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Class: Third Generation Cephalosporins
Molecular Formula: C15H14N4O6S2
CAS Number: 97519-39-6
Brands: Cedax

Medically reviewed by Last updated on Oct 1, 2018.


Antibacterial; β-lactam antibiotic; aminothiazolyl third generation cephalosporin.1 3

Uses for Ceftibuten

Acute Otitis Media (AOM)

Treatment of AOM caused by Haemophilus influenzae (including β-lactamase-producing strains), Moraxella catarrhalis (including β-lactamase-producing strains), or Streptococcus pyogenes (group A β-hemolytic streptococci).1 3 5 7 8 48 (See Acute Otitis Media under Cautions.)

When anti-infectives indicated, AAP recommends high-dose amoxicillin or amoxicillin and clavulanate as drugs of choice for initial treatment of AOM; 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.37

Pharyngitis and Tonsillitis

Treatment of pharyngitis and tonsillitis caused by S. pyogenes (group A β-hemolytic streptococci).1 14 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;10 16 17 other anti-infectives (oral cephalosporins, oral macrolides, oral clindamycin) recommended as alternatives in penicillin-allergic patients.10 11 16 17

If an oral cephalosporin used, 10-day regimen of first generation cephalosporin (cefadroxil, cephalexin) preferred instead of other cephalosporins with broader spectrums of activity (e.g., cefaclor, cefdinir, cefixime, cefpodoxime, cefuroxime).10 16 17

Respiratory Tract Infections

Treatment of acute bacterial exacerbations of chronic bronchitis caused by Streptococcus pneumoniae (penicillin-susceptible strains only), H. influenzae (including β-lactamase-producing strains), or M. catarrhalis (including β-lactamase-producing strains).1 9 12 26

Treatment of acute maxillary sinusitis caused by susceptible S. pneumoniae, H. influenzae, or M. catarrhalis.3 45 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.43 Oral amoxicillin or amoxicillin and clavulanate usually recommended for empiric treatment.43 44 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.43 44

Treatment of acute bronchitis,3 26 27 46 bronchiectasis,47 or pneumonia3 46 47 caused by susceptible bacteria.

Urinary Tract Infections (UTIs)

Treatment of uncomplicated UTIs caused by susceptible Escherichia coli, Klebsiella, Proteus mirabilis, Enterobacter, or staphylococci.3 63 64

Treatment of complicated or recurrent UTIs caused by susceptible E. coli, Klebsiella, P. mirabilis, Enterobacter, or staphylococci.3 63 64

Some clinicians suggest that certain oral third generation cephalosporins (cefdinir, cefpodoxime, ceftibuten) are one of several alternatives for outpatient treatment of recurrent UTIs or UTIs that occur in patients who have indwelling urinary catheters or acquired the infections in hospitals or nursing homes; these infections likely to be caused by multidrug-resistant gram-negative bacilli.11

Ceftibuten Dosage and Administration


Oral Administration

Administer capsules orally without regard to meals.1 15

Administer oral suspension at least 2 hours before or 1 hour after meals.1 (See Food under Pharmacokinetics.)


Reconstitute oral suspension at time of dispensing by adding the amount of water specified on the container in 2 portions; invert bottle and shake after each addition.1


Available as ceftibuten dihydrate; dosage expressed in terms of anhydrous ceftibuten.1

Pediatric Patients

Acute Otitis Media (AOM)

Children 6 months through 11 years of age: 9 mg/kg (up to 400 mg) once daily for 10 days.1

Children ≥12 years of age: 400 mg once daily for 10 days.1 3

Pediatric Dosage of Ceftibuten Oral Suspension for AOM1

Weight (kg)

Daily Dosage


90 mg once daily1


180 mg once daily1


360 mg once daily1


400 mg once daily1

Pharyngitis and Tonsillitis

Children 6 months through 11 years of age: 9 mg/kg (up to 400 mg) once daily for 10 days.1

Children ≥12 years of age: 400 mg once daily for 10 days.1

Pediatric Dosage of Ceftibuten Oral Suspension for Pharyngitis and Tonsillitis1

Weight (kg)

Daily Dosage


90 mg once daily1


180 mg once daily1


360 mg once daily1


400 mg once daily1

Respiratory Tract Infections
Acute Exacerbations of Chronic Bronchitis

Children ≥12 years of age: 400 mg once daily for 10 days.1 3


Acute Otitis Media (AOM)

400 mg once daily for 10 days.1 3

Pharyngitis and Tonsillitis

400 mg once daily for 10 days.1 3

Respiratory Tract Infections
Acute Exacerbations of Chronic Bronchitis

400 mg once daily for 10 days.1 3

Uncomplicated UTIs

400 mg once daily for 7 days.64

Prescribing Limits

Pediatric Patients


Maximum 400 mg once daily for children 6 months through 11 years of age.1



Maximum 400 mg once daily.1

Special Populations

Hepatic Impairment

Dosage adjustments not required.1

Renal Impairment

Dosage for Renal Impairment1

Clcr (mL/min)

Daily Dosage


9 mg/kg or 400 mg once every 24 hours1


4.5 mg/kg or 200 mg once every 24 hours1 4


2.25 mg/kg or 100 mg once every 24 hours1 4

For patients undergoing hemodialysis 2 or 3 times weekly, a single 400-mg dose (given as a capsule) or 9 mg/kg (up to 400 mg; given as the oral suspension) may be given at the end of each dialysis period.1 5

Geriatric Patients

No dosage adjustments except those related to renal impairment.1 (See Renal Impairment under Dosage and Administration.)

Cautions for Ceftibuten


  • Known hypersensitivity to ceftibuten or other cephalosporins.1



Superinfection/Clostridium difficile-associated Diarrhea and Colitis

Possible emergence and overgrowth of nonsusceptible organisms (e.g., Enterobacter, Pseudomonas, enterococci, Candida) with prolonged use.a Careful observation of the patient is essential.1 Institute appropriate therapy if superinfection occurs.1 a

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.1 42 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 ceftibuten, and may range in severity from mild diarrhea to fatal colitis.1 42 C. difficile produces toxins A and B which contribute to development of CDAD.42

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.1 42 Obtain careful medical history since CDAD has been reported to 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 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

Sensitivity Reactions

Hypersensitivity Reactions

Possible hypersensitivity reactions such as urticaria, pruritus, rash (maculopapular, erythematous, morbilliform), fever and chills, eosinophilia, joint pain or inflammation, edema, erythema, genital and anal pruritus, angioedema, shock, hypotension, vasodilatation, Stevens-Johnson syndrome, erythema multiforme, toxic epidermal necrolysis, exfoliative dermatitis, and anaphylaxis.a

If hypersensitivity reaction occurs, discontinue ceftibuten and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen).1


Partial cross-sensitivity among cephalosporins and other β-lactam antibiotics, including penicillins and cephamycins.1 49

Prior to initiation of therapy, make careful inquiry concerning previous hypersensitivity reactions to any cephalosporins or penicillins.1 Cautious use recommended in individuals hypersensitive to penicillins:a avoid use in those who have had an immediate-type (anaphylactic) hypersensitivity reaction1 49 50 and administer with caution to those who have had a delayed-type (e.g., rash, fever, eosinophilia) reaction.a

General Precautions

Diabetes Mellitus

Reconstituted oral suspension contains 1 g of sucrose per 5 mL.1

Acute Otitis Media

Possibly less effective than some other β-lactam antibiotics for the treatment of AOM caused by S. pneumoniae.1 7 Use for empiric therapy only when adequate antimicrobial coverage against S. pneumoniae has been previously administered.1

History of GI Disease

Use with caution in patients with a history of GI disease, particularly colitis.1 (See Superinfection/Clostridium difficile-associated Colitis under Cautions.)

Specific Populations


Category B.1


Not known whether distributed into milk;1 use with caution.1

Pediatric Use

Safety and efficacy not established in neonates and infants <6 months of age.1

Increased incidence of diarrhea in pediatric patients ≤2 years of age compared with older pediatric patients.1

Geriatric Use

Increased peak plasma concentrations and half-life may be due to age-related changes in renal function.1 3 5 15 Adjust dosage based on degree of renal impairment.1 (See Renal Impairment under Dosage and Administration.)

Hepatic Impairment

Pharmacokinetics not altered; dosage adjustments not required.1 3

Renal Impairment

Increased plasma half-life and decreased total body clearance.1 4

Use with caution and reduce dosage.a (See Renal Impairment under Dosage and Administration.)

Careful clinical observation and renal function tests recommended prior to and during cephalosporin therapy.a

Common Adverse Effects

GI effects (e.g., nausea, diarrhea, dyspepsia, vomiting, abdominal pain), headache, dizziness, increased BUN concentrations, eosinophilia.1 3 5 34

Interactions for Ceftibuten

Specific Drugs




No known pharmacokinetic interaction1

Histamine H2-receptor antagonists (ranitidine)

Potential for increased ceftibuten concentrations1


No evidence of pharmacokinetic interaction with IV theophylline;1 effects of concomitant oral theophylline unknown

Ceftibuten Pharmacokinetics



Rapidly and almost completely absorbed following oral administration.1 5 28 29 31 Oral bioavailability is 75–90%.5

In adults, a 400-mg ceftibuten dose given as the oral suspension is bioequivalent to a 400-mg dose given as 400-mg capsules.40


Food decreases rate and extent of absorption of ceftibuten; this effect is more pronounced with the oral suspension than with capsules.1 31



Distributed into blister fluid,31 bronchial secretions,1 31 33 nasal secretions,31 sputum,1 middle ear fluid,1 31 32 tracheal secretions,31 and tonsillar tissue.41

Not known whether the drug crosses the placenta or is distributed into milk.1 66

Plasma Protein Binding

Approximately 65%.1



Ceftibuten is present in plasma and urine principally as cis-ceftibuten; about 10% of a dose is converted in vivo to trans-ceftibuten.1 29 The trans-isomer has only about 12% of the antibacterial activity of the cis-isomer.1 30

Elimination Route

The cis- and trans-isomers of ceftibuten eliminated principally in urine.1 29 30 Approximately 56% of a dose eliminated in urine and 39% excreted in feces within 24 hours.1


Adults with normal renal function: 2–2.6 hours.1 29 30 31

Children 6 months to 16 years of age: 1.9–2.5 hours.31 35

Special Populations

In renal impairment, plasma half-life averages 7.1–22.3 hours depending on creatinine clearance.1





2–25°C in tight container.1

For Suspension

2–25°C.1 Following reconstitution, store suspension at 2–8°C; discard after 14 days.1

Actions and Spectrum

  • Third generation cephalosporin with an expanded spectrum of activity against aerobic gram-negative bacteria compared with first and second generation cephalosporins.3 5

  • Usually bactericidal.a

  • Like other β-lactam antibiotics, antibacterial activity results from inhibition of bacterial cell wall synthesis.a

  • In vitro spectrum of activity includes some gram-positive aerobic bacteria and some gram-negative aerobic bacteria; inactive against most anaerobes; inactive against fungi and viruses.3 19 a

  • Gram-positive aerobes: active in vitro and in clinical infections against Streptococcus pneumoniae (penicillin-susceptible strains only) and S. pyogenes (group A β-hemolytic streptococci).1 Inactive against other streptococci, staphylococci, and enterococci (e.g., Enterococcus faecalis).3 19 a

  • Gram-negative aerobes: active in vitro and in clinical infections against Haemophilus influenzae (including β-lactamase-producing strains) and Moraxella catarrhalis (including β-lactamase-producing strains).1 Inactive against Pseudomonas aeruginosa.1 3 5 19 22 23

  • Stable in the presence of a variety of plasmid-mediated β-lactamases produced by gram-positive and gram-negative bacteria;1 3 5 7 8 19 20 21 22 23 more active in vitro than other currently available oral third generation cephalosporins against Enterobacteriaceae that produce plasmid-mediated β-lactamases.3 5 7 19 20 21 22 23 Unstable in the presence of chromosomally-mediated cephalosporinases.1

  • Strains of staphylococci resistant to penicillinase-resistant penicillins (methicillin-resistant [oxacillin-resistant] staphylococci) should be considered resistant to ceftibuten, although results of in vitro susceptibility tests may indicate that the organisms are susceptible to the drug.24

Advice to Patients

  • Importance of administering oral suspension at least 2 hours before or 1 hour after meals.1 Capsules may be administered without regard to meals.1 15

  • Importance of completing full course of therapy.1

  • Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued. 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.

  • Importance of discontinuing ceftibuten and informing clinician if an allergic reaction occurs.1

  • For patients with diabetes, importance of being informed of sucrose content of oral suspension.1

  • Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs as well as any concomitant illnesses.1

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1

  • Importance of advising patients of other important precautionary information.1 (See Cautions.)


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.

Ceftibuten Dihydrate


Dosage Forms


Brand Names




400 mg (of anhydrous ceftibuten)



For suspension

90 mg (of anhydrous ceftibuten) per 5 mL



AHFS DI Essentials™. © Copyright 2019, Selected Revisions September 30, 2013. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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


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a. AHFS Drug Information 2003. McEvoy GK, ed. Cephalosporins General Statement. American Society of Health-System Pharmacists; 2003:125-39.