cefixime

Therapeutic Classification: anti-infectives

Pharmacologic Classification: third generation cephalosporins

REMS

Treatment of:
- Uncomplicated urinary tract infections,
- Uncomplicated gonorrhea,
- Pharyngitis and tonsilitis,
- Acute exacerbations of chronic bronchitis,
- Otitis media.

Binds to the bacterial cell wall membrane, causing cell death.

Therapeutic effects:

Bactericidal action against susceptible bacteria.

Spectrum:

Similar to that of second-generation cephalosporins, but activity against staphylococci is less, while activity against gram-negative pathogens is greater, even for organisms resistant to first- and second-generation agents.
Notable is increased action against:
- Haemophilus influenzae,
- Escherichia coli,
- Neisseria gonorrhoeae,
- Proteus mirabilis,
- Moraxella catarrhalis,
- Streptococcus pyogenes.
- Streptococcus pneumoniae.

Absorption: 40–50% absorbed following oral administration (oral suspension).

Distribution: Widely distributed. Crosses the placenta; enters breast milk in low concentrations. CSF penetration better than with first- and second-generation agents.

Metabolism/Excretion: 50% excreted unchanged in urine; ≥10% excreted in bile.

Half-Life: 3–4 hr (increased in renal impairment).

(blood levels)

ROUTE	ONSET	PEAK	DURATION
PO	rapid	2–6 hr	24 hr

Contraindicated in:

Hypersensitivity to cephalosporins;
Serious hypersensitivity to penicillins.

Use Cautiously in:

Renal impairment (↓ dosing/↑ dosing interval recommended if CCr ≤60 mL/min);
History of GI disease, especially colitis;
Phenylketonuria (chewable tablets contain aspartame);
OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk;
Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
Pedi: Children 6 mo (safety and effectiveness not established);
Geri: Dose adjustment due to age-related in renal function may be necessary.

Drug-drug:

Probenecid decreases excretion and increases serum levels.
Concurrent use of large doses of cephalosporins andNSAIDs may ↑ the risk of bleeding.
Concurrent use of loop diuretics or nephrotoxic agents including aminoglycosides may ↑ risk of nephrotoxicity.
May ↑ carbamazepine levels.

PO (Adults and Children >12 yr or >45 kg): Most infections: 400 mg once daily.Gonorrhea: 400 mg single dose.
PO (Children 6 mo-12 yr): 8 mg/kg once daily or 4 mg/kg every 12 hr.

Renal Impairment

PO (Adults ): CCr 21–60 mL/min: 75% of standard dose; CCr ≤20 mL/min: 50% of standard dose.

(Generic available)

Capsules: 400 mg
Chewable tablets (contain aspartame): 100 mg; 150 mg; 200 mg
Oral suspensionstrawberry flavor: 100 mg/5 mL; 200 mg/5 mL; 500 mg/5 mL
Tablets: 400 mg

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy.
Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of
Clostridioides difficile
-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.

Lab Test Considerations:

May cause positive results for Coombs' test in patients receiving high doses or in neonates whose mothers were given cephalosporins before delivery.
- May cause ↑ serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN, and serum creatinine.
- May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, lymphocytosis, and thrombocytosis.

Oral suspension should be used to treat patients with otitis media; results in higher peak blood levels than same dose of tablets.
PO: Administer around the clock. May be administered on full or empty stomach. Administration with food may minimize GI irritation. Shake oral suspension well before administering. Chewable tablets must be chewed before swallowing.

Instruct patient to take medication at evenly spaced times and to finish the medication completely, even if feeling better. Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses. Advise patient that sharing of this medication may be dangerous.
Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.

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Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇

Route/Dosage ⬆ ⬇

Availability ⬆ ⬇

Assessment ⬆ ⬇

Implementation ⬆ ⬇

Patient/Family Teaching ⬆ ⬇

Evaluation/Desired Outcomes ⬆ ⬇

US Brand Names ⬆