Cefixime (Monograph)

Brand name: Suprax
Drug class: Third Generation Cephalosporins

Medically reviewed by Drugs.com on Jul 10, 2025. Written by ASHP.

Introduction

Antibacterial; β-lactam antibiotic; third generation cephalosporin.¹ ² ³ ⁴ ⁶ ⁷ ¹³ ²³ ⁵⁷ ⁶⁰ ⁷⁵ ⁸³

Uses for Cefixime

Urinary Tract Infections

Treatment of adults and pediatric patients ≥6 months of age with uncomplicated UTIs¹ ² ⁵ ⁴⁰ ⁵¹ ⁶⁴ ⁷⁴ ⁷⁵ ¹⁸² caused by susceptible E. coli¹ ² ⁴⁰ ⁵¹ ⁶⁴ ⁷⁴ ⁷⁵ ¹⁸² or Proteus mirabilis;¹ ² ⁴⁰ ⁵¹ ⁷⁴ ⁷⁵ ¹⁸² also has been used for treatment of uncomplicated UTIs caused by susceptible Citrobacter spp.^{† [off-label]},² ⁵¹ ⁶⁴ ⁷⁴ C. diversus^{† [off-label]},² ⁷⁴ C. freundii^{† [off-label]},² ⁷⁴ Enterobacter spp.^{† [off-label]},² ⁴⁰ ⁵¹ E. aerogenes^{† [off-label]},² ⁴⁰ ⁷⁴ E. agglomerans^†,² ⁶⁴ Klebsiella spp.^†,² ⁴⁰ ⁵¹ ¹⁸² K. pneumoniae^†,² ⁶⁴ ⁷⁴ Morganella morganii^†,² Proteus spp.^†,² ⁵¹ ⁶⁴ or Serratia^†.² ⁵¹ ⁷⁴

Has been used for treatment of uncomplicated UTIs¹ ² ⁵ ⁴⁰ ⁵¹ ⁶⁴ ⁷⁴ ⁷⁵ ¹⁸² caused by susceptible gram-positive bacteria, including Staphylococcus epidermidis^†,² Staphylococcus spp.^†,² ⁵¹ Streptococcus agalactiae^†,² ⁴⁰ nonhemolytic streptococci^†,² ⁴⁰ ⁵¹ or Enterococcus faecalis^†.² ⁴⁰ Consider that treatment failures have been reported and gram-positive bacteria (e.g., staphylococci, S. agalactiae, enterococci) have been isolated in urine during or after cefixime treatment and usually are resistant to cefixime.² ⁵¹ ⁷⁴

Treatment of pyelonephritis^† and other complicated UTIs^†² ²³ ⁴⁰ ⁷⁵ caused by susceptible Enterobacteriaceae, including E. coli.² ²³

Otitis Media

Treatment of adults and pediatric patients ≥6 months of age with otitis media¹ ² ³ ⁵ ²³ ⁴³ ⁵⁶ ⁶¹ ⁶² ⁶³ ⁷⁵ ¹³⁸ ¹⁶⁴ ¹⁶⁵ caused by Haemophilus influenzae,¹ ² ²³ ⁶¹ ⁶² ⁶³ Moraxella catarrhalis,¹ ² ²³ ⁶¹ ⁶² ⁶³ or Streptococcus pyogenes (group A β-hemolytic streptococci).¹ ² ²³ ⁶² ⁶³ Has also been used for the treatment of otitis media caused by S. pneumoniae; however, overall response was approximately 10% lower for cefixime than for the comparator in clinical studies.¹

When anti-infectives indicated, AAP recommends high-dose amoxicillin or amoxicillin and clavulanate as drugs of choice for initial treatment of otitis media; certain cephalosporins (cefdinir, cefpodoxime, cefuroxime, ceftriaxone) recommended as alternatives for initial treatment in penicillin-allergic patients without a history of severe and/or recent penicillin-allergic reactions.¹⁸⁴ ⁷⁵⁰ ⁷⁵¹

Pharyngitis and Tonsillitis

Treatment of adults and pediatric patients ≥6 months of age with pharyngitis and tonsillitis caused by susceptible S. pyogenes (group A β-hemolytic streptococci).¹ ² ³ ⁵ ²³ ⁴⁴ ⁵⁶ ⁶⁴ ⁷⁵ Generally effective in eradicating S. pyogenes from nasopharynx; efficacy in prevention of subsequent rheumatic fever not established to date.¹

AAP, IDSA, AHA, and others recommend a penicillin regimen (10 days of oral penicillin V or oral amoxicillin or single dose of IM penicillin G benzathine) as treatment of choice for S. pyogenes pharyngitis and tonsillitis;⁸² ⁸⁶ ¹⁰⁴ ¹⁵² ⁷⁵⁰ other anti-infectives (oral cephalosporins, oral macrolides, oral clindamycin) recommended as alternatives in penicillin-allergic patients.⁸² ⁸⁶ ¹⁰⁴ ¹⁵² ⁷⁵⁰

If an oral cephalosporin is used, 10-day regimen of first generation cephalosporin (cefadroxil, cephalexin) is preferred instead of other cephalosporins with broader spectrums of activity (e.g., cefaclor, cefdinir, cefixime, cefpodoxime, cefuroxime).⁸² ⁸⁶ ¹⁵² ⁷⁵⁰

Acute Exacerbations of Chronic Bronchitis

Treatment of adults and pediatric patients ≥6 months of age with acute exacerbations of chronic bronchitis caused by S. pneumoniae,¹ ² ²³ ⁴⁴ ⁷⁰ ⁷² ¹⁰³ H. influenzae,¹ ² ²³ ⁴⁴ ⁷⁰ ⁷² ¹⁰³ or M. catarrhalis^†.² ⁴⁴ ⁷⁰ ⁷² ¹⁰³

Gonorrhea

Treatment of adults and pediatric patients ≥6 months of age with uncomplicated urethral, endocervical, or rectal infections^† caused by susceptible Neisseria gonorrhoeae.¹ ² ²³ ⁴⁸ ⁷¹ ¹⁰⁶ ¹⁰⁸ ¹⁰⁹ ¹¹⁰ ¹¹¹ ¹³⁰ ¹⁹⁷

Because of concerns related to reports of N. gonorrhoeae with reduced susceptibility to cephalosporins, CDC states that oral cephalosporins no longer recommended as first-line treatment for uncomplicated gonorrhea.¹³⁰ ¹⁹⁷ For treatment of uncomplicated urogenital, anorectal, or pharyngeal gonorrhea, CDC recommends a single dose of IM ceftriaxone.¹³⁰ Add treatment for chlamydia if not excluded.¹³⁰ ⁷⁴⁶ ⁷⁴⁷ ⁷⁴⁸

Cefixime recommended by CDC as an alternative in patients with urogenital or rectal^† gonorrhea when ceftriaxone cannot be used or not available.¹³⁰ ¹⁹⁷ Add treatment for chlamydia if not excluded.¹³⁰ ⁷⁴⁶ ⁷⁴⁷ ⁷⁴⁸

Consider that N. gonorrhoeae with reduced susceptibility to cefixime, including some treatment failures, reported in US and other countries.¹³⁰ ¹⁹⁴ ¹⁹⁵ ¹⁹⁶ ¹⁹⁷ ¹⁹⁸

If infection persists (treatment failure), culture relevant clinical specimens and perform in vitro susceptibility tests.¹³⁰ ¹⁹⁷ Also consult infectious disease specialist, STD/HIV Prevention Training Center ([Web]), or CDC (800-232-4636) for treatment advice and report the case to CDC through local or state health departments within 24 hours of diagnosis.¹³⁰

For all gonorrhea patients, ensure that their sex partners from preceding 60 days are evaluated promptly with culture and receive presumptive treatment with a recommended regimen.¹³⁰

Pneumonia

Has been used in adults or children for the treatment of mild to moderate pneumonia, including community-acquired pneumonia^†.¹³⁷ ¹⁶⁶ When used in hospitalized patients with community-acquired pneumonia, therapy was initiated with a parenteral third generation cephalosporin (e.g., ceftriaxone, cefotaxime) and then changed to oral cefixime, as appropriate, allowing therapy to be completed on an outpatient basis.¹³⁷ ¹⁶⁶

Other cephalosporins (e.g., ceftriaxone, cefotaxime, ceftaroline, ceftazidime, cefpodoxime, cefuroxime) are recommended by the American Thoracic Society/IDSA and others when a cephalosporin is used in the treatment of community-acquired pneumonia.⁵¹² ⁷⁵⁰ ⁷⁵¹

Lyme Disease

Has been used for treatment of disseminated Lyme disease^†.¹⁸¹ Other cephalosporins (cefotaxime, ceftriaxone, cefuroxime axetil) usually recommended by IDSA, AAP, and others when a cephalosporin is used in the treatment of Lyme disease.¹⁸⁵ ⁷⁴⁴ ⁷⁴⁵

Shigellosis

Has been used for treatment of shigellosis^† caused by susceptible Shigella;¹³⁹ ¹⁴⁸ however, other drugs are listed as a first-line or alternative agents in IDSA and AAP guidelines. ²¹⁷ ⁷⁵³

Sinusitis

Has been used for the treatment of mild to moderate sinusitis^† caused by S. pneumoniae,² ²³ ⁴⁴ ⁷⁰ ⁷² ¹⁰³ H. influenzae² ²³ ⁴⁴ ⁷⁰ ⁷² ¹⁰³ M. catarrhalis² ⁴⁴ ⁷⁰ ⁷² ¹⁰³ ¹³⁷ ¹⁶⁶ E. coli, H. parahaemolyticus, or H. parainfluenzae² ³ ⁴⁴ ⁷⁵ Because of variable activity against S. pneumoniae and H. influenzae, IDSA no longer recommends second or third generation oral cephalosporins for empiric monotherapy of acute bacterial sinusitis.¹⁹² Oral amoxicillin or amoxicillin and clavulanate usually recommended for empiric treatment.¹⁹² ¹⁹³ If an oral cephalosporin used as an alternative in children (e.g., in penicillin-allergic individuals), combination regimen that includes a third generation cephalosporin (cefixime or cefpodoxime) and clindamycin (or linezolid) recommended.¹⁹² ¹⁹³

Typhoid Fever and Other Salmonella Infections

Has been used in pediatric patients for the treatment of typhoid fever (enteric fever) or septicemia caused by multidrug-resistant strains of Salmonella typhi^†.¹⁴¹ ¹⁴² ¹⁸⁹ ¹⁹⁰ ¹⁹¹

Multidrug-resistant strains of S.typhi (i.e., strains resistant to ampicillin, chloramphenicol, and/or co-trimoxazole) reported with increasing frequency; fluoroquinolones (e.g., ciprofloxacin, ofloxacin) and third generation cephalosporins (e.g., ceftriaxone, cefotaxime) have been considered agents of first choice for treatment of typhoid fever or other severe infections known or suspected to be caused by these strains.⁸² ¹⁰⁴ ¹⁴⁶ ¹⁴⁷ ¹⁶³

Fluoroquinolones no longer recommended as empiric treatment for typhoid fever infections in US.⁷⁵² ⁷⁶⁶ Ceftriaxone considered a drug of choice for empiric treatment of enteric fever pending results of in vitro susceptibility tests.⁷⁵² Consider travel history and regional antibiotic resistance patterns when selecting empiric antibiotic therapy for enteric fever;⁷⁵² ⁷⁶⁵ ⁷⁶⁶ adjust treatment based on results of susceptibility testing.⁷⁶⁶

Cefixime Dosage and Administration

General

Pretreatment Screening

Prior to initiation of therapy, careful inquiry should be made concerning previous hypersensitivity reactions to cephalosporins, penicillins, other β-lactam anti-infectives, or other drugs.¹

Patient Monitoring

Monitor patients for hypersensitivity reactions.¹ If a severe hypersensitivity reaction occurs, immediately discontinue cefixime and institute appropriate therapy as indicated.¹
Carefully monitor patients receiving dialysis during treatment with cefixime.¹
Monitor prothrombin time in patients with impaired vitamin K synthesis or low vitamin K stores (e.g., chronic hepatic disease, malnutrition).¹ Administer vitamin K when indicated.¹

Other General Considerations

To reduce the development of drug-resistant bacteria and maintain effectiveness of cefixime and other antibacterials, use cefixime only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.¹

Administration

Oral Administration

Administer orally as capsules, conventional tablets, chewable tablets, or oral suspension.¹

Capsules and conventional tablets: Administer without regard to meals.¹

Chewable tablets: Must be chewed or crushed before swallowing.¹

Reconstitution

Reconstitute oral suspension at the time of dispensing by adding amount of water specified on the container in 2 equal portions; shake after each addition.¹ The reconstituted suspension contains 100, 200, or 500 mg/5 mL.¹

Shake oral suspension well just prior to administration of each dose.¹

Dosage

Available as cefixime trihydrate; dosage expressed in terms of cefixime.¹

Capsules containing 400 mg of cefixime are bioequivalent to conventional 400-mg tablets when administered under fasting conditions.¹

Chewable tablets are bioequivalent to oral suspension.¹

Conventional tablets and oral suspension are not bioequivalent.¹

Pediatric Patients

General Pediatric Dosage

Oral

Children beyond neonatal period: AAP recommends 8 mg/kg daily in 1 or 2 equally divided doses for treatment of mild or moderate infections.⁸² ⁷⁵⁷ AAP states the drug is inappropriate for treatment of severe infections.⁸²

Children weighing 5–7.5 kg: Oral suspension containing 100 mg/5 mL is preferred preparation.¹

Children weighing 7.6–10 kg: Oral suspension containing 100 or 200 mg/5 mL is preferred preparation.¹

Children weighing <10 kg: Chewable tablets not recommended.¹

Urinary Tract Infections (UTIs)

Uncomplicated UTIs

Oral

Children 6 months to 12 years of age: 8 mg/kg once daily or 4 mg/kg every 12 hours¹ for 5–10 days.² ⁴⁰ ⁵¹ ⁷⁴

Children >12 years of age or weighing >45 kg: 400 mg once daily or 200 mg every 12 hours¹ for 5–10 days.² ⁴⁰ ⁵¹ ⁷⁴

Otitis Media

Oral

Children 6 months to 12 years of age: 8 mg/kg once daily or 4 mg/kg every 12 hours¹ for 10–14 days.²³ ⁵⁶ ⁶² ⁶³

Children >12 years of age or weighing >45 kg: 400 mg daily¹ for 10–14 days.⁴⁴ ⁶⁴ ⁷²

Do not use capsules or conventional tablets for treatment of otitis media.¹

Pharyngitis and Tonsillitis

Oral

Children 6 months to 12 years of age: 8 mg/kg once daily or 4 mg/kg every 12 hours for ≥10 days.¹

Children >12 years of age or weighing >45 kg: 400 mg once daily or 200 mg every 12 hours¹ for ≥10 days.⁴⁴ ⁶⁴ ⁷²

Acute Exacerbations of Chronic Bronchitis

Oral

Children 6 months to 12 years of age: 8 mg/kg once daily or 4 mg/kg every 12 hours¹ for 10–14 days.⁴⁴ ⁶⁴ ⁷²

Children >12 years of age or weighing >45 kg: 400 mg once daily or 200 mg every 12 hours¹ for 10–14 days.⁴⁴ ⁶⁴ ⁷²

Gonorrhea and Associated Infections

Uncomplicated Urethral, Endocervical, or Rectal† Gonorrhea

Oral

In pediatric patients or adolescents weighing ≥45 kg when ceftriaxone is unavailable or cannot be used, CDC and AAP recommend a single oral cefixime dose of 800 mg.¹³⁰ ⁷⁴⁸

Prepubertal children ≥6 months of age weighing <45 kg: 8 mg/kg recommended by manufacturer.¹

Children ≥12 years of age or weighing ≥45 kg: 400 mg as a single dose recommended by manufacturer.¹

Not recommended by CDC as first-line treatment.¹³⁰ ¹⁹⁷ If chlamydia not excluded, also treat patient for chlamydia.¹³⁰ ⁷⁴⁸

Shigellosis†

Oral

8 mg/kg daily for 5 days.¹³⁹ ¹⁴⁸

Acute Treatment of Acute Bacterial Sinusitis†

Oral

8 mg/kg daily in 2 equally divided doses for 10–14 days.¹⁹²

Typhoid Fever†

Oral

Children 6 months to 16 years of age: 5–10 mg/kg twice daily.¹⁴¹ ¹⁴² ¹⁸⁹ ¹⁹⁰ ¹⁹¹ Usually given for 14 days;¹⁴¹ ¹⁴² ¹⁸⁹ high rate of treatment failure occurred when given for only 7 days.¹⁹⁰

Adults

Urinary Tract Infections (UTIs)

Uncomplicated UTIs

Oral

400 mg once daily or 200 mg every 12 hours¹ for 5–10 days.⁴⁰ ⁵¹ ⁷⁴

Otitis Media

Oral

400 mg once daily or 200 mg every 12 hours¹ for 10–14 days.²³ ⁵⁶ ⁶² ⁶³

Do not use capsules or conventional tablets for treatment of otitis media.¹

Pharyngitis and Tonsillitis

Oral

400 mg once daily or 200 mg every 12 hours for ≥10 days.¹

Acute Exacerbations of Chronic Bronchitis

Oral

400 mg once daily or 200 mg every 12 hours¹ for 10–14 days.⁴⁴ ⁶⁴ ⁷²

Gonorrhea and Associated Infections

Uncomplicated Urethral, Endocervical, or Rectal† Gonorrhea

Oral

800 mg as a single dose recommended by CDC as alternative when ceftriaxone unavailable or cannot be used.¹³⁰

Use in conjunction with treatment for chlamydia if chlamydia not ruled out.¹³⁰ Not recommended by CDC as first-line treatment.¹³⁰ ¹⁹⁷

Manufacturer recommends a single 400-mg dose of cefixime for treatment of uncomplicated cervical/urethral gonococcal infections.¹

Lyme Disease†

Oral

200 mg daily for 100 days (administered with oral probenecid).¹⁸¹

Special Populations

Renal Impairment

Dosage adjustments necessary in patients with Cl_cr <60 mL/minute.¹ ² Adults with Cl_cr 21–59 mL/minute: 260 mg daily as oral suspension, preferably as oral suspension containing 200 or 500 mg/5 mL; conventional tablets and chewable tablets not recommended.¹

Adults with Cl_cr ≤20 mL/minute: 200 mg daily as conventional tablets or chewable tablets, 172 mg daily as oral suspension containing 100 mg/5 mL, 176 mg daily as oral suspension containing 200 mg/5 mL, or 180 mg daily as oral suspension containing 500 mg/5 mL.¹

Adults undergoing hemodialysis: 260 mg daily as oral suspension, preferably as oral suspension containing 200 or 500 mg/5 mL; conventional tablets and chewable tablets not recommended.¹

Adults undergoing continuous peritoneal dialysis: 200 mg daily as conventional tablets or chewable tablets, 172 mg daily as oral suspension containing 100 mg/5 mL, 176 mg daily as oral suspension containing 200 mg/5 mL, or 180 mg daily as oral suspension containing 500 mg/5 mL.¹

Hepatic Impairment

The manufacturer makes no specific dosage recommendations for patients with hepatic impairment.¹

Geriatric Patients

No dosage adjustments except those related to renal impairment.² ³⁵ ³⁷

Cautions for Cefixime

Contraindications

Known hypersensitivity to cefixime or other cephalosporins.¹

Warnings/Precautions

Hypersensitivity Reactions

Hypersensitivity reactions such as anaphylaxis (including shock and fatalities), angioedema, serum sickness-like reactions, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported.¹ ⁵ ⁴⁰ ⁴¹ ⁴³ ⁵⁶ ⁶⁴ ⁷⁵

If an allergic reaction occurs, discontinue cefixime.¹

Partial cross-allergenicity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins.¹ ¹⁷² ¹⁷³ Use caution.¹

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to cephalosporins, penicillins, or other drugs.¹ Cefixime is contraindicated in individuals hypersensitive to cephalosporins.¹ Avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction and administer with caution in those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction.¹⁷³

Clostridioides difficile-associated Diarrhea

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridioides difficile.¹ ⁴² ¹⁷⁷ ¹⁷⁸ C. difficile infection (CDI) and C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) reported with nearly all anti-infectives, including cefixime, and may range in severity from mild diarrhea to fatal colitis.¹ ⁴² ¹⁷⁷ ¹⁷⁸ C. difficile produces toxins A and B which contribute to development of CDAD;¹ ⁴⁰ ⁴² hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.¹

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.¹ ⁴² ¹⁷⁷ ¹⁷⁸ Obtain careful medical history since CDAD may occur as late as 2 months or longer after anti-infective therapy is discontinued.⁴²

If CDAD is suspected or confirmed, discontinue anti-infectives not directed against C. difficile whenever possible.⁴² ¹⁷⁷ ¹⁷⁸ Initiate appropriate supportive therapy (e.g., fluid and electrolyte management, protein supplementation), anti-infective therapy directed against C. difficile (e.g., metronidazole, vancomycin), and surgical evaluation as clinically indicated.¹ ⁴² ¹⁷⁷ ¹⁷⁸

Dose Adjustment in Renal Impairment

Serum concentrations of cefixime higher and more prolonged in patients with moderate or severe renal impairment than in patients with normal renal function; decrease dose and/or frequency of administration of cefixime in patients with impaired renal function, including those undergoing continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis.² ²³ ³³ ³⁷ ⁷⁵ Carefully monitor patients undergoing dialysis during cefixime therapy.¹

Coagulation Effects

Prolonged PT reported.¹ ² ⁴¹

Patients with renal or hepatic impairment, poor nutritional status, prolonged anti-infective therapy, and previous anticoagulant therapy (stabilized) appear to be at risk.¹ Monitor PT in such patients and administer exogenous vitamin K as indicated.¹

Development of Drug-resistant Bacteria

To reduce development of drug-resistant bacteria and maintain effectiveness of cefixime and other antibacterials, the drug should be used only for the treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.¹ When selecting or modifying anti-infective therapy, results of culture and in vitro susceptibility testing should be used.¹ In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.¹

Patients with Phenylketonuria

Chewable tablets containing 100, 150, and 200 mg of cefixime contain aspartame , which is metabolized in the GI tract to provide 3.3, 5, and 6.7 mg of phenylalanine, respectively.¹ Phenylalanine can be harmful to patients with phenylketonuria; consider combined daily amount of phenylalanine from all sources before prescribing cefixime chewable tablets in such patients.¹

Specific Populations

Pregnancy

No adequate and controlled studies to date using cefixime in pregnant women; use drug during pregnancy only when clearly needed.¹ Use of drug during labor and delivery also not studied to date; use in these circumstances only when clearly needed.¹

Lactation

Distributed into milk in rats;³⁶ not known whether distributed into milk in humans.¹ Discontinue nursing or the drug.¹

Pediatric Use

Safety and efficacy not established in children <6 months of age.¹ Frequency of adverse GI effects (e.g., diarrhea, loose stools) similar to that in adults.¹

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults.¹

Possible increased oral bioavailability;¹ ³⁵ ³⁷ not considered clinically important.³⁵ ³⁷

Consider age-related decreases in renal function when selecting dosage and adjust dosage if necessary.² ³⁵ ³⁷

Hepatic Impairment

There is no evidence of metabolism of cefixime in vivo.¹ Hepatic impairment is not expected to affect clearance of cefixime.¹

Renal Impairment

Increased serum half-life in patients with moderate or severe renal impairment.¹ ² ²³ ³³ ³⁷ ⁷⁵ Dosage adjustments necessary if Cl_cr <60 mL/minute.¹ ² ³³ ³⁵ ³⁷

Common Adverse Effects

Diarrhea (16%), nausea (7%), loose stools (6%), abdominal pain (3%), dyspepsia (3%), vomiting.¹

Drug Interactions

Specific Drugs and Laboratory Tests

Drug or Test	Interaction	Comments
Antacids (aluminum- or magnesium-containing)	No clinically important effect on cefixime pharmacokinetics ³²
Anticoagulants, oral (warfarin)	Possible increased PT (with or without bleeding)¹
Carbamazepine	Increased carbamazepine concentrations¹	Monitor carbamazepine concentrations¹
Coomb's test	Possible false positive Coomb's test results with cephalosporins¹
Nifedipine	Possible increased plasma concentrations and AUC of cefixime¹⁴³
Probenecid	Increased cefixime plasma concentrations and AUC²
Salicylates	Possible decreased plasma concentrations and AUC of cefixime² ²⁵	Clinical importance unclear² ¹⁰²
Tests for glucose	Possible false-positive reactions in urine glucose tests using Clinitest, Benedict’s solution, or Fehling’s solution¹	Use glucose tests based on enzymatic glucose oxidase reactions (e.g., Clinistix, Tes-Tape)¹
Tests for ketones	Possible false-positive reaction for ketones in urine if nitroprusside tests used; not reported with tests using nitroferricyanide¹

Cefixime Pharmacokinetics

Absorption

Bioavailability

30–50% of a single oral dose absorbed;¹ ² ⁵ ⁷⁵ ¹⁰⁰ peak serum concentrations attained within 2–6 hours.¹ ² ²⁶ ³⁰ ³¹ ³⁵ ³⁷ ¹⁰⁰

Capsules containing 400 mg of cefixime are bioequivalent to conventional tablets containing 400 mg of the drug when administered under fasting conditions.¹

Chewable tablets are bioequivalent to the oral suspension.¹

Conventional tablets and oral suspension are not bioequivalent;¹ studies in adults indicate oral suspension results in peak serum concentrations and AUC 25–50% and 10–25% higher, respectively, than those attained with tablets.¹

Food

Conventional tablets and oral suspension: Food decreases rate¹ but not extent of absorption.¹ ² ³ ²⁶

Capsules: Food decreases absorption by about 15% (based on AUC) or 25% (based on peak serum concentrations).¹

Distribution

Extent

Distributed into bile,¹ ² ⁵ sputum,² ²³ tonsils,²³ maxillary sinus mucosa,²³ middle ear discharge,²³ blister fluid,² ⁷⁵ and prostatic fluid.²

Distribution into CSF unknown.¹

Crosses the placenta.² ²³ Not detected in human milk following a single 100-mg oral dose.²

Plasma Protein Binding

65–70%.¹ ² ²³ ²⁷ ³³ ³⁷ ⁷⁵

Elimination

Metabolism

Does not appear to be metabolized; no biologically active metabolites detected in serum or urine.¹ ² ⁵ ²³ ³⁰

Elimination Route

Eliminated by renal and nonrenal mechanisms.¹ ² ²³ ²⁴ ²⁶ ²⁷ ²⁹ ³⁰ ³¹ ³⁷ ⁵² ⁷⁵

7–50% of a dose excreted unchanged in urine within 24 hours.¹ ² ²³ ²⁴ ²⁶ ²⁷ ²⁹ ³¹ ³⁷ ⁷⁵ ¹⁰⁰ In animal studies, >10% of a dose may be excreted unchanged in bile.¹ ² ⁵²

Not substantially removed by hemodialysis or peritoneal dialysis.¹ ² ³³ ³⁷ ⁷⁵

Half-life

Adults with normal renal function: 2.4–4 hours.¹ ² ⁵ ²³ ²⁴ ²⁶ ²⁷ ²⁹ ³¹ ³³ ³⁷ ⁷⁵ ¹⁰⁰

Special Populations

Adults with moderate renal impairment (Cl_cr 20–40 mL/minute): Serum half-life averages 6.4 hours.¹

Adults with severe renal impairment (Cl_cr 5–20 mL/minute): Serum half-life averages 11.5 hours.¹

Geriatric patients: AUC at steady state approximately 40% higher than in younger adults; not considered clinically important.¹

Stability

Storage

Oral

Capsules, Conventional Tablets, Chewable Tablets

20–25°C.¹

For Suspension

20–25°C.¹ After reconstitution, store suspension in tight container at room temperature or in the refrigerator; discard after 14 days.¹

Actions and Spectrum

Based on spectrum of activity, classified as a third generation cephalosporin.³ ¹³ ¹⁵ ⁵⁰ ⁶⁹ ⁷⁵ Expanded spectrum of activity against gram-negative bacteria compared with first and second generation cephalosporins;² ³ ⁵ ¹⁴ ²³ ⁵⁹ ⁶⁰ ⁷⁵ less active against Enterobacteriaceae than some other third-generation cephalosporins.¹⁵ ⁷⁵ ¹⁰¹
Usually bactericidal.¹ ² ¹⁴ ³⁴ ⁶⁵ ⁶⁹ ⁷⁸
Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.¹ ² ⁷⁵
Spectrum of activity includes many gram-positive and gram-negative aerobic bacteria;¹ inactive against most anaerobic bacteria.² ¹⁴ ²³ ⁵⁹ ⁶⁰ ⁷⁵
Gram-positive aerobes: Active in vitro against Streptococcus pneumoniae¹ and Streptococcus pyogenes (group A β-hemolytic streptococci).¹ ² ³ ¹³ ¹⁴ ²⁰ ²³ ⁵⁰ ⁵⁹ ⁶⁰ ⁶⁶ ⁷⁷ ⁷⁸ ⁷⁹ Also active in vitro against S. agalactiae (group B streptococci)¹ ² ¹³ ¹⁵ ¹⁸ ²³ ⁵⁰ ⁵⁹ ⁶⁰ ⁶⁶ ⁷⁵ and groups C, F, and G streptococci.¹³ ²³ ⁵⁹ ⁶⁰ ⁶⁶ Most staphylococci, enterococci, and Listeria monocytogenes are resistant.¹ ² ³ ¹³ ¹⁴ ¹⁸ ²⁰ ²³ ⁵⁹ ⁶⁰ ⁶⁶ ⁶⁹ ⁷⁵ ⁷⁸ ¹⁰¹
Strains of staphylococci resistant to penicillinase-resistant penicillins (methicillin-resistant [oxacillin-resistant] staphylococci) should be considered resistant to cefixime, although results of in vitro susceptibility tests may indicate susceptibility.¹³²
Gram-negative aerobes: Active in vitro against Neisseria gonorrhoeae,¹ ² ³ ⁵ ¹¹ ¹⁴ ²³ ⁵⁹ ⁶⁰ ⁷⁵ Haemophilus influenzae (including β-lactamase-producing strains),¹ ² ³ ⁵ ⁸ ¹⁰ ¹³ ¹⁴ ¹⁸ ²⁰ ²³ ⁵⁰ ⁵⁹ ⁶⁵ ⁶⁶ ⁶⁸ ⁷⁵ ⁷⁶ ⁷⁷ ⁷⁸ Moraxella catarrhalis (including β-lactamase-producing strains),¹ ² ³ ⁵ ¹³ ²⁰ ²³ ⁵⁸ ⁵⁹ ⁶⁶ ⁷⁵ ⁷⁷ ⁷⁸ Escherichia coli,¹ and Proteus mirabilis.¹ ¹⁵ ²¹ ²³ ⁵⁹ ⁶⁰ ⁷⁵ Also active in vitro against Citrobacter amalonaticus,¹ C. diversus,¹ H. parainfluenzae,¹ ² ⁸ ¹³ Klebsiella,¹ Pasteurella multocida,¹ P. vulgaris,¹ Providencia,¹ Salmonella,¹ Shigella,¹ and Serratia.¹ Most Enterobacter⁵ ⁶⁰ ⁷⁵ and Pseudomonas are resistant.¹ ² ⁵ ¹³ ¹⁴ ¹⁵ ²⁰ ²³ ⁵⁹ ⁶⁰ ⁶⁶ ⁷⁵ ¹⁰¹

Advice to Patients

Advise patients that antibacterials (including cefixime) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).¹
Importance of completing full course of therapy, even if feeling better after a few days.¹
Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with cefixime or other antibacterials in the future.¹
Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.¹ Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.¹
Importance of discontinuing cefixime and informing clinician if an allergic reaction occurs.¹
Advise patients with phenylketonuria that cefixime chewable tablets containing 100, 150, and 200 mg of the drug contain aspartame, which is metabolized in the GI tract to provide 3.3, 5, and 6.7 mg of phenylalanine, respectively.¹
Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.¹
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.¹
Importance of informing patients of other important precautionary information.¹

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Cefixime (Trihydrate)
Routes	Dosage Forms	Strengths	Brand Names	Manufacturer
Oral	Capsules	400 mg (of cefixime)	Suprax	Lupin
	For suspension	100 mg (of cefixime) per 5 mL	Suprax	Lupin
		200 mg (of cefixime) per 5 mL	Suprax	Lupin
		500 mg (of cefixime) per 5 mL	Suprax	Lupin
	Tablets, chewable	100 mg (of cefixime)	Suprax	Lupin
		150 mg (of cefixime)	Suprax	Lupin
		200 mg (of cefixime)	Suprax	Lupin
	Tablets, film-coated	400 mg (of cefixime)	Suprax (scored)	Lupin

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

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