Cefixime

DEA Class; Rx

Common Brand Names; Suprax

Indicated in the treatment of acute exacerbations of chronic bronchitis caused by susceptible isolates of Streptococcus pneumoniae and Haemophilus influenzae.

Indicated in the treatment of otitis media caused by susceptible isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes.

Indicated in the treatment of pharyngitis and tonsillitis caused by susceptible isolates of Streptococcus pyogenes.

Alternative treatment of uncomplicated urogenital, anorectal, or pharyngeal gonorrhea if ceftriaxone unavailable; no longer indicated as first-line treatment, per CDC guidelines.

Indicated in the treatment of uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli and Proteus mirabilis

Typhoid Fever (Off-label)

Documented hypersensitivity

• Diarrhea (16%)
• Abdominal pain
• Candidiasis
• Dizziness
• Dyspepsia
• Elevated transaminases
• Eosinophilia
• Erythema multiforme
• Fever
• Flatulence
• Headache
• Increased blood urea nitrogen (BUN)
• Increased creatinine
• Leukopenia
• Nausea
• Prolonged prothrombin time (PT)
• Pruritus
• Pseudomembranous colitis
• Rash
• Serum sickness-like reaction
• Stevens-Johnson syndrome
• Thrombocytopenia
• Urticaria
• Vaginitis
• Vomiting

Limited activity against anaerobes

Dosage must be adjusted in severe renal insufficiency (high doses may cause CNS toxicity, including seizures); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy

Use with caution in patients with history of penicillin allergy

Bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy

Immune-mediated hemolytic anemia reported; monitor hematologic parameters during and for 2 to 3 weeks after therapy; discontinue therapy if hemolytic anemia occurs during treatment

Phenylalanine can be harmful to patients with phenylketonuria (PKU); chewable tablets contain aspartame, a source of phenylalanine; before prescribing, consider combined daily amount of phenylalanine from all sources, including chewable tablets

Use caution in patients with history of gastrointestinal disease

Clostridium difficile associated diarrhea (CDAD) reported with use of nearly all antibacterial agents, and may range in severity from mild diarrhea to fatal colitis; if CDAD is suspected or confirmed, discontinue ongoing antibacterial drug use not directed against C. difficile; institute appropriate fluid and electrolyte management, protein supplementation, antibacterial drug treatment of C. difficile, and surgical evaluation as clinically indicated

Immune-mediated hemolytic anemia reported; monitor hematologic parameters during and for 2 to 3 weeks after therapy; discontinue therapy if hemolytic anemia occurs during treatment

Cephalosporins may be associated with a fall in prothrombin activity; patients with renal or hepatic impairment, or poor nutritional state, patients receiving a protracted course of antimicrobial therapy, and patients previously stabilized on anticoagulant therapy; monitor prothrombin time in patients at risk and exogenous vitamin K administered as indicated

May cause acute renal failure including tubulointerstitial nephritis; discontinue therapy if renal failure occurs and initiate supportive therapy

Severe cutaneous reactions, including Stevens-Johnson syndrome, epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms (DRESS) reported; discontinue therapy and implement supportive therapy if reaction occurs

Available data from published observational studies, case series, and case reports over several decades with cephalosporin use, including cefixime, in pregnant women have not established drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes

There are no available data on presence of drug in human milk, effects on breastfed infant, or on milk production