cefixime
Suprax

Available forms
Available by prescription only
Powder for oral suspension: 100 mg/5 ml
Tablets: 200 mg, 400 mg

Indications and dosages
 Otitis media; acute bronchitis; acute exacerbations of chronic bronchitis, pharyngitis, tonsillitis; uncomplicated urinary tract infections caused by Escherichia coli and Proteus mirabilis; uncomplicated gonorrhea; disseminated gonococcal infections. Adults and children who weigh more than 50 kg (110 lb) or are older than age 12: 400 mg P.O. daily in one or two divided doses; for uncomplicated gonorrhea, 400 mg as a single dose.
Children older than age 6 months and younger than age 12 who weigh less than 50 kg: 8 mg/kg P.O. daily in one or two divided doses.
≡ Dosage adjustment. For renally impaired patients, dosage must be adjusted based on degree of renal impairment, severity of infection, and susceptibility of organism. For adult patients with creatinine clearance of 20 to 60 ml/minute and patients receiving hemodialysis, give 75% of the usual dose. For adult patients with creatinine clearance of less than 20 ml/minute and patients receiving continuous ambulatory peritoneal dialysis, give 50% of the usual dose.

Pharmacodynamics
Antibacterial action: Cefixime is primarily bactericidal; it acts by binding to penicillin-binding proteins in the bacterial cell wall, thereby inhibiting cell wall synthesis.
It’s used in the treatment of otitis media caused by Haemophilus influenzae (penicillinase- and non- penicillinase-producing), Moraxella (Branhamella) catarrhalis (which is penicillinase-producing), and Streptococcus pyogenes. Substantial drug resistance has been noted. Cefixime is also active in the treatment of acute bronchitis and acute exacerbations of chronic bronchitis caused by Streptococcus pneumoniae and H. influenzae (penicillinase- and non-penicillinase-producing), pharyngitis and tonsillitis caused by S. pyogenes, and uncomplicated urinary tract infections caused by E. coli and P. mirabilis.

Pharmacokinetics
Absorption: About 30% to 50% is absorbed following oral administration. The suspension form provides a higher serum level than the tablet form. Absorption is delayed by food, but the total amount absorbed isn’t affected.
Distribution: Widely distributed; about 65% is bound to plasma proteins.
Metabolism: About 50% is metabolized.
Excretion: Excreted primarily in the urine. In patients with end-stage renal disease, half-life may be prolonged to 11 1/2 hours.

Contraindications and precautions
Contraindicated in patients hypersensitive to drug or other cephalosporins. Use cautiously in patients with impaired renal function.

Interactions
Drug-drug. Carbamazepine: Elevates carbamazepine levels when administered together. Avoid use together.
Probenecid: May inhibit excretion and increase blood cefixime level. Use together cautiously.
Salicylates: May increase serum cefixime level. Use together cautiously.

Adverse reactions
CNS: headache, dizziness.
GI: diarrhea, loose stools, abdominal pain, nausea, vomiting, dyspepsia, flatulence, pseudomembranous colitis.
GU: genital pruritus, vaginitis, genital candidiasis.
Hematologic: thrombocytopenia, leukopenia, eosinophilia.
Skin: pruritus, rash, urticaria, erythema multiforme, Stevens-Johnson syndrome.
Other: drug fever, hypersensitivity reactions (serum sickness, anaphylaxis).

Effects on lab test results
• May increase BUN, creatinine, ALT, AST, alkaline phosphatase, bilirubin, GGT, and LDH levels.
• May increase eosinophil count. May decrease platelet and WBC counts.

Overdose and treatment
No specific antidote available. Gastric lavage and supportive treatment are recommended. Peritoneal dialysis and hemodialysis will remove substantial quantities of drug.

Special considerations
 ALERT Names of some cephalosporins are similar. Use caution when ordering.
 ALERT Some cephalosporins may cause seizures, especially in patients with renal failure who receive full therapeutic doses. If seizures occur, stop drug and start anticonvulsant therapy.
• Cefixime is the first orally active, third-generation cephalosporin that’s effective with once-daily dosing.
• Manufacturer suggests that tablets shouldn’t be substituted for suspension when treating otitis media.
• Cefixime may cause false-positive results in urine glucose tests using cupric sulfate (Benedict’s reagent or Clinitest); use glucose oxidase tests (Chemstrip uG, Diastix, or glucose enzymatic test strip) instead. Cefixime may cause false-positive results in tests for urine ketones that use nitroprusside (but not nitroferricyanide).
• False-positive direct Coombs’ test results have occurred with other cephalosporins.
• Evaluate patients with antibiotic-induced diarrhea for overgrowth of pseudomembranous colitis caused by Clostridium difficile. Mild cases usually respond to discontinuation of the drug; moderate to severe cases may require fluid, electrolyte, and protein supplementation. Oral vancomycin is the drug of choice for the treatment of antibiotic-associated C. difficile pseudomembranous colitis.
 ALERT Observe patient for hypersensitivity. Treat acute hypersensitivity reactions immediately. Emergency measures, such as airway management, pressor amines, epinephrine, oxygen, antihistamines, and corticosteroids, may be required.
• In patient with renal impairment, monitor renal function before and during therapy.
Pregnant patients
• Use during pregnancy only when clearly needed.
Breast-feeding patients
• It’s unknown whether drug appears in breast milk. Breast-feeding should be discontinued during cefixime therapy.
Pediatric patients
• The risk of adverse GI effects in children receiving oral suspension is similar to that in adults receiving tablets.

Patient education
• Instruct patient to report rash or symptoms of superinfection.
• Advise patient that oral suspension is stable for 14 days after reconstitution and doesn’t require refrigeration.
• Tell patient to take all medication exactly as prescribed, even if he feels better.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use