Pharmacologic class: Third-generation cephalosporin
Therapeutic class: Anti-infective
Pregnancy risk category B
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.
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
• Renal impairment
• Hypersensitivity to cephalosporins or penicillins
Use cautiously in:
• renal impairment, phenylketonuria
• history of GI disease
• elderly patients
• pregnant or breastfeeding patients
• 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.
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
Skin: urticaria, maculopapular or erythematous rash
Other: chills, fever, superinfection, anaphylaxis, serum sickness
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
• 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.
• 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.
ClassificationTherapeutic: anti infectives
Pharmacologic: third generation cephalosporins
- Urinary and gynecologic infections including gonorrhea,
- Respiratory tract infections,
- Otitis media.
- Haemophilus influenzae,
- Escherichia coli,
- Klebsiella pneumoniae,
- Moraxella catarrhalis,
- Borrelia burgdorferi.
Time/action profile (blood levels)
|PO||rapid||2–6 hr||24 hr|
Adverse Reactions/Side Effects
Central nervous system
- seizures (very high doses) (life-threatening)
- pseudomembranous colitis (life-threatening)
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- rashes (most frequent)
- blood dyscrasias
- hemolytic anemia
- allergic reactions including anaphylaxis and serum sickness (life-threatening)
Drug-Drug interactionProbenecid 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.
Renal ImpairmentOral (Adults) CCr 21–60 mL/min—75% of standard dose; CCr ≤20ml/min—50% of standard dose.
- 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 DiagnosesRisk for infection (Indications, Side Effects)
Diarrhea (Adverse Reactions)
- 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.
- 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.
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.