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Cefixime Disease Interactions

There are 5 disease interactions with cefixime:

Major

Antibiotics (applies to cefixime) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  4. Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
  5. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  6. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  7. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  8. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  9. Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
  10. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
  11. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  12. Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
  13. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  14. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  15. Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
  16. Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
  17. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  18. Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
  19. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  20. Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
  21. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  22. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  23. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  24. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
  25. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  26. "Multum Information Services, Inc. Expert Review Panel"
  27. Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
  28. Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
  29. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  30. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  31. Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
  32. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  33. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  34. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  35. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  36. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  37. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  38. Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
  39. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  40. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  41. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  42. Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
  43. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  44. Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
  45. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  46. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  47. Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
View all 47 references
Moderate

Beta-lactams (oral) (applies to cefixime) renal dysfunction

Moderate Potential Hazard, High plausibility.

Most beta-lactam antibiotics are eliminated by the kidney as unchanged drug and, in some cases, also as metabolites. The serum concentrations of beta-lactam antibiotics and their metabolites may be increased and the half-lives prolonged in patients with impaired renal function. Dosage adjustments may be necessary and modifications should be based on the degree of renal impairment as well as severity of infection in accordance with the individual product package labeling. Renal function tests should be performed periodically during prolonged and/or high-dose therapy, since nephrotoxicity and alterations in renal function have occasionally been associated with the use of these drugs.

References

  1. Sjovall J, Westerlund D, Alvan G "Renal excretion of intravenously infused amoxycillin and ampicillin." Br J Clin Pharmacol 19 (1985): 191-201
  2. DeSante KA, Zeckel ML "Pharmacokinetic profile of loracarbef." Am J Med 92 (1992): s16-9
  3. "Product Information. Geocillin (carbenicillin)." Roerig Division, New York, NY.
  4. Jackson EA, McLeod DC "Pharmacokinetics and dosing of antimicrobial agents in renal impairment, part I." Am J Hosp Pharm 31 (1974): 36-52
  5. "Product Information. Suprax (cefixime)." Lupin Pharmaceuticals Inc, Baltimore, MD.
  6. Guay DR, Meatherall RC, Harding GK, Brown GR "Pharmacokinetics of cefixime (CL 284,635; FK 027) in healthy subjects and patients with renal insufficiency." Antimicrob Agents Chemother 30 (1986): 485-90
  7. Solomon AE, Briggs JD "The administration of cephradine to patients in renal failure." Br J Clin Pharmacol 2 (1975): 443-8
  8. Therasse DG, Farlow DS, Davidson RL, et al. "Effect of renal dysfunction on the pharmacokinetics of loracarbef." Clin Pharmacol Ther 54 (1993): 311-6
  9. St Peter JV, Borin MT, Hughes GS, et al "Disposition of cefpodoxime proxetil in healthy volunteers and patients with impaired renal function." Antimicrob Agents Chemother 36 (1992): 126-31
  10. Latos DL, Bryan CS, Stone WJ "Carbenicillin therapy in patients with normal and impaired renal function." Clin Pharmacol Ther 17 (1975): 692-700
  11. Granero L, Gimeno MJ, Torresmolina F, Chesajimenez J, Peris JE "Studies on the renal excretion mechanisms of cefadroxil." Drug Metab Dispos 22 (1994): 447-50
  12. Kunin CM, Finkelberg Z "Oral cephalexin and ampicillin: antimicrobial activity, recovery in urine, and persistence in blood of uremic patients." Ann Intern Med 72 (1970): 349-56
  13. Nakano H, Sasaki K, Mizoguchi M, Ishibe T, Nihira H "Absorption and excretion of carbenicillin indanyl sodium in patients with reduced kidney function." Chemotherapy 23 (1977): 299-308
  14. Bergan T "Pharmacokinetic comparison of oral bacampicillin and parenteral ampicillin." Antimicrob Agents Chemother 13 (1978): 971-4
  15. Guay DRP "Ceftibuten: A new expanded-spectrum oral cephalosporin." Ann Pharmacother 31 (1997): 1022-33
  16. Fillastre JP, Leroy A, Humbert G, Godin M "Cefaclor pharmacokinetics and renal impairment." J Antimicrob Chemother 6 (1980): 155-6
  17. Bloch R, Szwed JJ, Sloan RS, Luft FC "Pharmacokinetics of cefaclor in normal subjects and patients with chronic renal failure." Antimicrob Agents Chemother 12 (1977): 730-2
  18. Berman SJ, Boughton WH, Sugihara JG, et al "Pharmacokinetics of cefaclor in patients with end stage renal disease and during hemodialysis." Antimicrob Agents Chemother 14 (1978): 281-3
  19. Finkelstein ER, Quintiliani R, Nightingale CH "Pharmacokinetics of oral cephalosporins." J Pediatr 93 (1978): 902
  20. Humbert G, Leroy A, Fillastre JP, Godin M "Pharmacokinetics of cefadroxil in normal subjects and in patients with renal insufficiency." Chemotherapy 25 (1979): 189-95
  21. Braga PC, Fraschini F, Ceccarelli G, Scaglione F, Scarpazza G "Clinical pharmacokinetic evaluation of bacampicillin." Clin Ther 4 (1981): 32-42
  22. Andriole VT "Pharmacokinetics of cephalosporins in patients with normal or reduced renal function." J Infect Dis 137 (1978): s88-99
  23. Regamey C, Humair L "Pharmacokinetics of cephalexin in renal insufficiency." Postgrad Med J 47 Supp) (1971): 69-77
  24. Santoro J, Agarwal BN, Martinelli R, et al "Pharmacology of cefaclor in normal volunteers and patients with renal failure." Antimicrob Agents Chemother 13 (1978): 951-4
  25. "Product Information. Spectrobid (bacampicillin)." Roerig Division, New York, NY.
  26. Ehrnebo M, Nilsson SO, Boreus LO "Pharmacokinetics of ampicillin and its prodrugs bacampicillin and pivampicillin in man." J Pharmacokinet Biopharm 7 (1979): 429-51
  27. Arancibia A, Droguett MT, Fuentes G, et al "Pharmacokinetics of amoxicillin in subjects with normal and impaired renal function." Int J Clin Pharmacol Ther Toxicol 20 (1982): 447-53
  28. Leroy A, Humbert G, Godin M, Fillastre JP "Pharmacokinetics of cefadroxil in patients with impaired renal function." J Antimicrob Chemother 10 (1982): 39-46
  29. Bailey RR, Gower PE, Dash CH "The effect of impairment of renal function and haemodialysis on serum and urine levels of cephalexin." Postgrad Med J 46 (1970): 60-4
  30. "Product Information. Vantin (cefpodoxime)." Pharmacia and Upjohn, Kalamazoo, MI.
  31. "Product Information. Duricef (cefadroxil)." Bristol-Myers Squibb, Princeton, NJ.
  32. "Product Information. Velosef (cephradine)." Apothecon Inc, Plainsboro, NJ.
  33. Neu HC "The pharmacokinetics of bacampicillin." Rev Infect Dis 3 (1981): 110-6
  34. Chow M, Quintiliani R, Cunha BA, et al "Pharmacokinetics of high-dose oral cephalosporins." J Clin Pharmacol 19 (1979): 185-94
  35. "Product Information. Cedax (ceftibuten)." Schering-Plough, Liberty Corner, NJ.
  36. Gartenberg G, Meyers BR, Hirschman SZ, Srulevitch E "Pharmacokinetics of cefaclor in patients with stable renal impairment, and patients undergoing haemodialysis." J Antimicrob Chemother 5 (1979): 465-70
  37. Gibaldi M, Perrier D "Drug distribution and renal failure." J Clin Pharmacol 12 (1972): 201-4
  38. Reisberg BE, Mandelbaum JM "Cephalexin: absorption and excretion as related to renal function and hemodialysis." Infect Immun 3 (1971): 540-3
  39. Spyker DA, Gober LL, Scheld WM, et al "Pharmacokinetics of cefaclor in renal failure: effects of multiple doses and hemodialysis." Antimicrob Agents Chemother 21 (1982): 278-81
  40. Hoffler D, Koeppe P, Corcilius M, Przyklink A "Cefpodoxime proxetil in patients with endstage renal failure on hemodialysis." Infection 18 (1990): 157-62
  41. "Product Information. Lorabid (loracarbef)." Lilly, Eli and Company, Indianapolis, IN.
  42. Yamasaku F, Tsuchida R, Usada Y "A study of the kinetics of cephalosporins in renal impairment." Postgrad Med J Suppl (1970): 57-9
  43. Bailey RR, Eastwood JB, Vaughan RB "The pharmacokinetics of an oral form of carbenicillin in patients with renal failure." Postgrad Med J 48 (1972): 422-5
  44. Andriole VT "Pharmacokinetics of cephalosporins in patients with normal or reduced renal function." J Infect Dis 137 (1978): s88-97
  45. "Product Information. Omnicef (cefdinir)." Parke-Davis, Morris Plains, NJ.
  46. Hyslop DL "Cefaclor safety profile: a ten-year review." Clin Ther 11 Suppl A (1988): 83-94
  47. "Product Information. Ceclor (cefaclor)." Lilly, Eli and Company, Indianapolis, IN.
  48. Kirby WM, de Maine JB, Serrill WS "Pharmacokinetics of the cephalosporins in healthy volunteers and uremic patients." Postgrad Med J 47 Suppl (1971): 41-6
  49. "Product Information. Spectracef (cefditoren)." TAP Pharmaceuticals Inc, Deerfield, IL.
  50. Nix DE, Symonds WT, Hyatt JM, et al. "Comparative pharmacokinetics of oral ceftibuten, cefixime, cefaclor, and cefuroxime axetil in healthy volunteers." Pharmacotherapy 17 (1997): 121-5
  51. Hoffman TA, Cestero R, Bullock WE "Pharmacodynamics of carbenicillin in hepatic and renal failure." Ann Intern Med 73 (1970): 173-8
  52. Nelson JD, Reimold EW "Carbenicillin pharmacokinetics in an anephric patient." Lancet 1 (1973): 486-7
  53. "Product Information. Cefzil (cefprozil)." Bristol-Myers Squibb, Princeton, NJ.
  54. Spyker DA, Thomas BL, Sande MA, Bolton WK "Pharmacokinetics of cefaclor and caphalexin: dosage nomograms for impaired renal function." Antimicrob Agents Chemother 14 (1978): 172-7
  55. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham, Philadelphia, PA.
  56. Yamasaku F, Tsuchida R, Usuda Y "A study of the kinetics of cephalosporins in renal impairment." Postgrad Med J Suppl (1970): 57-9
  57. Dhib M, Moulin B, Leroy A, et al "Relationship between renal function and disposition of oral cefixime." Eur J Clin Pharmacol 41 (1991): 579-83
  58. Standiford HC, Jordan MC, Kirby WM "Clinical pharmacology of carbenicillin compared with other penicillins." J Infect Dis 122 (1970): s9-13
  59. Humbert G, Spyker DA, Fillastre JP, Leroy A "Pharmacokinetics of amoxicillin: dosage nomogram for patients with impaired renal function." Antimicrob Agents Chemother 15 (1979): 28-33
  60. "Product Information. Polymox (amoxicillin)." Bristol-Myers Squibb, Princeton, NJ.
  61. Hori R, Okumura K, Nihira H, et al "A new dosing regimen in renal insufficiency: application to cephalexin." Clin Pharmacol Ther 38 (1985): 290-5
  62. Schwinghammer TL, Norden CW, Gill E "Pharmacokinetics of cephradine administered intravenously and orally to young and elderly subjects." J Clin Pharmacol 30 (1990): 893-9
  63. Brogard JM, Pinget M, Dorner M, Lavillaureix J "Determination of cefalexin pharmacokinetics and dosage adjustments in relation to renal function." J Clin Pharmacol 15 (1975): 666-73
  64. Shyu WC, Pittman KA, Wilber RB, et al "Pharmacokinetics of cefprozil in healthy subjects and patients with renal impairment." J Clin Pharmacol 31 (1991): 362-71
  65. "Product Information. Keflex (cephalexin)." Dista Products Company, Indianapolis, IN.
  66. Pommer W, Krause PH, Berg PA, et al "Acute interstitial nephritis and non-oliguric renal failure after cefaclor treatment." Klin Wochenschr 64 (1986): 290-3
  67. Kabins SA, Kelner B, Walton E, Goldstein E "Cephalexin therapy as related to renal function." Am J Med Sci 259 (1970): 133-42
View all 67 references
Moderate

Cefdinir/cefixime (applies to cefixime) nitroprusside tests

Moderate Potential Hazard, High plausibility. Applicable conditions: Diabetes Mellitus

The cephalosporins, cefixime and cefdinir, have been reported to cause false-positive reactions for ketones in the urine with tests using nitroprusside, but not with tests using nitroferricyanide. Clinicians should be cognizant of this interaction when prescribing or administering either of these agents to patients with diabetes.

References

  1. "Product Information. Suprax (cefixime)." Lupin Pharmaceuticals Inc, Baltimore, MD.
  2. "Product Information. Omnicef (cefdinir)." Parke-Davis, Morris Plains, NJ.
Moderate

Cephalosporins (applies to cefixime) liver disease

Moderate Potential Hazard, Moderate plausibility.

Cases of hepatitis have been reported with the use of certain cephalosporins. Transient rise in SGOT, SGPT, and alkaline phosphatase levels have also been observed. Caution and monitoring is recommended when these agents are prescribed to patients with hepatic disorders.

Moderate

Cephalosporins (applies to cefixime) seizure disorders

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Seizures

Cephalosporins have been implicated in triggering seizures. Nonconvulsive status epilepticus (NCSE), encephalopathy, coma, asterixis, neuromuscular excitability, and myoclonia have been reported with cephalosporins particularly in patients with a history of epilepsy and/or when recommended dosages of cephalosporins were exceeded due to renal impairment. Adjust dosing based on creatinine clearance. Anticonvulsant therapy should be continued in patients with known seizure disorders. If CNS adverse reactions including seizures occur, patients should undergo a neurological evaluation to determine whether treatment should be discontinued.

Cefixime drug interactions

There are 38 drug interactions with cefixime

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.