CEFIXIME

CEFIXIMe
(ce-fix'ime)
Suprax
Classifications: antibiotic, beta-lactam; third-generation cephalosporin;
Therapeutic:antibiotic
; cephalosporin
Prototype: Cefotaxime sodium
Pregnancy Category: B

Availability

100 mg/5 mL, 200 mg/5 mL suspension

Action

Cefixime is a third-generation cephalosporin. As a beta-lactam antibiotic like the penicillins, it is mainly bactericidal. It inhibits the third and final stage of bacterial cell wall synthesis by preferentially binding to specific penicillin-binding proteins (PBPs) located inside the bacterial cell wall.

Therapeutic Effect

Cefixime is highly stable in the presence of beta-lactamases (penicillinases and cephalosporinases) and therefore has excellent activity against a wide range of gram-negative bacteria. It is bactericidal against susceptible bacteria.

Uses

Effective against Streptococcus pyogenes, Streptococcus pneumoniae, and gram-negative bacilli, including Haemophilus influenzae, Branhamella catarrhalis, and Neisseria gonorrhoeae. Little activity against Staphylococci, and no activity against Pseudomonas aeruginosa; also uncomplicated UTI, otitis media, pharyngitis, tonsillitis, and bronchitis.

Contraindications

Patients with known allergy to the cephalosporin group of antibiotics, severe reaction to penicillin.

Cautious Use

Allergy to penicillin, history of colitis, renal insufficiency, GI disease, coagulopathy, pregnancy (category B), lactation. Safety and effectiveness in infants <6 mo have not been established.

Route & Dosage

Infection
Adult: PO 400 mg/d in 1–2 divided doses
Child: PO 8 mg/kg/d in 1–2 divided doses

Administration

Oral
  • Do not substitute tablets for liquid in treatment of otitis media because of lack of bioequivalence.
  • After reconstitution, suspension may be kept for 14 d at room temperature or refrigerated. Store away from heat and light. Keep tightly closed and shake well before using.

Adverse Effects (≥1%)

GI: Diarrhea, loose stools, nausea, vomiting, dyspepsia, flatulence. CNS: Drug fever, headache, dizziness. Skin: Rash, pruritus, Urogenital: Vaginitis, genital pruritus.

Interactions

Drug: aminoglycosides may increase risk of nephrotoxicity and have additive/synergistic effects. May decrease efficacy of oral contraceptives. Probenecid may increase levels.

Pharmacokinetics

Absorption: 40–50% from GI tract. Peak: 2–6 h. Distribution: Into breast milk. Elimination: 50% in urine, 50% in bile. Half-Life: 3–4 h.

Nursing Implications

Assessment & Drug Effects

  • Determine previous hypersensitivity reactions to cephalosporins, penicillins, and history of other allergies, particularly to drugs prior to initiation of therapy.
  • Lab tests: Perform culture and sensitivity tests prior to initiation of therapy and periodically during therapy. Therapy may be implemented pending test results.
  • Discontinue if seizures associated with the drug therapy occur.
  • Monitor for superinfections (see Appendix F) caused by overgrowth of nonsusceptible organisms, particularly during prolonged use.
  • Monitor I&O rates and pattern: Nephrotoxicity occurs more frequently in patients >50 y, with impaired renal function, in the debilitated, and in patients receiving high doses or other nephrotoxic drugs.
  • Carefully monitor anyone with a history of allergies, especially to drugs. Report manifestations of hypersensitivity (see Appendix F).
  • Promptly report loose stools or diarrhea, which may indicate pseudomembranous colitis (see Appendix F). Discontinuation of drug may be necessary.

Patient & Family Education

  • Report loose stools or diarrhea during drug therapy and for several weeks after. Older adult patients are especially susceptible to pseudomembranous colitis.
  • Take this antibiotic for the full course of treatment.
  • Do not miss any doses and take the doses at evenly spaced times, day and night.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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