CEFIXIME 100 MG/5 ML POWDER FOR ORAL SUSPENSION
Active substance(s): CEFIXIME / CEFIXIME / CEFIXIME
NAME OF THE MEDICINAL PRODUCT
Cefixime 100 mg/5 ml Powder for Oral Suspension
QUALITATIVE AND QUANTITATIVE COMPOSITION
Each 5 ml of reconstituted suspension contains 111.917 mg of cefixime trihydrate
equivalent to 100 mg of cefixime (anhydrous).
Excipient(s): Each 5 ml of reconstituted suspension contains 2.43 g of sucrose.
For a full list of excipients, see section 6.1.
Powder for oral suspension.
Off-white to pale yellow coloured powder with characteristic odour and gives a cream
colour to pale yellow coloured viscous suspension after reconstitution with water.
Cefixime is indicated for the treatment of the following infections when caused by
susceptible organisms (see sections 4.4 and 5.1)
Acute exacerbations of chronic bronchitis
Lower urinary tract infections
In the treatment of:
The use of Cefixime should be reserved for infections where the causative organism
is known or suspected to be resistant to other commonly used antibiotics, or where
treatment failure may carry significant risk.
Consideration should be given to official guidance on the appropriate use of
Posology and method of administration
Adults and children over 10 years of age (body weight is greater than 50 kg)
The recommended dose is 200-400 mg daily according to the severity of the
infection, given either as a single dose or in two divided doses.
Elderly patients may be given the same dose as recommended for adults. Renal
function should be assessed and dosage should be adjusted in severe impairment (See
dosage for renal impairment and section 4.4).
Children younger than 10 years of age (body weight is lower than 50 kg) –
Paediatric Oral Suspension
The recommended dosage for children is 8 mg/kg/day administered as a single dose
or in two divided doses. The following table describes a range of paediatric dosage
according to the weight of the child:
Daily dose according to the syringe
2 ml (once daily) or 1 ml (twice daily)
4 ml (once daily) or 2 ml (twice daily)
5 ml (once daily) or 2.5 ml (twice daily)
6 ml (once daily) or 3 ml (twice daily)
7 ml (once daily) or 3.5 ml (twice daily)
8 ml (once daily) or 4 ml (twice daily)
9 ml (once daily) or 4.5 ml (twice daily)
10 ml (once daily) or 5 ml (twice daily)
Children weighing more than 50 kg or older than 10 years should be treated with the
recommended adult dose (200 -400 mg daily), depending on the severity of the
Children younger than 6 months of age
The safety and efficacy of cefixime has not been established in children less than 6
Cefixime may be administered in the presence of impaired renal function. Normal
dose and schedule may be given in patients with creatinine clearance of 20 ml/ min or
greater. In patients whose creatinine clearance is less than 20 ml/min, it is
recommended that a dose of 200 mg once daily should not be exceeded. The dose and
regimen for patients who are maintained on chronic ambulatory dialysis or
haemodialysis should follow the same recommendation as that for patients with
creatinine clearance of less than 20 ml/min.
Method of administration
Cefixime powder for oral suspension is for oral administration only.
The absorption of cefixime is not significantly affected by the presence of food.
Hence it can be administered with or without food.
For instructions on reconstitution of the medicinal product before administration, see
Duration of treatment
The usual course of treatment is 7 days. In severe cases, this can be extended to 14
Patients with known hypersensitivity to cefixime, other cephalosporin antibiotics or
to any of the excipients.
Cefixime is also contraindicated in patients with previous, immediate and/or severe
hypersensitivity to penicillin or any beta-lactam antibiotics and preterm and term
newborn infants (0-27 days).
Special warnings and precautions for use
Cefixime should be given with caution to patients who have shown hypersensitivity
to other drugs. Cephalsporins should be given with caution to penicillin-sensitive
patients, as there is some evidence of partial cross-allerginicity between penicillin and
Patients have had severe reactions (including anaphylaxis) to both classes of drugs.
Special care is indicated in patients who have experienced any allergic reaction to
penicillins or any beta-lactam antibiotics as cross-reactions may occur (see section
If severe hypersensitivity reactions or anaphylactic reactions occur after
administration of Cefixime, the medicine should be discontinued immediately and
appropriate emergency measures should be initiated.
Prolonged use of cefixime may result in the overgrowth of non-susceptible
Treatment with a broad spectrum of antibiotics alters the normal flora of the colon
and may permit the overgrowth of Clostridia. Studies indicate that a toxin produced
by Clostridium difficile is a primary cause for antibiotic-associated diarrhoea.
Pseudomembranous colitis is associated with the use of broad-spectrum antibiotics
(including macrolides, semi-synthetic penicillins, lincosamides and cephalsporins). It
is therefore important to consider its diagnosis in patients who develop diarrhoea in
association with the use of antibiotics.
In patients who develop severe diarrhoea during or after use of cefixime, the risk of
life threatening pseudo-membranous colitis should be taken into account (see section
4.8). The use of cefixime should be discontinued and appropriate treatment measures
should be established. Management of pseudomembranous colitis should include
sigmoidoscopy, appropriate bacteriologic studies, fluids, electrolyte and protein
supplementation. If the colitis does not improve after the drug has been discontinued
or if the symptoms are severe, oral vancomycin is the drug of choice for antibioticassociated pseudomembreanous colitis produced by C. Difficile. Other causes of
colitis should be excluded. The use of medicinal products inhibiting the intestinal
peristalsis is contra-indicated.
Cefixime contains sucrose. Patients with rare hereditary problems of galactose
intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should
not take this medicine.
Use of Nifedipine, a calcium channel blocker, may increase bioavailability of
Cefixime upto 70%.
Cefixime should be administered with caution in adult patients with creatinine
clearance <20ml/min (see sections 4.2 and 5.2). There are insufficient data regarding
use of cefixime in the pediatric and adolescent age group in the presence of renal
insufficiency: the use of cefixime in these patient-groups is not recommended.
Interaction with other medicinal products and other forms of interaction
The administration of cephalsporins may interfere with the results of some laboratory
A false positive reaction for glucose in the urine may occur with the Benedict’s or
Fehling’s solutions or with copper sulphate test tablets, but not with tests based on
enzymatic glucose oxidase reactions.
A false positive direct Coombs’test has been reported during treatment with
cephalosporin antibiotics, therefore it should be recognised that a positive Coombs’
test may be due to the drug.
In common with other cephalsporins, increases in prothrombin times have been noted
in a few patients. Care should therefore be taken in patients receiving anticoagulation
In use with Nifedipine, a calcium channel blocker, may increase bioavailability of
Cefixime upto 70%.
Fertility, pregnancy and lactation
For cefixime, no clinical data on exposed pregnancies are available. Animal studies
do not indicate direct or indirect harmful effects with respect to pregnancy,
embryonal/foetal development, parturition or postnatal development (see section 5.3).
Caution should be exercised when prescribing to pregnant women. Cefixime should
not be used in pregnant mothers unless considered essential by the physician.
It is unknown whether cefixime is excreted in human milk and non-clinical studies
have shown excretion of cefixime in animalmilk. A decision on whether to
continue/discontinue breast-feeding or to continue/discontinue therapy with cefixime
should be made taking into account the benefit of breast-feeding to the child and the
benefit of cefixime therapy to the woman. However, until further clinical experience
is available, cefixime should not be prescribed to breast-feeding mothers.
Animal studies do not indicate any harmful effects with respect to fertility, however,
no clinical data are available
Effects on ability to drive and use machines
Cefixime has no known influence on the ability to drive and use machines. However,
side effects may occur (see section 4.8), which may influence the ability to drive and
Cefixime, like other cephalsporin antibiotics, may be associated with adverse events.
Within each frequency grouping, undesirable effects are presented in order of
The following undesirable effects have been divided in the following categories:
>1/100 to <1/10
>1/1,000 to <1/100
>1/10,000 to <1/1,000
cannot be estimated from the available data
MedDRA System Organ
Infections and infestations
Blood and lymphatic
Immune system disorders
Metabolism and nutrition
Nervous system disorders
Anaphylactic shock, serum
Skin and subcutaneous
Renal and urinary
General disorders and
Abdominal pain, nausea,
Cases of pseudomembraneous
Hepatitis, cholestatic jaundice
toxic epidermal necrolysis,
Hepatic enzyme increased
Blood urea increased
Blood creatinine increased
There is no experience with overdoses with Cefixime.
Adverse reactions seen at dose levels up to 2 g of cefixime in normal subjects did not
differ from the profile seen in patients treated at the recommended doses. Gastric
lavage may be indicated in overdosage. No specific antidote exists. Cefixime is not
removed from the circulation in significant quantities by dialysis.
Pharmacotherapeutic group: antibacterial for systemic use, belonging to the class of
cephalsporins, ATC code: J01DD08.
Mode of action
Cefixime is an antibiotic belonging to the third generation cephalosporin group.
Like other cephalsporins, cefixime exerts antibacterial activity by binding to and
inhibiting the action of penicillin-binding proteins involved in the synthesis of
bacterial cell walls. This leads to bacterial cell lysis and cell death.
The time that the plasma concentration of cefixime exceeds the MIC of the infecting
organism has been shown to best correlate with efficacy in PK/PD studies.
Mechanism of resistance
Bacterial resistance to cefixime may be due to one or more of the following
Hydrolysis by extended-spectrum beta-lactamases and/or by chromosomally-encoded
(AmpC) enzymes that may be induced or de-repressed in certain aerobic gramnegative bacterial species
Reduced affinity of penicillin-binding proteins
Reduced permeability of the outer membrane of certain gram-negative organisms
restricting access to penicillin-binding proteins
Drug efflux pumps
More than one of these mechanisms of resistance may co-exist in a single bacterial
cell. Depending on the mechanism(s) present, bacteria may express cross-resistance
to several or all beta-lactams and/or antibacterial drugs of other classes.
Clinical minimum inhibitory concentration (MIC) breakpoints established by
EUCAST (May 2009) for cefixime are:
Breakpoints (MIC, mg/L)
Microorganism Susceptible (≤)
Enterobacteriaceae: For uncomplicated urinary tract infections only. The
breakpoints for Enterobacteriaceae will detect reduced susceptibility
mediated by most clinically important beta-lactamases in
Enterobacteriaceae. Occassional ESBL-producing strains will be reported
susceptible. For purposes of infection control, epidemiology and
surveillance, laboratories may wish to use specific tests to screen for and
Non-species related breakpoints
The prevalence of resistance may vary geographically and over time for selected
species and local information on resistance is desirable, particularly when treating
severe infections. As necessary, expert advice should be sought when local
prevalence if resistance is such that the utility of the agent in at least some types of
infections is questionable.
Category 1: Commonly Susceptible organisms
Streptococcus pneumoniae (penicillinEscherichia Coli%
Category 2: Organisms for which acquired resistance may be problematic
Category 3: Resistant organisms
Streptococcus pneumoniae (Penicillin resistant)
% Extended spectrum beta-lactamase (ESBL) producing isolates are always
+ Cefixime has poor activity against staphylococci (regardless of susceptibility to
The absolute bioavailability of cefixime is in the range of 22-54%. Absorption is not
significantly modified by the presence of food. Cefixime may therefore be given
without regard for meals.
Serum protein binding is well characterised for human and animal sera; cefixime is
almost exclusively bound to the albumin fraction, the mean free fraction being
approximately 30%. Protein binding of cefixime is only concentration dependent in
human serum at very high concentrations which are not seen following clinical
From in vitro studies, serum or urine concentrations of 1 mg/L or greater were
considered to be adequate for most common pathogens against which cefixime is
active. Typically, the peak serum levels following the recommended adult or
paediatric doses are between 1.5 and 3 mg/L. Little or no accumulation of cefixime
occurs following multiple dosing.
Metabolism and elimination
Cefixime is predominantly eliminated as unchanged drug in the urine. Glomerular
filtration is considered the predominant mechanism. Metabolites of cefixime have not
been isolated from human serum or urine.
Transfer of 14C-labelled cefixime from lactating rats to their nursing offspring through
breast milk was quantitatively small (approximately 1.5% of the mothers' body
content of cefixime in the pup). No data are available on secretion of cefixime in
human breast milk. Placental transfer of cefixime was small in pregnant rats dosed
with labelled cefixime.
Special age groups
The pharmacokinetics of cefixime in healthy elderly (aged > 64 years) and young
volunteers (11-35) compared the administration of 400 mg doses once daily for 5
days. Mean Cmax and AUC values were slightly greater in the elderly. Elderly patients
may be given the same dose as the general population (see section 4.2).
Preclinical safety data
There are no findings from chronic toxicity investigations suggesting that any side
effects unknown to date could occur in humans. Furthermore, in vivo and in vitro
studies did not yield any indication of a potential to cause mutagenicity. Long-term
studies on carcinogenicity have not been conducted. Reproduction studies have been
performed in mice and rats at does up to 400 times the human dose and have revealed
no evidence of impaired fertility or harm to the foetus due to cefixime. In the rabbit,
at doses up to 4 times the human dose, there was no evidence of a teratogenic effect;
there was a high incidence of abortion and maternal death, which is an expected
consequence of the known hypersensitivity of rabbits to antibiotic-induced changes in
the population of the microflora of the intestine.
List of excipients
Silica colloidal, anhydrous
Flavour strawberry (maltodextrin, triethyl acetate –E1505, propylene glycol – E1520)
Unopened: 2 years.
After reconstitution: The reconstituted suspension may be stored for 14 days below
Special precautions for storage
Unopened: This medicinal product does not require any special storage conditions.
For storage conditions of the reconstituted medicinal product, see section 6.3.
After reconstitution, the suspension can be stored below 25º C for 14 days without
significant loss of potency. Do not freeze. Keep bottles tightly closed and shake well
before use. Discard any unused portion after 14 days. Dilution of the suspension is
Nature and contents of container
Nature of container: Type III molded, amber coloured, round glass bottle with 100ml
ring mark and with a plastic child resistant cap with induction seal liner.
Contents of container: Bottle of size 100 ml.
Bottles are supplied with a single 5 ml plastic dosing pipette (plunger, barrel and
piston) with a scale from 0 to 5 ml and graduations for each 0.1 ml printed on the
plunger of the syringe.
Special precautions for disposal
Instructions for the preparation of the oral suspension:
Cefixime 100 mg/5 ml Powder
for Oral Suspension
Directions for Reconstitution
100 mg/ 5 ml
Add 68 ml of water in two portions to
the dry mixture in the bottle. Shake
well after each addition.
Any unused product or waste material should be disposed of in accordance with local
MARKETING AUTHORISATION HOLDER
Generics [UK] Ltd t/a Mylan
MARKETING AUTHORISATION NUMBER(S)
DATE OF FIRST AUTHORISATION/RENEWAL OF THE
DATE OF REVISION OF THE TEXT
Source: Medicines and Healthcare Products Regulatory Agency
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