Cefixime

Oral
Susceptible infections

Patient on CAPD or haemodialysis: Max: 200 mg once daily.

CrCl (mL/min)	Dosage
<20	Max: 200 mg once daily.

May be taken with or without food. May be taken w/ food or milk to reduce GI discomfort.

Oral susp: Add appropriate amount of water specified on the bottle in 2 portions. Shake well after each addition until contents are evenly suspended.

Hypersensitivity to cephalosporins, penicillins or any beta-lactam antibiotics.

Patient with history of cephalosporin-associated haemolytic anaemia, gastrointestinal disease, hypersensitivity to penicillins and other beta-lactam antibiotics. Renal impairment. Children. Pregnancy and lactation.

Significant: Encephalopathy including convulsions, confusion, impaired consciousness, and movement disorders (in patient with renal impairment); bacterial or fungal superinfection, decreased prothrombin activity.
Blood and lymphatic system disorders: Neutropenia, thrombocytosis, leucopenia, thrombocytopenia, eosinophilia.
Gastrointestinal disorders: Diarrhoea, abdominal pain, dyspepsia, flatulence, nausea, vomiting.
General disorders and admin site conditions: Pyrexia, face oedema.
Hepatobiliary disorders: Jaundice, hepatitis.
Immune system disorders: Serum sickness-like reaction, urticaria, angioedema.
Investigations: Increased LFTs; elevated BUN, serum bilirubin and creatinine.
Metabolism and nutrition disorders: Anorexia.
Musculoskeletal and connective tissue disorders: Arthralgia.
Nervous system disorders: Headache, dizziness, vertigo.
Reproductive system and breast disorders: Vaginitis, genital pruritus.
Respiratory, thoracic and mediastinal disorders: Dyspnoea.
Skin and subcutaneous tissue disorders: Rash, pruritus.
Potentially Fatal: Drug-induced haemolytic anaemia, acute renal failure including tubulointerstitial nephritis, Clostridium difficile-associated diarrhoea, pseudomembranous colitis, severe cutaneous reactions such as toxic epidermal necrolysis, Stevens-Johnson syndrome, drug rash with eosinophilia and systemic symptoms (DRESS); anaphylactic/anaphylactoid reactions including shock.

PO: B

This drug may cause confusion, impaired coordination, movement disorders and convulsions as side effects, if affected, do not drive or operate machinery.

Monitor CBC, LFT and renal function periodically for prolonged treatment. Monitor signs and symptoms of anaphylaxis during 1st dose. Perform culture/sensitivity tests and allergy history prior to treatment initiation.

Symptoms: Encephalopathy characterised by confusion, impaired consciousness, movement disorders and convulsions. Management: Symptomatic and supportive treatment. May consider stomach emptying by gastric lavage.

May increase prothrombin time with or without bleeding and enhance effects of anticoagulants (e.g. warfarin K). Increased bioavailability for up to 70% with nifedipine. Increased serum concentration with probenecid. May elevate plasma concentrations of carbamazepine.

Delayed rate of absorption with food.

May give false-positive direct Coombs’ test. False-positive reaction for urinary glucose tests with Benedict’s or Fehling’s solution or with cupric sulfate test tablets but not with tests based on enzymatic glucose oxidase reactions. False-positive serum or urine creatinine with alkaline picrate-based Jaffé reaction. False-positive urine ketones with nitroprusside-based tests (except nitroferricyanide).

Description: Cefixime, a 3rd generation cephalosporin, binds to 1 or more of the penicillin-binding proteins (PBPs) which inhibits the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall, thus inhibiting biosynthesis and arresting cell wall assembly resulting in bacterial cell lysis and death.
Pharmacokinetics:
Absorption: Slowly absorbed from the gastrointestinal tract (40-50%). Food, delays rate of absorption. Bioavailability: Approx 22-54%. Time to peak plasma concentration: 2-6 hours (susp); 3-8 hours (cap).
Distribution: Widely distributed into most tissues and body fluids (e.g. synovial, pericardial, pleural, and peritoneal fluids; bile, sputum, urine, bone, myocardium, gallbladder, skin and soft tissues). Crosses placenta. Plasma protein binding: Approx 65%.
Excretion: Mainly via urine (approx 50% as unchanged drug); faeces (10%). Elimination half-life: 3-4 hours.

Source: National Center for Biotechnology Information. PubChem Database. Cefixime, CID=5362065, https://pubchem.ncbi.nlm.nih.gov/compound/Cefixime (accessed on Jan. 21, 2020)

Store between 20-25°C. Reconstituted oral susp: Store between 2-8°C, stable for up to 14 days. Do not freeze.

Cephalosporin

J01DD08 - cefixime ; Belongs to the class of third-generation cephalosporins. Used in the systemic treatment of infections.

Anon. Cefixime. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 22/07/2019.

Anon. Cefixime. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 22/07/2019.

Buckingham R (ed). Cefixime. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 22/07/2019.

Cefixime 100 mg/5 mL Powder for Oral Suspension (Generics [UK] Ltd., t/a Mylan). MHRA. https://products.mhra.gov.uk/. Accessed 22/07/2019.

Cefixime Powder for Suspension (Aurobindo Pharma Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 22/07/2019.

Joint Formulary Committee. Cefixime. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 22/07/2019.

Suprax Tablet; Capsule; Tablet, Chewable; Powder, for Suspension (Lupin Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 22/07/2019.

Trufix 200 mg Capsule (Trumed Pharmaceuticals). MIMS Philippines. http://www.mims.com/philippines. Accessed 22/07/2019.