Cefixime
(generic name; brand names include Tivan, Cefix, and others)
Cefixime is an oral cephalosporin antibiotic. It’s used to treat a variety of bacterial infections by interfering with the bacteria’s cell‑wall synthesis, ultimately leading to bacterial death.
1. Indications
| Condition |
Typical Use |
| Urinary Tract Infections (UTIs) |
3‑5 days for uncomplicated cystitis |
| Acute Otitis Media (middle‑ear infection) |
7 days |
| Acute Bacterial Sinusitis |
7 days |
| Streptococcal Pharyngitis (Strep A) |
10 days |
| Bacterial Bronchitis |
5‑7 days |
| Skin/Soft‑tissue infections |
5‑10 days, depending on severity |
| Sexually Transmitted Infections (STIs) such as gonorrhea |
7 days (single dose or 7 days course) |
| Other infections |
5‑10 days (e.g., community‑acquired pneumonia, bronchiectasis) |
Always follow your healthcare provider’s prescription. Use the lowest effective dose for the shortest duration.
2. Dosage & Administration
| Age/Weight |
Adult (≥ 18 y) |
Pediatric (5‑17 y) |
Pediatric (< 5 y) |
| Dose |
400 mg orally once daily (or 200 mg BID) |
10 mg/kg/day, divided BID |
5 mg/kg/day, divided BID (max 400 mg/day) |
| Duration |
3‑5 days (UTI), 7 days (other infections) |
Same as adult, adjust by weight |
Same as adult, adjust by weight |
| Form |
Tablets (200 mg, 400 mg), oral suspension (5 mg/mL) |
Same |
Same |
| Timing |
With or without food |
Same |
Same |
| Special Instructions |
Do not exceed 400 mg/day |
Do not exceed 200 mg BID |
Avoid exceeding pediatric max dose |
The suspension can be mixed with water, juice, or milk. Shake well before each dose.
3. Mechanism of Action
- Cefixime is a β‑lactam antibiotic that binds to penicillin‑binding proteins (PBPs) in bacterial cell walls.
- This inhibits transpeptidase activity, preventing cross‑linking of peptidoglycan chains, leading to cell lysis and death.
4. Pharmacokinetics (Adults)
| Parameter |
Typical Value |
| Absorption |
Oral bioavailability ~ 45–70 % (unchanged by food) |
| Distribution |
Widely distributed; penetrates most tissues (including middle ear, sinuses, urinary tract) |
| Metabolism |
Minimal hepatic metabolism |
| Elimination |
Renal excretion (≈ 70 % unchanged). Clearance increased in patients with augmented renal clearance. |
| Half‑life |
~ 2 hours (dose‑dependent) |
Renal impairment: Reduce dose or prolong dosing interval. See dosing table in “Renal Adjustment” below.
5. Contraindications
- Allergy to cefixime, any cephalosporin, or penicillin (cross‑reactivity ≈ 1‑10 %).
- Severe hypersensitivity reactions (e.g., anaphylaxis) to β‑lactam antibiotics.
6. Warnings & Precautions
| Category |
Key Points |
| Drug Interactions |
• Warfarin – can increase INR. Monitor closely.
• Methotrexate – may increase plasma levels; monitor MTX toxicity.
• Oral contraceptives – no clinically significant effect.
• Probenecid – reduces renal clearance; consider dose adjustment. |
| Renal Function |
Reduce dose in moderate (CrCl 30–49 mL/min) and severe (CrCl < 30 mL/min) impairment. |
| Pregnancy & Lactation |
Category B. Generally considered safe but consult provider. |
| Pregnancy‑Associated Breastfeeding |
Breast milk levels low; unlikely to harm nursing infant. |
| Gastrointestinal |
Diarrhea is common; monitor for Clostridioides difficile‑associated diarrhea. |
| Hepatic |
Rare hepatotoxicity; monitor LFTs if prolonged therapy or hepatic disease. |
| Immunocompromised |
Use with caution; infections may be more severe. |
| HIV‑Positive |
May be used; monitor for opportunistic infections. |
7. Adverse Effects
| Common (≥ 1 %) |
Rare (0.1 – 1 %) |
Very Rare (< 0.1 %) |
| Nausea, vomiting |
Rash, urticaria |
Anaphylaxis, Stevens‑Johnson syndrome |
| Diarrhea |
Hypersensitivity reactions |
Severe neutropenia |
| Headache, abdominal pain |
Elevated liver enzymes |
Severe hypersensitivity (angioedema) |
| Flatulence |
|
|
If severe diarrhea or a rash develops, contact your clinician immediately.
8. How to Take Cefixime
- Measure dose precisely (use measuring cup or pill cutter for tablets).
- Swallow whole with a full glass of water unless using the suspension.
- Consistency: Take at the same time each day to maintain steady plasma levels.
- Do not stop early: Even if symptoms improve, finish the full course unless advised otherwise by your provider.
- Avoid alcohol during therapy to reduce GI upset.
9. Storage
- Store at room temperature (≤ 25 °C / 77 °F).
- Protect from light and moisture.
- Keep out of reach of children.
10. Renal Dose Adjustment (Adults)
| CrCl (mL/min) |
Adjusted Dose (daily) |
Frequency |
| > 90 |
400 mg once daily |
Once daily |
| 70–90 |
400 mg once daily |
Once daily |
| 30–69 |
200 mg twice daily |
BID |
| < 30 |
100 mg twice daily |
BID |
Reassess renal function every 7‑10 days during therapy if CrCl < 30 mL/min.
11. Quick Reference Card
| Item |
Info |
| Generic |
Cefixime |
| Class |
Cephalosporin (third‑generation) |
| Route |
Oral |
| Typical Adult Dose |
400 mg daily (UTI) or 200 mg BID (other infections) |
| Common Side Effects |
Nausea, diarrhea, headache, rash |
| Key Interaction |
Warfarin ↑ INR |
| Contraindication |
Allergy to β‑lactams |
| Renal Adjustment |
See table above |
Bottom Line
Cefixime is a reliable, well‑tolerated oral antibiotic for many bacterial infections. It’s safe for most patients, but watch for kidney function, drug interactions, and allergic reactions. If you’re prescribed cefixime, take it exactly as directed, finish the entire course, and contact your healthcare provider if you experience severe side effects or new symptoms.
Any questions about dosing, side‑effect management, or specific situations (e.g., pregnancy, renal disease)?