptible E. coli or Klebsiella pneumoniae. At higher concentrations, direct lysis of the organisms may occur as well as spheroplast formation and rupture. Following in vitro exposure to cefixime, morphologic changes in beta-lactamase-producing E. coli are the same as those seen in non-beta-lactamase-producing strains of the organism.
Lysis occurs in susceptible anaerobic bacteria following in vitro exposure to cefixime.
For most susceptible organisms, the minimum bactericidal concentration (MBC) of cefixime is only 1-4 times higher than the minimum inhibitory concentration (MIC). However, for some strains of Enterobacter, Klebsiella, Morganella, Proteus, Providencia, and Serratia, the MBC may be 9-32 times higher than the MIC.
Cefixime is a cephalosporin antibiotic that is used orally for the treatment of various infections caused by susceptible bacteria. Because cefixime has a long serum half-life and can be administered once or twice daily, some clinicians suggest that the drug may be particularly useful when patient compliance is a concern (e.g., in the treatment of otitis media). Although cefixime is an effective alternative to other anti-infective agents for the treatment of many infections, the drug offers no clear advantage (except for a convenient dosage regimen) over other equally effective, less expensive anti-infectives available for the treatment of uncomplicated urinary tract infections or upper and lower respiratory tract infections.
In addition, use of cefixime as empiric therapy in some infections (e.g., urinary tract infections, respiratory tract infections, soft tissue infections) is limited by its spectrum of activity since the drug is inactive against staphylococci, enterococci, and Pseudomonas aeruginosa. Because cefixime is inactive against most anaerobic bacteria, the drug is ineffective in and should not be used alone if a mixed aerobic-anaerobic bacterial infection is suspected.
Generic name: cefixime
Pronunciation: (seff-ICKS-eem)
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
Today’s intelligence on Cefixime
Indications
The following indications are listed for Cefixime:
- E. Coli Urinary Tract Infection
- Haemophilus Influenzae Acute Otitis Media
- Haemophilus Influenzae Bronchitis
- Moraxella Catarrhalis Acute Otitis Media
- Pharyngitis Due To Streptococcus Pyogenes
- Proteus Urinary Tract Infection
- Streptococcus Acute Otitis Media
- Streptococcus Pneumoniae Bronchitis
- Tonsillitis Due To Streptococcus Pyogenes
Also known as: Acute Otitis Media Due To H. Flu, Acute Otitis Media Due To Haemophilus Influenzae, Acute Otitis Media Due To Hemophilus Influenzae, Acute Otitis Media Due To Influenza Bacillus, Acute Otitis Media Due To Moraxella Catarrhalis, Acute Otitis Media Due To Pfeiffer's Bacillus, Acute Otitis Media Due To Streptococcus Species, Bronchitis Due To Diplococcus Pneumoniae, Bronchitis Due To Fraenkel's Pneumococcus, Bronchitis Due To Fraenkel-Weichselbaum Pneumococcus, Bronchitis Due To H. Flu, Bronchitis Due To H. Influenzae, Bronchitis Due To Haemophilus Influenzae, Bronchitis Due To Hemophilus Influenzae, Bronchitis Due To Influenzae Bacillus, Bronchitis Due To Pfeiffer's Bacillus, Bronchitis Due To Pneumococcus, Bronchitis Due To Pneumonococcus, Bronchitis Due To Streptococcus Pneumoniae, E. Coli Uti, Epidemic Sore Throat, Pharyngitis Due To Group A Beta-Hemolytic Streptococci, Pharyngitis Due To Streptococcus Epidemicus, Septic Sore Throat, Streptococcal Pharyngitis, Streptococcus Pyogenes Tonsillitis, Urinary Tract Infection Due To Escherichia Coli, Urinary Tract Infection Due To Proteus Species, Uti Due To Proteus Species.
Dosing
Cefixime is commercially available as the trihydrate; potency of the drug is expressed in terms of cefixime (the free acid), calculated on the anhydrous basis.
Cefixime is administered orally as capsules, conventional tablets, chewable tablets, or an oral suspension.
Capsules containing 400 mg of cefixime are bioequivalent to conventional tablets containing 400 mg of the drug when administered under fasting conditions.
Cefixime chewable tablets are bioequivalent to cefixime oral suspension.
Cefixime conventional tablets and oral suspension are not bioequivalent.
Store cefixime capsules, conventional tablets, or chewable tablets at 20-25degreesC.
Store cefixime powder for oral suspension in tight containers at 20-25degreesC. After reconstitution, store the oral suspension in a tight container. The reconstituted suspension is stable for 14 days at room temperature or when refrigerated; discard any unused suspension after 14 days.
Cefixime may be administered once or twice daily. Once- and twice-daily regimens reportedly are similarly effective for the treatment of otitis media, tonsillitis, or uncomplicated urinary tract infections. Relative efficacy of the 2 regimens has not been evaluated in other infections, and some clinicians suggest that twice-daily dosing may be preferable for the treatment of some lower respiratory tract infections or for complicated urinary tract infections+. Results of most studies indicate that the incidence of GI effects is similar with once- and twice-daily regimens.
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No dosing information is available for this tab.
Drug interactions
There is no enhanced messaging for this drug.
There are no contraindication interactions for this drug.
There are no severe interactions for this drug.
There are no moderate interactions for this drug.
Contraindications
*Known hypersensitivity to cefixime or other cephalosporins.
There are no contraindication contraindications for this drug.
There are no severe contraindications for this drug.
There are no moderate contraindications for this drug.
Adverse reactions
The most common adverse reactions in patients receiving cefixime are diarrhea (16%), nausea (7%), loose stools (6%), abdominal pain (3%), dyspepsia (3%), and vomiting.
There are no severe adverse reactions for this drug.
There are no less severe adverse reactions for this drug.
Precautions
No enhanced messaging available.
Safety and efficacy of cefixime in children <6 months of age have not been established.
The frequency of adverse GI effects (e.g., diarrhea, loose stools) reported in pediatric patients receiving cefixime oral suspension is similar to that reported in adults receiving cefixime tablets. Diarrhea or loose stools has been reported in up to 15% of children 6 months to 13 years of age receiving oral cefixime. CDAD has been reported rarely in children receiving cefixime. In 3 reported cases, the onset of symptoms (abdominal pain, diarrhea) occurred 4-14 days after the first dose of cefixime.
Reproduction studies in mice and rats using oral cefixime dosages up to 40 times the usual human dosage have not revealed evidence of harm to the fetus. Cefixime has been reported to cross the placenta. There are no adequate and controlled studies to date using cefixime in pregnant women, and the drug should be used during pregnancy only when clearly needed. Use of cefixime during labor and delivery has not been studied to date, and the drug should be used in these circumstances only when clearly needed.
Cefixime is distributed into milk in rats. Although the drug reportedly was not detected in milk following a single dose in lactating women in one study, it is not known whether cefixime is distributed into milk in humans. Therefore, consideration should be given to temporarily discontinuing nursing during therapy with the drug.
Modification of the usual dosage of cefixime is not necessary in geriatric adults based on age, but may be required because of age-related decreases in renal function.
Clinical studies did not include sufficient numbers of patients >=65 years of age to determine whether geriatric patients respond differently than younger adults. Other reported clinical experience has not identified differences in responses between geriatric and younger patients.
Some evidence indicates that oral bioavailability of the drug may be increased in geriatric patients, but such increases are not considered clinically important.
Because renal function decreases with age and may be impaired in geriatric patients, the possibility that adjustment of cefixime dosage may be necessary in this age group should be considered.
Although the difference was not considered clinically important, one study in geriatric patients >64 years of age receiving 400-mg doses of cefixime once daily for 5 days indicated that peak serum concentrations of cefixime were 20-26% higher and AUCs were approximately 40-42% higher in these geriatric adults than in healthy adults 18-35 years of age.
ICD codes
No ICD codes are available for this drug.
Formulary status
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Last reviewed · Source: First Databank (FDB) drug data
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