cefixime

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Indications ⬇

REMS

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

Contraind./Precautions ⬆ ⬇

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.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: rash, urticaria

GI: diarrhea, nausea, vomiting, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), cramps

Hemat: bleeding, blood dyscrasias, hemolytic anemia

Neuro: SEIZURES (VERY HIGH DOSES)

Misc: superinfection, ANAPHYLAXIS AND SERUM SICKNESSALLERGIC REACTIONS INCLUDING

Interactions ⬆ ⬇

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.

Availability ⬆ ⬇

(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

Route/Dosage ⬆ ⬇

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.

US Brand Names ⬆ ⬇

Suprax

Action ⬆ ⬇

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.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification: third generation cephalosporins

Pharmacokinetics ⬆ ⬇

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).

Time/Action Profile ⬆ ⬇

(blood levels)

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

Patient/Family Teaching ⬆ ⬇

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.

Pronunciation ⬆

se-FIX-eem