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Cefixime is an oral third-generation cephalosporin used selectively in pediatrics; dosing and use depend on indication and susceptibility.
Dose once daily (8 mg/kg/day) or divided twice daily based on tolerance and indication.
Reserve for scenarios with suspected beta-lactamase–producing organisms or when adherence favors once-daily therapy.
Verify recent culture susceptibilities; cefixime has reduced pneumococcal coverage compared with first-line beta-lactams.
Cefixime is an oral third-generation cephalosporin reserved for upper respiratory infections and UTIs when first-line therapies fail or cannot be used.
Use cefixime when beta-lactamase coverage is required and adherence benefits from once-daily dosing. Culture guidance and local resistance patterns should drive selection.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Acute otitis media | Children ≥6 months | No | Reserve for patients who cannot take amoxicillin or amoxicillin-clavulanate; ensure susceptibility to third-generation cephalosporins. |
| Acute bacterial rhinosinusitis | Children and adolescents | No | Alternative when first-line agents are contraindicated or poorly tolerated and local resistance patterns allow. |
| Group A streptococcal pharyngitis | Children and adolescents | No | 8 mg/kg once daily (max 400 mg) for 10 days is an acceptable alternative when penicillin is not an option. |
| Uncomplicated urinary tract infection | Children and adolescents | No | Use culture-directed therapy when Enterobacterales are susceptible and first-line agents (nitrofurantoin, TMP-SMX) are unsuitable. |
FDA-approved primary uses with Level A evidence
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Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Cefixime is typically well tolerated; gastrointestinal upset and rash are the most common adverse effects. Counsel families to complete the full course while watching for allergy signs or severe diarrhea.
Most side effects are manageable with supportive care. Escalate quickly for allergic reactions, persistent diarrhea, or symptoms suggesting hemolytic anemia.
Diarrhea / loose stools
Common • mild
Abdominal pain / nausea
Common • mild
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Maculopapular rash
Common • mild
Urticaria / angioedema
Rare • severe
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Transient eosinophilia
Uncommon • mild
Hemolytic anemia
Very rare • severe
Elevated liver enzymes
Rare • mild
Renal impairment (dose-related)
Very rare • moderate
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Cefixime’s once-daily option improves adherence, but accurate measuring and shake-before-use instructions are key.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Cefixime is an oral third-generation cephalosporin that disrupts bacterial cell wall synthesis with enhanced stability against beta-lactamases produced by common respiratory pathogens.
It binds penicillin-binding proteins (PBPs) in gram-negative bacteria, inhibiting peptidoglycan cross-linking and leading to cell lysis. Its long half-life allows once-daily dosing.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Cefixime is a convenient once-daily beta-lactam, but stewardship and follow-up are critical to avoid resistance and missed failures.
Use these pearls to optimize dosing and safety when cefixime is chosen as a second-line agent.
Deploy cefixime after amoxicillin/clavulanate failure or intolerance. Document why first-line therapy is unsuitable to s…
Confirm local susceptibility of H. influenzae and S. pneumoniae—resistance patterns vary seasonally.
Educate families that a single morning dose with breakfast maintains therapeutic levels and improves completion rates co…
Cefixime can trigger false-positive Clinitest results; use enzymatic assays if glucose monitoring necessary.
Core insights every provider should know
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Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Cefixime and monitor your child's response to treatment.
Yes. A light meal or snack can lessen stomach upset without affecting absorption. Shake the suspension well and measure each dose with an oral syringe.
Give it as soon as you remember unless the next dose is due within 6 hours. Do not double up—resume the regular schedule and call if multiple doses are missed.
Magnesium- or aluminum-containing antacids can reduce absorption and should be separated by at least 2 hours. Notify your clinician about anticoagulants or other antibiotics, as monitoring may be needed.
Fever and pain typically improve within 48–72 hours. If symptoms persist, worsen, or new rash develops, contact your clinician to reassess the diagnosis and culture results.
It treats susceptible gram-negative bacteria but does not cover Pseudomonas or Enterococcus. Culture-guided therapy is important; follow-up is needed if symptoms recur.