cefixime (Rx)

Brand and Other Names:Suprax
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 400mg

tablet, chewable

  • 100mg
  • 200mg

oral suspension

  • 100mg/5mL
  • 200mg/5mL
  • 500mg/5mL

Acute Exacerbations of Chronic Bronchitis

Indicated in the treatment of acute exacerbations of chronic bronchitis caused by susceptible isolates of Streptococcus pneumoniae and Haemophilus influenzae

400 mg/day PO in single daily dose or divided q12hr

Otitis Media

Indicated in the treatment of otitis media caused by susceptible isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes

400 mg/day PO in single daily dose or divided q12hr

Pharyngitis/Tonsillitis

Indicated in the treatment of pharyngitis and tonsillitis caused by susceptible isolates of Streptococcus pyogenes

400 mg/day PO in single daily dose or divided q12hr

Uncomplicated Gonorrhea

Alternative treatment of uncomplicated urogenital, anorectal, or pharyngeal gonorrhea if ceftriaxone unavailable; no longer indicated as first-line treatment, per CDC guidelines

400 mg PO once plus azithromycin 1 g PO once (preferred) or alternatively doxycycline 100 mg PO q12hr for 7 days

CDC STD guidelines: MMWR Recomm Rep. June 5, 2015:64(RR3);1-137

Uncomplicated Urinary Tract Infections

Indicated in the treatment of uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli and Proteus mirabilis

400 mg/day PO in single daily dose or divided q12hr

Typhoid Fever (Off-label)

15-20 mg/kg/day PO divided q12hr for 7-14 days

Dosing Modifications

Renal impairment

  • CrCl >60 mL/min: No dosage adjustment necessary
  • CrCl 21-60 mL/min: 260 mg/day PO
  • CrCl ≤20 mL/min or continuous peritoneal dialysis : 200 mg/day PO

Dosing Considerations

Treatment of infections due to Streptococcus pyogenes, cefixime should be administered for at least 10 days

Susceptible organisms

  • Escherichia coli, Haemophilus influenzae, Neisseria gonorrhoeae, Proteus mirabilis, Streptococcus pneumoniae, Streptococcus pyogenes, Enterobacteriaceae, Salmonella spp, Serratia spp, Shigella spp

Dosage Forms & Strengths

capsule

  • 400mg

tablet, chewable

  • 100mg
  • 200mg

oral suspension

  • 100mg/5mL
  • 200mg/5mL
  • 500mg/5mL

Acute Bronchitis & Acute Exacerbations of Chronic Bronchitis

<6 months: Safety and efficacy not established

6 months-12 years, ≤45 kg: 8 mg/kg/day PO in single daily dose or divided q12hr  

>12 years, >45 kg: 400 mg/day PO in single daily dose or divided q12hr

Otitis Media

<6 months: Safety and efficacy not established

6 months-12 years, ≤45 kg: 8 mg/kg/day PO in single daily dose or divided q12hr  

>12 years, >45 kg: 400 mg/day PO in single daily dose or divided q12hr

Pharyngitis/Tonsillitis

<6 months: Safety and efficacy not established

6 months-12 years, ≤45 kg: 8 mg/kg/day PO in single daily dose or divided q12hr  

>12 years, >45 kg: 400 mg/day PO in single daily dose or divided q12hr

Uncomplicated Gonorrhea

Cervical or urethral gonorrhea

<6 months: Safety and efficacy not established

6 months-12 years, ≤45 kg: 8 mg/kg/day PO in single daily dose or divided q12hr  

>12 years, >45 kg: 400 mg PO once plus azithromycin 1 g in single dose or doxycycline 100 mg PO q12hr for 7 days

Uncomplicated Urinary Tract Infections

<6 months: Safety and efficacy not established

6 months-12 years, ≤45 kg: 8 mg/kg/day PO in single daily dose or divided q12hr  

>12 years, >45 kg: 400 mg/day PO in single daily dose or divided q12hr

Typhoid Fever (Off-label)

15-20 mg/kg/day PO divided q12hr for 7-14 days; not to exceed 400 mg/day

Next:

Interactions

Interaction Checker

and cefixime

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            >10%

            Diarrhea (16%)

            Frequency Not Defined

            Abdominal pain

            Candidiasis

            Dizziness

            Dyspepsia

            Elevated transaminases

            Eosinophilia

            Erythema multiforme

            Fever

            Flatulence

            Headache

            Increased blood urea nitrogen (BUN)

            Increased creatinine

            Leukopenia

            Nausea

            Prolonged prothrombin time (PT)

            Pruritus

            Pseudomembranous colitis

            Rash

            Serum sickness-like reaction

            Stevens-Johnson syndrome

            Thrombocytopenia

            Urticaria

            Vaginitis

            Vomiting

            Previous
            Next:

            Warnings

            Contraindications

            Documented hypersensitivity

            Cautions

            Limited activity against anaerobes

            Dosage must be adjusted in severe renal insufficiency (high doses may cause CNS toxicity, including seizures); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy

            Use with caution in patients with history of penicillin allergy

            Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

            Immune-mediated hemolytic anemia reported; monitor hematologic parameters during and for 2 to 3 weeks after therapy; discontinue therapy if hemolytic anemia occurs during treatment

            Phenylalanine can be harmful to patients with phenylketonuria (PKU); chewable tablets contain aspartame, a source of phenylalanine; before prescribing, consider combined daily amount of phenylalanine from all sources, including chewable tablets

            Use caution in patients with history of gastrointestinal disease

            Clostridium difficile associated diarrhea (CDAD) reported with use of nearly all antibacterial agents, and may range in severity from mild diarrhea to fatal colitis; if CDAD is suspected or confirmed, discontinue ongoing antibacterial drug use not directed against C. difficile; institute appropriate fluid and electrolyte management, protein supplementation, antibacterial drug treatment of C. difficile, and surgical evaluation as clinically indicated

            Immune-mediated hemolytic anemia reported; monitor hematologic parameters during and for 2 to 3 weeks after therapy; discontinue therapy if hemolytic anemia occurs during treatment

            Cephalosporins may be associated with a fall in prothrombin activity; patients with renal or hepatic impairment, or poor nutritional state, patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy; monitor prothrombin time in patients at risk and exogenous vitamin K administered as indicated

            May cause acute renal failure including tubulointerstitial nephritis; discontinue therapy if renal failure occurs and initiate supportive therapy

            Severe cutaneous reactions, including Stevens-Johnson syndrome, epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms (DRESS) reported; discontinue therapy and implement supportive therapy if reaction occurs

            Drug interactions overview

            • Concomitant use with cefixime and carbamazepine may elevate carbamazepine levels reported in postmarketing experience
            • Administration of cefixime may result in a false-positive reaction for glucose in the urine using Clinitest®, Benedict’s solution, or Fehling’s solution; use glucose tests based on enzymatic glucose oxidase reactions (such as Clinistix® or TesTape®) be used
            • A false-positive direct Coombs test reported during treatment with other cephalosporins; therefore, it should be recognized that a positive Coombs test may be due to the drug
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy

            There are no adequate and well-controlled studies in pregnant women

            Cefixime has not been studied for use during labor and delivery

            Treatment should only be given if clearly needed

            Lactation

            Unknown whether cefixime is excreted in human milk

            Consider discontinuing nursing temporarily during treatment

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Third-generation oral cephalosporin with broad activity against gram-negative bacteria; by binding to 1 or more penicillin-binding proteins, it arrests bacterial cell-wall synthesis and inhibits bacterial growth

            Absorption

            Bioavailability: 40-50%

            Average peak plasma concentration: ~2 mcg/mL (single 200 mg-tablet); ~3.7 mcg/mL (single 400 mg-tablet)

            Peak plasma time: 2-6 hr (single 200mg, 400 mg–tablet or 400mg suspension); 2-5 hr (single 200 mg-suspension); 3-8 hr (single 400 mg-capsule)

            Food reduces absorption following administration of the capsule by ~15% based on AUC and 25% based on peak plasma concentrations

            Distribution

            Distributed widely throughout body and reaches therapeutic concentration in most tissues and body fluids, including synovial, pericardial, pleural, and peritoneal; bile, sputum, and urine; bone, myocardium, gallbladder, skin, and soft tissue

            Protein bound: 65%

            Elimination

            Half-life: 3-4 hr

            Excretion: Urine (50% as unchanged drug), feces (10%)

            Previous
            Next:

            Administration

            Oral Suspension Preparation

            Tap bottle several times to loosen powder contents prior to reconstitution

            Add ~1/2 of the total amount of water for reconstitution and shake well (refer to prescribing information for specific volumes)

            Add remainder of water and shake well

            Oral Administration

            Administer orally once or twice daily depending on indication

            Do not substitute tablet or capsule for the chewable tablets or suspension in the treatment of otitis media

            Chewable tablets must be chewed or crushed before swallowing

            Storage

            Capsules, chewable tablets, or tablets: Store at 20-25°C (68-77°F)

            Unused suspension: Store at 20-25°C (68-77°F)

            Reconstituted suspension

            • Store at room temperature, or under refrigeration, without significant loss of potency for up to 14 days
            • Keep tightly closed
            • Shake well before using
            • Discard unused portion after 14 days
            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.