Clinical beta
FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.
Drug Monograph
Cefixime
Third-generation oral cephalosporin
Indication
Uncomplicated UTI β’ pharyngitis alternative β’ GC (check resistance) β’ typhoid (selected regions)
INDICATIONS (CORE USE)
Uncomplicated UTI; otitis/sinusitis (susceptible); **gonorrhea only if local resistance allows** β verify guideline.
ADULT DOSE (STANDARD)
400 mg PO daily or 200 mg PO q12h (indication-specific)
MAX DOSE
400 mg/day typical adult max
Route
PO
PEDIATRIC DOSE
8 mg/kg/day PO max 400 mg/day (suspension) β verify indication
Must-not-miss safety points
Major warning
- **Misuse boundary:** NOT appropriate as sole therapy for **pyelonephritis**, **bacteremia**, or **unstable systemic infection** β escalate route/spectrum when indicated - **MRSA:** **no reliable MRSA coverage** β do not use as monotherapy when MRSA in differential - Ξ²-lactam anaphylaxis - **Gonorrhea resistance** β ceftriaxone-based regimens often first-line; oral cefixime only where guideline-endorsed - Poor staph reliability β not first-line cellulitis if MRSA in differential - Renal adjustment
USE IF: Uncomplicated UTI with susceptible organisms; selected respiratory infections per guideline; GC only if public health guidance supports. AVOID IF: MRSA cellulitis; severe infection needing IV; resistant GC.
Primary
Secondary
Other
STANDARD (ADULT PO)
400 mg PO once daily (many UTIs)
ADULT DOSE
400 mg PO daily or divided BID depending on indication; UTI duration per guideline (often short)
PEDIATRIC DOSE
Suspension dosing by weight β max 400 mg/day.
MAX DOSE
400 mg/day (adult usual ceiling)
Practical Note
Check stone patient adherence β single daily may improve compliance.
Clinical warnings
Adverse effects
Pediatrics
8 mg/kg/day PO max 400 mg/day (suspension) β verify indication
Pregnancy
Generally acceptable
Lactation
low risk.
Renal impairment
CrCl <60 β reduce dose/interval per label. **CrCl scaffold (FMBM β titrate to FDA/SFDA label + institutional pharmacy nomogram):** - **CrCl β₯50** β usual PO regimen - **CrCl 10β50** β extend interval or β total daily dose per label - **CrCl <10** β further reduction; align **HD** timing with absorption / redose per protocol
Hepatic impairment
No routine adjustment.
Elderly
Renal dosing; fall risk.
PO with or without food per tolerance.
Clinical Picture
**Life-threatening (first):** **anaphylaxis**; **CNS toxicity** (seizures, encephalopathy) β uncommon vs IV but consider **massive ingestion + severe CKD** or continued dosing in renal failure. **Secondary:** GI upset (nausea, vomiting, diarrhea).
Immediate Actions
Stop drug β ABCs; seizures β benzos; anaphylaxis β epinephrine + ACLS
Antidote
No specific antidote; treat complications (e.g. anaphylaxis β epinephrine per ACLS)
Decontamination
Large recent ingestion β charcoal if appropriate window, airway protected
Escalation
Refractory shock, angioedema, seizures, intractable vomiting β **ED/ICU**; **severe neurotoxicity or renal failure with suspected accumulation β consider hemodialysis** (agent-dependent) β nephrology + pharmacy
Common mistakes, resistance logic, and bedside traps
Oral third-gen for **UTI** + selected **resp** β **GC oral use is public-health dependent**. Renal adjust.
Stewardship: avoid treating asymptomatic bacteriuria except pregnancy/surgery indications. De-escalation from IV ceftriaxone when safe. *Stewardship (all antimicrobials):* Empiric choice β syndrome severity + **local antibiogram**; shortest effective course.
PO absorption moderate; renal elimination; half-life allows q24h for some indications.
Oral third-gen cephalosporin β gram-negative weighted spectrum.
Saudi Arabia
Suprax, Cefixime
Global
(placeholder β verify local formulary)
Common trade names are curated examples only β formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.
Saudi Arabia
International