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a third-generation cephalosporin antibiotic used in treatment of bronchitis, pharyngitis, tonsillitis, and acute otitis media; administered orally.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.



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.


Capsules: 400 mg

Oral suspension: 90 mg/5 ml

Indications and dosages

Acute bacterial exacerbations of chronic bronchitis caused by Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae; pharyngitis and tonsillitis caused by Streptococcus pyogenes; acute bacterial otitis media caused by H. influenzae, M. catarrhalis, and S. pyogenes
Adults and children ages 12 and older: 400 mg P.O. q 24 hours for 10 days
Children ages 12 and younger: 9 mg/kg P.O. daily for 10 days. Maximum dosage shouldn't exceed 400 mg daily.

Dosage adjustment

• Renal impairment

Off-label uses

• Urinary tract infections


• Hypersensitivity to cephalosporins and penicillins


Use cautiously in:

• renal impairment, hepatic disease, biliary obstruction, phenylketonuria

• history of GI disease

• elderly patients

• pregnant or breastfeeding patients

• children.


• Obtain specimens for culture and sensitivity testing as necessary before starting therapy.

• Give oral suspension at least 1 hour before or 2 hours after a meal.

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, easy bruising, 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 ceftibuten

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

• Assess 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

• Instruct patient to take oral suspension at least 1 hour before or 2 hours after a meal.

• Inform diabetic patient that oral suspension contains 1 g sucrose per teaspoon.

• Advise patient to continue to take full amount prescribed even when he feels better.

• Tell 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.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and herbs mentioned above.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


A broad-spectrum cephalosporin antibiotic, C15H14N4O6S2, used primarily to treat ear and respiratory infections.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


Cedax® A once-daily broad-spectrum cephalosporin used for acute bacterial otitis media, acute bacterial exacerbation of chronic bronchitis, pharyngitis/tonsillitis. See Cephalosporin.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.
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References in periodicals archive ?
Ceftibuten: A new orally active cephalosporin for pediatric infections.
First-generation cephalosporins (eg, cephalexin, cefadroxil) are effective only against S aureus; second-generation (cefuroxime axetil and cefprozil) and extended-spectrum third-generation (cefdinir and cefpodoxime) cephalosporins are effective against S aureus, H influenzae, and M catarrhalis; and third-generation (eg, cefixime, ceftibuten) cephalosporins are only effective against H influenzae and M catarrhalis.
Group 1 Group 2 Group 3 (Related side chains) (Related side chains) (Unique side chains) Amoxicillin Cefepime Cefazolin Ampicillin Cefotaxime Cefdinir Cefaclor Cefpodoxime Cefixime Cefadroxil Ceftriaxone Cefotetan Cefprozil Ceftazidime Cephalexin Ceftibuten Penicillin Cefuroxime Source: Dr.
DENVER--Acute sinusitis symptoms and quality of life improved equally well in 11 patients treated with the third-generation cephalosporin ceftibuten and in 20 patients given the less expensive antibiotics amoxicillin or trimethoprim-sulfamethoxazole, Dr.
Third-generation cephalosporins include cefixime and ceftibuten. They are good for gram-negative organisms but not as effective for gram-positive bacteria, Dr.
Neither cefixime nor ceftibuten has enough coverage for susceptible or resistant S.
Because National Committee for Clinical Laboratory Standards (NCCLS)-approved breakpoints are lacking for the six other cephalosporins examined in this study (cefpodoxime, cefixime, ceftibuten, cefprozil, cefaclor, and loracarbef), rates of resistance were not determined for these drugs.
TABLE 4 Compliance-Enhancing Ranking of Antibiotic Suspensions STRONGLY COMPLIANCE-ENHANCING * Amoxicillin * Cefdinir (Omnicef) * Loracarbef (Lorabid) * Cefaclor (Ceclor) * Cefixime (Suprax) MODERATELY COMPLIANCE-ENHANCING * Cefprozil (Cefzil) * Ceftibuten (Cedax) EQUIVOCAL COMPLIANCE-ENHANCING * Azithromycin (Zithromax) NOT COMPLIANCE-ENHANCING * Amoxicillin-clavulanate (Augmentin) * Erythromycin-sulfasoxazole (Pediazole) * TMP-SMX (Bactrim or Septra) DISCOURAGES COMPLIANCE * Cefpodoxime (Vantin) * Cefuroxime (Ceftin) * Clarithromycin (Biaxin) TMP-SMX, trimethoprim sulfamethoxazole Sources: Adapted from Steele RW, et al.
If the first-line drug resistance is high in your area, consider an oral third- generation cephalosporin, such as ceftibuten (Cedax) or cefixime (Suprax).
A total of 4,782 children were randomized to treatment with 10 days of penicillin, or 5 days of amoxicillin and potassium clavulanate (Augmentin), ceftibuten (Cedax), cefuroxime axetil (Ceftin), loracarbef (Lorabid), clarithromycin (Biaxin), or erythromycin.