Suprax

cefixime

Suprax

Pharmacologic class: Third-generation cephalosporin

Therapeutic class: Anti-infective

Pregnancy risk category B

Action

Interferes with bacterial cell-wall synthesis and division by binding to cell wall, causing cell to die. Active against gram-negative and gram-positive bacteria, with expanded activity against gram-negative bacteria. Exhibits minimal immunosuppressant activity.

Availability

Oral suspension: 100 mg/5 ml

Tablets: 400 mg

Indications and dosages

Uncomplicated gonorrhea caused by Neisseria gonorrhoeae
Adults and children weighing more than 50 kg (110 lb): 400 mg P.O. daily

Uncomplicated urinary tract infections caused by Escherichia coli and Proteus mirabilis; otitis media caused by Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes; pharyngitis and tonsillitis caused by S. pyogenes; acute bronchitis and acute exacerbation of chronic bronchitis caused by H. influenzae and Streptococcus pneumoniae
Adults and children older than age 12 or weighing more than 50 kg (110 lb): 400 mg P.O. daily or 200 mg P.O. q 12 hours
Children ages 12 and younger or weighing 50 kg (110 lb) or less: 8 mg/kg P.O. daily or 4 mg/kg P.O. q 12 hours

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to cephalosporins or penicillins

Precautions

Use cautiously in:
• renal impairment, phenylketonuria
• history of GI disease
• elderly patients
• pregnant or breastfeeding patients
• children.

Administration

• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.
• Know that drug may be taken with food.
• Be aware that suspension should be given for otitis media because it provides higher serum concentration.

Adverse reactions

CNS: headache, lethargy, paresthesia, syncope, seizures

CV: hypotension, palpitations, chest pain, vasodilation

EENT: hearing loss

GI: nausea, vomiting, diarrhea, abdominal cramps, oral candidiasis, pseudomembranous colitis

GU: vaginal candidiasis, nephrotoxicity

Hematologic: lymphocytosis, eosinophilia, bleeding tendency, hemolytic anemia, hypoprothrombinemia, neutropenia, thrombocytopenia, agranulocytosis, bone marrow depression

Hepatic: hepatic failure, hepatomegaly

Musculoskeletal: arthralgia

Respiratory: dyspnea

Skin: urticaria, maculopapular or erythematous rash

Other: chills, fever, superinfection, anaphylaxis, serum sickness

Interactions

Drug-drug.Aminoglycosides, loop diuretics: increased risk of nephrotoxicity

Probenecid: decreased excretion and increased blood level of cefixime

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine, eosinophils, gamma-glutamyltransferase, lactate dehydrogenase: increased levels
Coombs' test, urinary 17-ketosteroids, nonenzyme-based urine glucose tests (such as Clinitest): false-positive results

Hemoglobin, platelets, white blood cells: decreased values

Drug-herbs.Angelica, anise, arnica, asafetida, bogbean, boldo, celery, chamomile, clove, danshen, fenugreek, feverfew, garlic, ginger, ginkgo, ginseng, horse chestnut, horseradish, licorice, meadowsweet, onion, papain, passionflower, poplar, prickly ash, quassia, red clover, turmeric, wild carrot, wild lettuce, willow: increased risk of bleeding

Patient monitoring

• Monitor baseline CBC and kidney and liver function test results.
• Monitor for signs and symptoms of superinfection and other serious adverse reactions.
• Be aware that cross-sensitivity to penicillins may occur.

Patient teaching

• Tell patient to take once-daily doses at same time each day.
• Advise patient to take drug exactly as prescribed and to continue to take full amount prescribed even when he feels better.
• Instruct patient to report signs and symptoms of allergic response and other adverse reactions, such as rash, easy bruising, bleeding, severe GI problems, or difficulty breathing.
• Caution patient not to take herbs without consulting prescriber.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

cefixime

(se-fix-eem) ,

Suprax

(trade name)

Classification

Therapeutic: anti infectives
Pharmacologic: third generation cephalosporins
Pregnancy Category: B

Indications

Treatment of:
  • Urinary and gynecologic infections including gonorrhea,
  • Respiratory tract infections,
  • Otitis media.

Action

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

Therapeutic effects

Bactericidal action against susceptible bacteria.
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:
  • Enterobacter,
  • Haemophilus influenzae,
  • Escherichia coli,
  • Klebsiella pneumoniae,
  • Neisseria,
  • Proteus,
  • Providencia,
  • Serratia,
  • Moraxella catarrhalis,
  • Borrelia burgdorferi.

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 and Excretion: 50% excreted unchanged in urine; ≥10% excreted in bile.
Half-life: 3–4 hr (increased in renal impairment).

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
POrapid2–6 hr24 hr

Contraindications/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; Geriatric: Geriatric patients (dose adjustment due to age-related decrease in renal function may be necessary); Obstetric: Pregnancy and lactation (has been used safely).

Adverse Reactions/Side Effects

Central nervous system

  • seizures (very high doses) (life-threatening)

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • cramps

Dermatologic

  • rashes (most frequent)
  • urticaria

Hematologic

  • bleeding
  • blood dyscrasias
  • hemolytic anemia

Miscellaneous

  • allergic reactions including anaphylaxis and serum sickness (life-threatening)
  • superinfection

Interactions

Drug-Drug interaction

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

Route/Dosage

Oral (Adults and Children >12 yr or >50 kg) Most infections—400 mg once daily.Gonorrhea—400 mg single dose.
Oral (Children) 8 mg/kg once daily or 4 mg/kg every 12 hr.

Renal Impairment

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

Availability

Oral suspensionstrawberry flavor: 100 mg/5 mL, 200 mg/5 mL
Tablets: 400 mg
Chewable tablets: 100 mg, 150 mg, 200 mg

Nursing implications

Nursing assessment

  • 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 pseudomembranous colitis. May begin up to several weeks 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 creatinine.
    • May rarely cause leukopenia, neutropenia, agranulocytosis, thrombocytopenia, eosinophilia, lymphocytosis, and thrombocytosis.

Potential Nursing Diagnoses

Risk for infection (Indications,  Side Effects)
Diarrhea (Adverse Reactions)

Implementation

  • Oral suspension should be used to treat patients with otitis media; results in higher peak blood levels than same dose of tablets.
  • Oral: 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.

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.

Evaluation/Desired Outcomes

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

Suprax

A brand name for CEFIXIME.
References in periodicals archive ?
Lupin's current brands sales force will promote InspiraChamber in the US market and the product will be marketed along with other Lupin brands, including Suprax, Alinia for Oral suspension, Locoid Lotion and Antara.
The product will be marketed along with Lupin's Suprax and Antara.
The blanks were German Schott Suprax, 60mm thick (since Pyrex is no longer easily available).
In August, the Centers for Disease Control and Prevention stated it no longer recommends the oral antibiotic cefixime, which goes by the brand name Suprax, as a first-line treatment against the sexually transmitted disease.
Brand Name Sample Score Mean of Score Mean of Motive * Utilitarian Expressive 1 Shogun125 6 81 59,6 Utilitarian 2 Jupiter MX 10 81,9 63,7 Utilitarian 3 SupraX 125 10 76,4 50,3 Utilitarian 4 Scorpio Z 10 78,6 64,9 Utilitarian 5 Tiger 18 79,5 59,6 Utilitarian 6 Thunder 3 80,33 74,33 Utilitarian 7 Spin 0 -- -- -- 8 Vario 19 77,87 53,84 Utilitarian 9 Mio Sporty 24 82,9 64,3 Utilitarian * number of respondent who choose the brand Table 2: Respondent Involvement level No.
Since 2010, Haad quality auditors conducted 1,127 visits to pharmaceutical facilities, supermarkets and herbal centres, where hundreds of fake and expired medication was confiscated, some of which included: Viagra; Snafi and Levitra (sexual enhancers); Phyto-shape Lesvos (weight loss); Suprax (Anti-biotic); and Olay Total Effect (cosmetics).
The confiscated medications included sex drugs such as Viagra, Cialis, Snafi, Levitra, Phyto-Shape Lesvos (obesity), Suprax (antibiotics), Olay Total Effect (cosmetics) and Phyto-Diasol (chronic).
Lupin's current pediatric portfolio consists of Suprax and Alinia for Oral Suspension and such the Company is well positioned to capitalize on this opportunity.
collectively, Lupin) has received approval for SUPRAX (Cefixime) for Oral Suspension, 500 mg/5mL from the United States Food and Drugs Administration (FDA).
Marrazzo explained that Wyeth Pharmaceuticals discontinued manufacture of cefixime tablets, once marketed as Suprax, when the patent for the medication expired in 2002.
He has worked on numerous antibacterial programs including the development of the marketed products, Suprax, Zosyn and Tygacil.
In 2004, Lupin introduced its first brand to the US: Suprax, a cefixime product that had previously been marketed by Wyeth until March 2003.