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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.
• Renal impairment
• 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
• 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.
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, 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
• 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.
• 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.