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