cefixime

cefixime /ce·fix·ime/ (sĕ-fik´sēm) a third-generation cephalosporin effective against a wide range of bacteria, used in the treatment of otitis media, bronchitis, pharyngitis, tonsillitis, gonorrhea, and urinary tract infections.

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cefixime (sef´iksēm´),

n brand name: Suprax;
drug class: third-generation cephalosporin;
action: inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable;
uses: uncomplicated urinary tract infections, pharyngitis and tonsillitis, otitis media, acute bronchitis, and acute exacerbations of chronic bronchitis.

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cefixime

a third generation cephalosporin antibiotic.

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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: 200 mg, 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.

Route	Onset	Peak	Duration
P.O.	Rapid	2-6 hr	24 hr

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.